What are the gastrointestinal endoscopic requirements of a cancer centre?

To describe the elective endoscopy requirements of a cancer centre.

A prospective register of all patients referred from a cancer centre to our unit over a period of 1 year was maintained. Emergency procedures out of hours were not included.

The Endoscopic Unit at the Chelsea and Westminster Hospital provides a service to the local population of southwest London and the Fulham Road branch of the Royal Marsden Hospital. Between 1 January and 31 December 2003, 3720 new National Health Service patients with cancer were seen at the Royal Marsden Hospital; 1423 of these patients were seen at the Fulham Road branch. In the same period, the Endoscopy Unit at the Chelsea and Westminster Hospital investigated 5270 patients. Of these, 426 patients (8.1%) were referred from the Royal Marsden Hospital. In total, these patients underwent 491 procedures. Two hundred and fifty-three patients were men, with a median age of 65 years (range 22-100), and 173 were women, with a median age of 58 years (range 18-100). The diagnostic procedures carried out included colonoscopy (n=125), upper gastrointestinal endoscopy (n=136), flexible sigmoidoscopy (n=90), endoscopic ultrasound (n=24), anorectal physiology measurement (n=5) and endoscopic retrograde cholangio-pancreatography (ERCP) (n=1). Therapeutic procedures included ERCP (biliary stents/sphincterotomy/stone extraction) (n=38), placement of percutaneous endoscopic gastrostomy (n=29), balloon dilatation of oesophageal strictures (n=25), oesophageal, gastric, duodenal or colonic stent insertion or laser therapy (n=16), naso-jejunal tube insertion (n=1) and banding of oesophageal varices (n=1). All patients were treated as day cases. Four patients were admitted for observation after their investigation. All others were discharged home or back to the Royal Marsden Hospital.

Cancer centres increasingly require diagnostic, palliative and therapeutic endoscopic support as part of the acute and follow-up management of patients. Many procedures are urgent. This study suggests that a significant number of patients being managed in a cancer centre will require endoscopic intervention and the range of procedures, equipment and skills required is wide.