Quicker, more convenient and more comfortable tests
The successful pilot of a cutting-edge diagnostic procedure at Whipps Cross hospital is helping hundreds of patients get their test results faster.
The technique of TNE, or transnasal endoscopy, is less uncomfortable than traditional methods and not only better for the patient but more efficient too. It uses a thin tube that passes through the nose to look into the upper digestive tract rather than inserting a large tube via a patient’s mouth.
The patient can more easily tolerate the thin tube and doesn’t experience a gagging reflex in the throat. So they don’t need conscious sedation as they would with a traditional gastroscopy, and instead the nose is numbed with a local anaesthetic.
Differences in method of insertion between standard and transnasal approach (diagram courtesy of Dr S Inglis/BMJ).
Yet the procedure is just as effective in enabling clinicians to inspect the foodpipe, stomach and start of the smaller intestine and detect problems including cancer. The whole process (including recovery) takes less time, can be done by specially trained nurses in an outpatient clinic, and costs less in staffing and space too.
Whipps Cross was one of ten sites across London that piloted TNE over a six-month period. The hospital undertook over 200 procedures, each taking about 15 minutes.
The London-wide study showed the biggest saving came from patients not needing sedation. That not only saved the cost of drugs but also an hour’s recovery time, requiring one less member of staff in the team.
The report also highlighted the key role played by TNE champions at each pilot site, such as Dr Ahmed Albusoda at Whipps Cross. Patients reported positive feedback from the one-stop service at the hospital.
Dr Albusoda said:
“We invested in eight new scopes with high-resolution cameras and found they were a lot more comfortable for patients, particular those in wheelchairs. We’ve done about 450 procedures in the last year and are now doing them at the Royal London and Mile End hospitals too.”
Sas Bannerjee, clinical director for London and a colorectal surgeon at Barking, Havering and Redbridge University Hospitals NHS Trust – which was also a pilot site – said NHS London was now exploring how to roll-out the procedure more widely.
“The great thing about TNE is that you are not using sedation so it is less invasive. Patients don’t need an escort, they sit up for the test and stay awake – all this is reassuring for frail people who might otherwise worry about what is happening.“
“Many of the procedures can be done by a clinical nurse endoscopist rather than a doctor, and don’t need specialist facilities. So you get the same diagnostic result yet free up a lot of clinical space to see more complex patients.”
Endoscopists across north east London have been collaborating through a clinical network for the past year, and the integrated care system is among the best-performing in the capital.