OUT OF HOURS ENDOSCOPY

The majority of requests for emergency or out of hours endoscopy involve the management of patients with acute gastrointestinal bleeding. The BSG Report¹ states that it is essential that consultant gastroenterologists are available to come to the endoscopy unit when necessary to supervise the management of patients with acute gastrointestinal haemorrhage. However, it is recognised that it is difficult for smaller units to provide 24 hour cover. In our sample 38% (69/180) of hospitals operate an out of hours on-call rota and 14 hospitals did not answer this question. Of the hospitals that completed the question on out of hours cases, 35% (67/190) performed these cases within the endoscopy unit. In 55% (105/190) of hospitals out of hours emergencies were dealt with in main theatres contrary to recommendations in the BSG Report: “Emergency endoscopy should be performed in the main Endoscopy Unit with experienced nursing staff available – not as a rushed procedure, either in a side room on a medical ward, or in a main operating theatre, unless the endoscopy is being performed immediately prior to surgery.” However, NCEPOD recognises that in some circumstances, for example upper GI bleeds, it might be more appropriate to treat the patient in a fully-equipped operating theatre. It may also be too costly to ensure that an Endoscopy Department is open 24 hours a day to receive such patients, especially in small units.