All endoscopists will be aware of the current controversy and differing guidelines on endocarditis prophylaxis for GI procedures. A working group of the BSG Endoscopy Committee met in March 2006 to revise the 2001 guidance.

NICE has now considered this issue as well. It has come out against the use of antibiotic prophylaxis to prevent endocarditis during gastrointestinal endoscopy. Its guidance on endocarditis prophylaxis was unveiled on 26 March 2008:

Upper endoscopy is a safe procedure and complications are uncommon. The following is a list of possible complications: Aspiration of food or fluids into the lungs if patient is not fasting, the risk of which can be minimized by refraining from eating or drinking for 6 hours before the examination.

The endoscope can cause a tear or hole in the natural orifices being examined. Like oesophagus or stomach or colon. This is a serious complication but fortunately occurs only very rarely.

Bleeding can occur from biopsies or the removal of polyps from tissue, but it is usually minimal and stops quickly on its own or can be easily controlled.

Reactions to the sedative medications are possible; the endoscopy team (doctors and nurses) will ask about previous medication allergies or reactions and about health problems such as heart, lung, kidney, or liver disease. Providing this information to the doctor ensures a safer examination.

The medications can also produce irritation or risk to the patient in the vein at the site of the intravenous line. If redness, swelling, or warmth occurs, warm wet towels applied to the site may relieve the discomfort. If discomfort persists, a patient should call their primary care provider or the endoscopy unit. If this is not possible, the patient should seek assistance in an emergency department.

The following signs and symptoms should be reported immediately: Severe abdominal pain (more than gas cramps)

A firm, distended abdomen

Vomiting

Temperature greater than 101ºF or 38ºC

Difficulty swallowing or severe throat pain

A crunching feeling under the skin.

The recently opened, state-of-the-art Endoscopy training facility at Laparoscopy Hospital is one of the excellent National centres commissioned to improve endoscopy training in India. Laparoscopy Hospital offers several different types of ‘Basic Skills’ course, including: Basic Skills in Colonoscopy

Basic Skills in GI Endoscopy

Endoscopy training the Trainers

Training the Trainers (TET)

Basic Skills in Flexible Sigmoidoscopy

Basic Skills in Therapeutic GI Endoscopy

Colonoscopy Masterclass

Courses for Nurses

Until April 2008, core courses are aimed at trainees doctor who are currently working within the India (due to the programme being funded by many companies).

After April 2008, the courses will become available to trainees across the Globe. The following fees will apply: In order to be eligible to attend the ‘Basic Skills’ courses you must have an identified trainer to supervise your endoscopy training with organised endosopy sessions for at least 6 months after the course. Details of these centres, core-course dates and contact details can be found by clicking either endoscopy skills courses or training centre contact details. For details of non-core endoscopy courses, please contact the centres directly to find out what they offer. If you wish to apply for a place on a course, please contact the centres directly. The administrator will then send you an application form and places will be allocated on a strictly first come, first served basis. Please be advised that these courses are extremely popular and there are only a very limited number of places available.