The BSGE has recently received an enquiry into the use of Entonox and fitness to drive. Entonox (50% nitrous oxide, 50% oxygen, manufactured by BOC) is mainly used in obstetric units and by the ambulance service, but its analgesic and sedative properties with rapid onset and offset make it a potentially attractive agent in patients having colonoscopy and it is already in use in many units. A number of publications in the 1990s showed that it is safe and effective, with reduced discomfort and nausea compared to IV agents and allows earlier discharge from the recovery unit. It is perhaps surprising that it is not more widely used.

As for the question of fitness to drive: the recently revised product licence states that patients are fit to drive a vehicle (or operate machinery) after only 30 minutes. Used in combination with a rapidly acting bowel cleansing agent, this could mean that for patients whose colonoscopy is to be done mid-week, only half a day away from work is required – a major advantage for the self-employed. A pdf file, "Entonox: Information for the User" is available from BOC (and on the BSG website)

Alistair McNair, Secretary BSG Endoscopy

• BOC Entonox Product Guide  [ 44 Kb ]

The European Society of Gastrointestinal Endoscopy (ESGE) offers three categories of grants to fully trained endoscopists wishing to undertake further training in highly specialised endoscopic techniques at one of the officially recognised ESGE training centres. Application is available to ESGE Individual Members (please see PDF file below for further information on ESGE membership).

Module I: Basic Training with Experts

The grantee receives training on basic steps and specific techniques. A maximum of four weeks training is foreseen, depending on the techniques studied. Module I grants do not contain hands-on training.

Tokyo National Cancer Centre and Okayama University Hospital

Prior to my visit I worked as a clinical and endoscopy fellow in a large DGH for 2 years, developing advanced endoscopic techniques and services. This involved the identification and removal of early gastro-intestinal neoplasia throughout the aero-digestive tract, with techniques brought back to the UK by a consultant who had attended the Tokyo National Cancer Centre (NCCH) 6 years previously.

My visit to the NCCH for 2 weeks and another centre of endoscopic excellence in Okayama, was to further improve my diagnostic, therapeutic and teaching skills, whilst contrasting our current UK practice with the Japanese.

Over my visit I attended a structured experiential programme shadowing Consultants and Senior Residents. The normal working day started just before 8 and rarely finished before 6, with the Japanese doctors often finishing much later. The morning consisted of screening and pre-operative upper endoscopy cases, and the afternoon lower screening cases. Concurrently in the afternoon upper and lower GI therapeutic cases occurred.

Typically 40-50 screening OGD cases were available to view and 10-15 lower screening cases. Typically 2-3 gastric or oesophageal ESD/EMR cases, 1 lower ESD, and several lower EMR's cases were performed each afternoon. EUS was also performed.

A typical week included 4 early morning therapeutic cancer meetings, with Friday being the earliest (07.15 am). The meetings were multi-disciplinary and included presentation and discussion (in good English) of multiple endoscopic, surgical and pathological images. The meetings were lower and upper GI specific, two with educational opportunities and two more formal meetings. Opportunities to attend research and other relevant meetings were also available in the evenings and I attended 3 over my 4 week stay, finishing late in the evenings.

The JAG has proposed alternative processes for the re-certification of endoscopy units.

The process of JAG Certification for Units changed in 2005 from the original paper based self-certification for five years to the current round of comprehensive JAG Visits to every Unit in the UK. Scotland, Wales and Northern Ireland are working hard to establish processes for JAG Certification and no Units have been through the updated assessment at the time of this report. In 2008, a new electronic assessment system was unveiled, the JAG Visits website. The JAG Visits website provides a user-friendly platform through which Units can upload their supporting evidence and complete the JAG Online Checklist, a vital component of a JAG Visit. This is supported by a face-to-face, on-site JAG Visit. The JAG Visit validates the self-certified GRS scores and in addition, provides an opportunity to interview the workforce and training staff and inspect the physical environment and decontamination facilities.

• A Proposal for Future JAG Unit Accreditation [DRAFT]  [ 104 Kb ]

Request for Members' Feedback

I urge members to read the document and e-mail comments on the two recertification options directly to the JAG office: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Dr Edwin Swarbrick - Chair, BSG Endoscopy

ERCP-Quality Network

Over the last decade there has been increasing interest in quality issues in Endoscopy. The GRS has served to drive up the quality of service and there is ongoing work under the auspices of JAG to derive a framework for quality assurance of individual Endoscopists. What has been lacking hitherto is an infrastructure to facilitate collection and analyses of data to allow practitioners to compare themselves with others ("benchmarking").