12. Upper Gastrointestinal Dilation and Tubal Prosthesis Insertion
INTRODUCTION
PROCEDURES AND PATIENTS
SPECIALTY AND GRADE OF ENDOSCOPIST
ANALGESIA AND ANAESTHESIA
METHODS OF DIALTION, COMPLICATIONS AND DEATH
RECOMMENDATIONS
CHAPTER REFERENCES
n = number of cases where information was provided

 

SPECIALTY AND GRADE OF ENDOSCOPIST

Key points
76% of procedures were performed by specialised upper GI physicians or surgeons.

A rigid oesophagoscope was used in 39% of thoracic and 92% of ENT cases.

In 84% of cases a consultant endoscopist was present.

Physicians or surgeons who were specialised in upper GI work did 76% (2,211/2,925) of all procedures. The other surgeons were general 6% (164/2,925), thoracic 7% (211/2,925) or ENT 2% (48/2,925) surgeons. Most of the other physicians were general physicians; one was a paediatrician, yet the patient was 56 years old. All the cases done by general practitioners were done within a hospital environment.

Table 69. Procedure type by specialty of most senior endoscopist
 
Flexible
Rigid
Other
Total
(%)
Dilation
Dilation &
tubal
prosthesis
Insertion of
tubal
prosthesis
Dilation
Dilation & tubal prosthesis
Other
Specialised physician
1,176
39
268
8
1
5
1,497
(51)
General physician
125
3
29
0
0
1
158
(5)
Specialised surgeon
560
15
125
8
3
3
714
(24)
General surgeon
126
2
30
6
0
0
164
(6)
Radiologist
61
2
24
0
1
2
90
(3)
General practitioner
22
0
1
0
0
0
23
(1)
Nurse endoscopist
9
1
0
0
0
0
10
(<1)
Other
7
0
0
1
1
0
9
(<1)
Thoracic surgeon
114
1
13
80
3
0
211
(7)
ENT surgeon
1
0
3
44
0
0
48
(2)
Paediatrician
1
0
0
0
0
0
1
(<1)
Sub-total
2,202
63
493
147
9
11
2,925
Not answered
15
1
3
1
0
0
20
(1)
Total
2,217
64
496
148
9
11
2,945

Table 69 illustrates that a rigid endoscope was used in 39% (83/211) of thoracic cases and 92% (44/48) of ENT cases. This perhaps reflects a difference in surgical subspecialty training for specific endoscopic procedures.

Table 70. Grade of the most senior endoscopist
Grade of most senior endoscopist
Total
(%)
Consultant
2,453
(84)
Associate specialist
73
(2)
Staff grade
63
(2)
Clinical assistant/hospital practitioner
17
(<1)
General practitioner
13
(<1)
Nurse endoscopist
11
(<1)
SpR-year 3 or over
243
(8)
SpR-year 1/2
41
(1)
SHO
9
(<1)
Other
4
(<1)
Sub-total
2,927
Not answered
18
(<1)
Total
2,945

A consultant was the most senior endoscopist for 84% (2,453/2,927) of these procedures. An SpR-year 1/2 would not appear to be an appropriate grade for upper GI dilation or insertion of tubal prosthesis; it is unlikely that they would have had sufficient experience to perform these procedures unsupervised. However, NCEPOD does not know their experience before starting their SpR training, which, for those coming from SAS to training grades,
can sometimes be considerable. 41 cases were done by SpRs of year 1/2, 35 were flexible endoscopic dilation, 4 were flexible endoscopic insertion of tubal prosthesis and 2 were rigid endoscopic dilation. An unsupervised SHO should never be the most senior endoscopist
for upper GI dilation or insertion of tubal prosthesis. Nine cases were undertaken by SHOs.
Of particular concern was that seven of the nine were rigid endoscopic dilations that were done by surgical SHOs. Of the remainder, one was a flexible endoscopic dilation and one
a flexible endoscopic insertion of a tubal prosthesis. Consultants should ensure that all doctors who are under their supervision have the training and experience to perform the procedures that they are undertaking.

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