Small bowel and capsule endoscopy
The Royal Hallamshire Hospital offers a regional one stop small bowel service with the provision of capsule endoscopy (small bowel, colon, crohn’s and upper gastro-intestinal capsule), push and double balloon enteroscopy. 4 consultants provide the service (Mark McAlindon, David Sanders, Reena Sidhu and Melissa Hale) and the centre performs over 900 small bowel capsule endoscopies per annum and is currently the largest providing centre in Europe, having been established in 2002. The centre was involved in the BSG guidelines for capsule endoscopy and enteroscopy and also has the largest number of publication on small bowel endoscopy in the UK. They are keenly involved in training in capsule endoscopy as well as research with current focus on the use of capsule endoscopy in coeliac disease and steerable upper gastro-intestinal capsules.
The Sheffield Teaching Hospitals is a JAG approved training centre for endoscopy. It offers an excellent opportunity for trainees to learn endoscopy including ERCP and aspects of advanced endoscopy like Endoscopic mucosal resection (EMR), dilatation and stenting.
STH offers an advanced therapeutic colonoscopy service for large colonic polyps being run in close collaboration with the regions lower gastrointestinal cancer network. The service provides training, diagnostic and interventional therapy for large colonic polyps using predominantly the EMR technique for the regions’ population. The endoscopy units currently perform over four thousand lower GI endoscopies of which 300 involve removal of large polyps by EMR.
Regional Endoscopy Training Centre
Sheffield is one of the original 7 JAG accredited Regional Endoscopy Training Centres and has run endoscopy training courses since 2002. These courses are consistently evaluated as being excellent by attendees. There are a range of courses offered, including basic skills colonoscopy, training the colonoscopy trainer (TCT) – for senior trainees, and a unique pig model therapeutic course for simulation of polypectomy, EMR and haemostatic techniques, as well as preparation courses for the BCSP accreditation exam. The unit is equipped with “Scope-Guide” 3-D imagers as well as an advanced computerised simulator together with a large DVD learning library and full AV links between endoscopy rooms and a closely adjacent, spacious and fully equipped seminar room. The two lead trainers are Dr Stuart Riley and Dr Mark Donnelly, who between them have delivered more than 100 endoscopy training courses and who both have a national and international reputation for endoscopy training. This core faculty is enhanced by visiting trainers, from locally and further afield – all of whom have a proven track record for training excellence and all of whom have completed a TCT course.
The South Yorkshire Endoscopic Ultrasound Service is based at Sheffield Teaching Hospitals and runs in close collaboration with the regions upper gastrointestinal cancer network. The service provides the full range of diagnostic and interventional EUS (Cancer staging, fine needle aspiration, trucut biopsy, cyst drainage etc) to the regions population. The unit is currently performing over 300 procedures per year making this an ideal unit to train in pancreato-biliary and gastro-oesophageal ultrasound. The unit also has a focus on research with a current interest in chronic pancreatitis.
Inflammatory bowel disease
The IBD service at Sheffield Teaching Hospitals has provided a comprehensive service for IBD patients over the last 30 years. Specialist IBD clinic by clinicians and IBD specialist nurses runs weekly in addition to a ward base for the service and a weekly in reach service of IBD ward patients by a multi-disciplinary team, ensuring easy access for urgent patient review. The team includes 7 IBD specialist nurses who provide a nurse led telephone help line, community clinics and an infusion service for patients on biological therapies. Specialist clinics such as transition clinics for patients transferring from paediatric care and joint medical-surgical IBD clinics run on a regular basis. These are in conjunction with the Sheffield Children’s Hospitals and the department of colorectal surgery, who have considerable expertise in surgical aspects of IBD. Weekly joint radiology multi-disciplinary team and departmental meetings allows multidisciplinary management of complex patients including those who require escalation to biological therapy. There is therefore, the opportunity for considerable, concentrated exposure to the management of complex IBD. Professor Alan Lobo, who leads the service is the current chair of the NICE Guideline Development Group for ulcerative colitis and has been a recent member of the NICE Crohn’s disease GDG , as well as a member of the national IBD committee of the BSG. In addition there are 3 other consultants specialising in IBD: Dr Alenka Brooks, Dr Melissa Hale, and Dr Josh Chew. The IBD team is involved in a wide range of research projects including participation in several multi-centre trials.
The Sheffield Nutrition service offers a multidisciplinary approach to nutrition assessment and support to all patients within the trust and surrounding areas. The Nutrition Steering Group oversees the co-ordination of delivery of nutritional care between different disciplines and is responsible for ensuring a comprehensive education and training programme for undergraduates in medicine and nursing and for qualified staff.
The nutrition team comprises of 2 consultants: Dr Ching Lam and Professor McAlindon, a dedicated dietician, 2 clinical nurse specialists (CNS) and a pharmacist. There are 4 nutrition ward rounds a week and a weekly MDT ensuring patients with complex nutritional needs are assessed and monitored by a specialist team. The primary purpose of this team is to assess patients’ suitability for PN, to prescribe and monitor progress. The team also provide continuing care for patients requiring long term, or home parenteral nutrition, who are seen in a regular Intestinal Failure Clinic.
The hepatology team in Sheffield provides inpatient and outpatient care across both sites at Northern General Hospital and the Royal Hallamshire Hospital. The team of 4 consultants (Professor Dermot Gleeson, Dr Claire Salmon, Dr Barbara Hoeroldt, Dr Al Joudeh) and the specialist nurses treat liver in-patients with a wide array of conditions and also provide general and specialist hepatology clinics including management of patients with chronic liver conditions, primary liver tumours and viral hepaititis. In addition there is a weekly hepatology radiological MDT and weekly hepatology teaching for the trainees. The hepatology department at Sheffield has close links to the local transplant centres and is involved in the management of pre and post transplant patients. The department offers a fibroscan service and receives referrals from regional hospitals and from 2017 onwards, the interventional radiology team also offers a service for transjugular intrahepatic porto-systemic shunts. The hepatology department has a long history of research and has ongoing research interests in alcoholic and autoimmune hepatitis.
The GI Physiology service, based at the Northern General Hospital, provides a regional service to the local hospitals and investigates approximately 3000 patients annually. The department is a regional training unit and undertakes undergraduate and post graduate research.
The investigations undertaken utilise state of the art equipment including high resolution oesophageal manometry, 3D high definition anorectal manometry, 3D ultrasound for evaluation of the integrity of the anal sphincter complex and TNM staging of rectal cancer. A full range of GI investigations are provided including oesophageal pH and impedance monitoring, Bilitec, small bowel motility studies, hydrogen and urea breath testing, electrogastrography and the department also provides a retraining service for patients with pelvic floor dysfunction. Patients are now also being offered Posterior Tibial Nerve Stimulation – a recent development for the treatment of faecal incontinence.