Improvement to the colonoscopy service in Dunedin will
require funding and people working together constructively,
national Gastroenterology Society president Associate Prof
Susan Parry says.
There was "good potential" for the service under the
proposals to redevelop the existing Dunedin Hospital
endoscopy suite, but people would need to work together to
solve problems and put the plans into action.
Funding was always constrained, but it was an important
initiative, she said.
Prof Parry, of Auckland, was in Dunedin for the recent annual
scientific meeting of the society and the gastroenterology
nurses' section of the New Zealand Nurses' Organisation.
She said the collaboration between the University of Otago
and Southern District Health Board over the proposed
development of a gastrointestinal diseases centre of
excellence was a great idea for Dunedin.
It had the potential to "catapult" Dunedin into "quite a
different scenario" with regard to delivering
gastroenterology services.
"It has only got to be good for the people in Otago."
Prof Parry said the centre would increase the possibilities
for dialogue between gastroenterologists and surgeons and
researchers and help stop "silo" thinking.
Problems with access to colonoscopy services at Dunedin
Hospital hit the headlines about two years ago and while
there has been some increase in the number of procedures
carried out, there is a limit to what can be offered in the
existing cramped endoscopy suite.
The district health board has allocated $1.82 million for
redevelopment of the unit in this financial year and another
$729,000 next year.
Prof Parry said the chief concern for all those involved with
the upgrade had to be the people of Otago with symptoms of
concern who might be waiting anxiously for the timely
delivery of procedures.
Speaking about national bowel cancer screening, Prof Parry
said it was "absolutely great" to hear that the first of the
screening kits had been sent out in the pilot programme being
run by the Waitemata District Health board this week.
She accepted there were critics of the length of time it had
taken to get this far, but offering a safe, well-monitored,
timely, quality programme was much more than offering the
initial test.
Asked when she would like to see a decision made about a
national screening programme, Prof Parry suggested the
question be put to her again in two years when one round of
the pilot would have been completed.
The Ministry of Health has consistently not given any
decision date, but indicated it would follow analysis of the
full pilot, which is expected to take two years.
At the final day of the conference last week, among the
topics under discussion were nurse endoscopists, and whether
flexible sigmoidoscopy was a better and possibly cheaper
alternative to the faecal occult blood testing being offered
in the pilot programme.
University of Otago cancer researcher and screening programme
authority Associate Prof Brian Cox, who supports a one-off
flexible sigmoidsocopy (FS, a procedure which internally
examines the lower bowel) as a screening tool, showed how it
could be introduced over a five-year period which would
include time for training of extra nurse or GP endoscopists.
He suggested such a programme could save more lives and $67
million over 10 years.
His view was counteracted by gastroenterologist Dr Tim King
who said an FS screening programme would result in more
follow-up colonoscopies and impose a significant procedural
burden for potentially relatively small gains.
Prof Parry said one of the concerns about FS was the expected
lower take-up of the test.
She noted that the Waitemata pilot was the first screening
programme involving men and it would be "very interesting to
see how they respond".
On the issue of nurse or non-medical endoscopists, Prof Parry
said the society had not yet made a decision about how to
raise endoscopist numbers.
This was also a complex issue.
There was already a shortage of gastroenterologists, but they
would be required to train the new endoscopists and there was
the other issue of limited theatre space.
elspeth.mclean@odt.co.nz
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