PENTAX Medical equipment used for pioneering technique
PENTAX Medical equipment has been used to set up a pioneering head and neck cancer detection programme at a hospital Trust in Coventry, which has achieved remarkable results; reduced the length of time the patient stays in hospital and reduced costs.
Consultant Head and Neck Surgeon, Mr Gary Walton, heads up the Coventry Transnasal Oesophagoscopy (TNO) unit, and pioneered the introduction of the technique to the University Hospitals NHS Coventry and Warwickshire Trust, where he works.
The Trust set up the service with just two PENTAX Medical EE1580K endoscopes along with an HD TV and DVD recorder. It was led by two Head and Neck Consultant Surgeons, a specialist nurse and specialist healthcare assistant and was set up in outpatients.
The procedure involves the patient being seen by the trained nurse and is given a local anaesthetic only by a nurse prescriber. The TNO takes five minutes and is always carried out in the outpatient clinic and the patient is shown the DVD of the procedure afterwards. After a recovery period, they can be discharged.
Mr Walton said: “We have now undertaken over 150 procedures and as a result saved the equivalent of 150 bed days. Effectively this has generated a net income of over £90,000 for our Trust. As a result of this success the TNO team won the Innovation and Service Development OSCA (Outstanding Service and Care Award) from the Trust, which was presented at a black tie dinner awards evening recently.
So what led to the development of such a pioneering clinic at the hospital? Mr Walton explains: “A common complaint referred for investigation is that of perceived dysphagia for which there is no clear diagnostic pathway. Many of these patients were having a variety of investigations including radiological investigations, prior to rigid endoscopy under general anaesthesia.
“Following the introduction of the ‘Rapid Access Referral Pathway’ for head and neck cancer there followed a year on year increase in patients requiring diagnostic investigations by the head and neck team.
“This pressure, combined with difficulty in gaining access to additional theatre facilities, led the head and neck team to explore novel working practices and the use of transnasal oesophagoscopy was one of the techniques considered that could help to prevent diagnostic delays,” he said.
The technique of transnasal oesophagoscopy (TNO) allows investigation of patients in the outpatient setting with minimal risk and has the potential to reduce costs as the whole of the laryngopharynx, post cricoid and oesophagus can be examined by direct inspection. This reduces the number of radiological investigations required and shortens the diagnostic pathway.
Mr Walton decided to further investigate the technique’s suitability for use at Coventry, after being convinced of its benefits. He said: “The magnified and high resolution image obtained in the oesophagoscope provides a more accurate visual assessment of these areas compared with conventional rigid endoscopy.
“A further advantage of the technique is that it is still easy to perform in patients who have had previous treatment whereas repeated general anaesthesia for assessment in these patients often carried some risk and frequently it proved impossible to obtain an adequate view with rigid endoscopy.”
The team carried out an assessment of available equipment, which is limited to PENTAX Medical and one other supplier. The team at Coventry assessed both options before deciding to go ahead with PENTAX Medical.
“The PENTAX Medical endoscope is constructed along the lines of a conventional gastroscope but on a smaller scale. There is an instrumentation port, suction, lens wash and air insufflation. Image quality is excellent due the distally mounted chip. The dedicated system allows the potential use of i-scan image processing technology, with the scope and it may also be connected to a dedicated recording device with slow replay facility, which is essential for accurate viewing of the post-cricoid region. We chose the PENTAX Medical endoscope as we felt it would be more versatile in the long run and were impressed by the image clarity.”
He added: “PENTAX Medical have been very helpful and supportive throughout the process of procuring equipment and in terms of after sales advice and help and I am very grateful for their help with a recent TNO training course held in Coventry.”
So what benefits has adopting this new technique brought to Coventry cancer patients? Firstly, it is quick – once mastered, the actual procedure takes less than five minutes and patients at the clinic, who recently took part in a satisfaction survey, said they have been surprised at how easy it is to tolerate the procedure.
The system also allows patients to see their investigation played back to them and by slowing down the video replay at important points it is easy for the consultant to explain to patients the results of their investigations and answer any questions they may have.
Mr Walton said: “Other clinicians I have spoken to, have reported a 90% reduction in the need for general anaesthetic endoscopy, which would make a considerable difference to waiting times for other procedures. I would recommend considering introducing this technique in any head and neck service to streamline patient pathways.
In Coventry, the clinicians have now reached a point whereby they can advance in their skill levels. Mr Walton said: “A number of biopsy procedures in patients who would have had a challenging anaesthetic due to co-morbidity have been performed and we now plan to expand this aspect of the service to further reduce the need for admissions. The use of this technique has spawned multi-disciplinary working between the upper GI team and the Head & Neck team, with a number of inter-speciality referrals for patients with suspected pathology.”