A survey of all gastroenterologists in the Trent Region (population 4.7 million) showed that in 1992 the number of upper gastrointestinal endoscopies had continued to rise considerably. There were 8.6 per thousand of the population. Colonoscopies had also increased to 1.4 per thousand. There had been a large fall in barium meal examinations to 4.8 per thousand. Barium enema examinations had increased slightly to 5.3 per thousand. The number of endoscopic retrograde cholangiopancreatographies (ERCPs) and variceal sclerotherapies had also increased by 54% and 21% respectively since 1986 and were available in most of the 20 hospitals. Percutaneous endoscopic gastrostomy had been introduced at most hospitals. Emergency endoscopy was readily available at night in only half the hospitals. Fourteen hospitals offered formal open access endoscopy. Intravenous sedation was used routinely in 12 hospitals. The rate for perforation at routine upper gastrointestinal endoscopy was 1 in 4500 and for death was 1 in 20,000. There were serious deficiencies in provision of facilities or staff, or both at 14 hospitals. The total number of gastroenterologists had only increased from 25 to 26 since 1986. Thus endoscopy workload continues to increase and diversify often without adequate staffing, facilities, and funding.
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