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 20 November 2017

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News

Colonoscopy practice in the UK today

Gastroenterology units in the United Kingdom are already overstretched. These would sink beneath increased demands posed by a national bowel cancer screening program, suggests a study in Gut.

News image

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In their audit, the investigators evaluated over 9000 colonoscopies carried out during a 4-month period in English district general and teaching hospitals.

Dr Owen Epstein's team comments "Unless there is a dramatic increase in manpower and resources available for lower gastrointestinal investigations, the introduction of a national screening program would rapidly overburden already inadequate facilities".

Of the 9223 procedures assessed, normal results were found in only 4 out of 10 patients.
Demand for colonoscopy has quintupled in the last 15 years.
Gut

Polyps were found in around 1 in 4 cases, although cancer was found in less than 4% of patients. Other diagnoses included diverticular disease and inflammatory bowel disease.

However, the investigators determined that 1 in 5 procedures failed reach the cecum. They found that in 1 in 3 cases, this was because the patient found it too painful.

In the remainder of failed colonoscopies, inexpert handling of the colonoscope or inadequate bowel preparation were responsible.

Dr Epstein's team found that only 17% of those carrying out the colonoscopies had received the recommended supervised training for their first 100 procedures. Only 4 in 10 had received formal training.

In addition, demand for colonoscopy has quintupled in the last 15 years.

It has been estimated that the introduction of a national bowel screening program would require at least 6 additional colonoscopies per week in district general hospitals.

The team concluded, "While there are centers where practice is of the highest quality, considerable effort is required to raise the overall quality of colonoscopy".

In a related editorial in the same population, Drs Palmer and Morris, from the British Society of Gastroenterology and the Joint Advisory Group on Gastrointestinal Endoscopy, respectively, find the audit "disturbing".

However, they comment that the findings have already prompted both their organizations and the government to review training, equipment, and facilities.

It will take some time before these measures take full effect. While colonoscopy practice will undoubtedly improve as a result, Drs Palmer and Morris point out that regular audits are the only way of confirming this.

However, they comment "The Department of Health seems remarkably unenthusiastic to support large scale audits of gastrointestinal practice".

Gut 2004; 53: 277-283
13 January 2004

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