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.