An examination of the outcomes of therapeutic GI endoscopy using national data sets

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Harvey, Philip (2020). An examination of the outcomes of therapeutic GI endoscopy using national data sets. University of Birmingham. M.D.

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Abstract

Background

Prospective research in therapeutic endoscopy is challenging. Database studies are widely reported, but with recognised limitations. Reported in this thesis are targeted analyses of databases with the aim improving patient outcomes and providing examples of database studies in gastro-intestinal therapeutic endoscopy.

Methods

Hospital Episode Statistics (HES, secondary care) and The Health Improvement Network (THIN, primary care) were used to investigate therapeutic endoscopy outcomes and the populations that undergo such procedures.

Analyses included; ERCP for malignant biliary obstruction, colonic stents as a bridge to curative resection, 10-year outcomes of endoscopic pneumatic dilatations and myotomy for achalasia, morbidity and mortality following PEG placements in learning disability subjects, and long term outcomes of achalasia subjects from population based data.

Results

HES demonstrated excellent coding of procedures and mortality. Complications of procedures and provision of chemotherapy were variable. Key strengths of HES data were large subject cohorts and a mechanism to examine provider volume effects.

THIN data was limited for peri-procedure outcome data. However, long term population health data items describe important outcomes observed in primary care and are therefore unavailable in HES.

Conclusions

Careful application of database studies can yield useful clinical observations to target research and support service design.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):