Endo Express Newsletter – December 2015


New website on the way

We continue to be very busy at Westbury on Trym Primary Care Centre and thank you for your referrals to both the endoscopy service and the community clinics.

We are currently constructing a new website so it is likely this will be last of our stand alone Endoscopy Express issues. We will direct you to our website in the New Year for the latest editions. This will help us to keep you more up to date, as well as including useful information for patients referred to the service.

Activity and Quality

During the last year we have seen a 19% increase in the number of endoscopic procedures performed with just under 4000 endoscopies carried out and we are now working at weekends to keep up with referrals and keep our waiting list as short as possible.

Part of this increase reflects our work as a bowel cancer screening centre.

We continue to have excellent colonoscopy completion rates, adenoma detection rates and polyp recovery rates and remain a JAG approved unit. We are also a training centre (see more on this below) and we will be shortly upgrading all our endoscopy and decontamination equipment. This upgrade will include a scope guide.

Liberalisation of referral guidelines will result in even more activity in the forthcoming years. Consequently we have now become an endoscopy-training centre and are in the process of increasing our endoscopy capacity to meet this demand. If you would like any more information or help with the guidelines, please let us know – contact details are below.

Faecal Calprotectin

At the time of writing, this test is only available to GPs working within the North Bristol NHS Trust catchment area.
We have encouraged UHB to release this test to GPs within South Bristol and the CCG are supportive of this. We understand this may happen soon and will let you know you as soon as we hear any update on this.

NICE have endorsed faecal calprotectin as a good test for those patients who have diarrhoea but no red flag symptoms. A normal result may obviate the need for Colonoscopy in younger patients who have IBS. Thus far, there has been only one study looking at the use of faecal calprotectin in primary care and more work is happening in this field.
It is likely that the cut off figure of 100mcg/g has been set too low. We certainly are seeing a significant number of patients referred with FCP’s in the 100-250 range who are subsequently found to have normal colons. This trend is being mirrored around the country.

Please repeat the FCP If you do find a slight or moderate rise.
FCP is a measure of gut inflammation so any gut infection may cause a rise.

Some drugs such as NSAID’s and omeprazole may also cause a rise in the FCP so please stop these for 4 weeks before doing the test.

Straight to Test

This principle underpins all our work at Prime Endoscopy Bristol. Referrals are triaged on a daily basis.

It is vital that you give us all the relevant information so that this may be done appropriately and safely.

Colonoscopy is an invasive test with risks of perforation and bleeding. Patients take bowel preparation which may affect renal function.

Please complete a fitness for colonoscopy form* with all colonoscopy referrals.

Renal Function is mandatory as bowel preparations may be dangerous in those with poor renal function.

*the fitness for colonoscopy form is part of the referral document (2 pages). Until our new website is ready you can download a referral form by clicking here.

Farewell and Welcome

Dr. Richard Spence, one of the founders of Prime Endoscopy Bristol, has now retired from practice. This service would not have got off the ground without his enthusiasm and commitment. We thank him for all his hard work and wish him all the very best for the future.
Mr. Paul Sylvester, Consultant Colorectal Surgeon at UHB has joined us as a Consultant Clinical Adviser. Paul is the Colon Cancer Screening Lead for Bristol and Weston and we have worked closely with him over recent years.

Dr. Anne McCune is a Consultant Gastroenterologist and Hepatologist at UHB and is now doing regular endoscopy sessions with us.

We also welcome Dr. Michael Sproat and Dr. Simon Thornton to our clinical team. They both combine their gastroenterology work with careers in General Practice.