Smooth operation

ON the TV screen, Tim Henman is struggling against an opponent way below him in the world rankings. So what's new? Simon Smith is watching half-heartedly. He's sitting in one of the smart new chairs in the waiting area of the endoscopy unit at York District Hospital, wearing only a dressing gown and hospital garment.

The day before, he was jet-skiing in Cumbria with his family. Today, the 30 year old is waiting for an endoscopy to determine whether the new treatment regime for his Crohn's Disease is working.

Crohn's is a condition in which parts of the intestine or colon become inflamed and ulcerated, meaning food cannot be digested properly.

Simon, a fishmonger at Tesco in Leeds who lives in Acomb, was diagnosed three years ago. Within a year his weight had plummeted. "My weight just suddenly dropped," he says. "It went from 13 stone to eight stone within about 14 months."

Eventually, part of his colon had to be removed. Since then, his condition has fluctuated - sometimes better, sometimes worse, as the remaining part of his colon periodically flares up.

Three months ago, staff at York District Hospital started him on a new treatment regime. He's in hospital today for a colonoscopy - a procedure in which a tiny digital camera on the end of a tube is inserted into his colon - so a doctor can see for himself how the treatment is working.

The endoscopy unit at York is new, officially opened in February last year. There is a smart reception, a comfortable waiting area with TV, two patient changing rooms and five consulting and interviewing rooms.

Through a swing door you come to the three endoscopy rooms, almost like miniature operating theatres, in which the procedures are carried out, and a two-stage recovery area - one with eight beds, a second with comfortable chairs where patients are treated to tea and toast as they recover.

It's a far cry from a couple of years ago, when the endoscopy unit occupied a cramped bay in the hospital's day unit and patients had to share a recovery room.

There are three kinds of procedure carried out here using the endoscope: gastroscopy, in which the little hi-tech tube is inserted through the mouth and down into the stomach; bronchoscopy, in which it is inserted into the lung; and colonoscopy, in which it is inserted into the colon or large intestine.

It is a vital diagnostic tool, says deputy ward sister Lynden Tiplady, enabling doctors to examine instantly the condition of a patient's gut, stomach or lung via the magnified TV-style images on a screen.

The endoscope is used for much more than taking pictures. A tiny implement threaded through the tube enables the doctor to extract biopsy samples for proper analysis, while the tube also can be used to deliver medication.

Simon's colonoscopy will allow consultant gastroenterologist James Turvill to examine the lining of his gut from the inside to check for inflammation and ulceration. Dr Turvill will also take biopsy samples.

Simon's appointment is for 2pm. After being checked in, he goes into a consulting room for a chat with Lynden, where she talks him through the procedure, answers his questions and puts him at ease.

Most patients, Lynden says, are anxious. Having a tube inserted down the throat into the stomach, which is what happens during a gastroscopy, isn't pleasant. So a large part of the initial consultation with a nurse is reassurance.

The most difficult part for many patients facing a gastroscopy, she says, is actually swallowing the tube - we have a natural cough reflex that makes that difficult.

"But after that it is more or less plain sailing," she says. "It is a five-minute procedure usually, not much longer than that. Once we've explained it to them, patients usually feel quite relieved."

At least they are in good hands. The team of nurses and doctors in the unit dealt with 500 patients in May this year alone - experience that in itself is very reassuring.

The procedure Simon is having today, the colonoscopy, takes about 20-25 minutes. But the 30 year old is an old hand, having had one a couple of years ago. He knows what to expect.

Is he anxious? "I'm not concerned," he says with a resigned grin. "I think it is a case of you get resigned to being prodded about. I come into the hospital every week to have something done, and you just get used to it." His grin broadens. "It's a good job I haven't got a fear of needles!"

What he is looking forward to is his tea and toast in the recovery room afterwards. He's been on a strict diet for two days to prepare for the procedure - white bread, jelly and a bit of chicken the first day, liquids only the second. He's hungry.

By 2.45 he's ready, sitting in his gown in the waiting area, watching Henman on the telly. Lynden pops over to check on him every now and again. "It shouldn't be long now," she says at about 3.15. "It's been an extra long procedure the patient before him but it shouldn't be long now."

At 3.30, the team are ready. He's led through into one of the endoscopy rooms, where he's settled on a trolley. An IV line is attached to one wrist to administer a gentle sedative, an oxygen tube to one nostril.

He's awake throughout the procedure, drowsy but still aware. He chats sleepily to staff nurse Ruth Whittam, who sits beside him, and watches the progress of the colonoscopy on the TV monitor.

Dr Turvill talks him through what's happening. It's like a scene from the sci-fi movie Fantastic Voyage, where a submarine is shrunk to miniature size to explore the blood vessels of a critically-injured patient.

As the camera explores, the inner lining of Simon's gut opens like a cave. Much of it is lumpy and heavily scarred - the result, Dr Turvill says, of the disease. It is in stark contrast to healthier parts of his intestine, where the gut walls are smooth and the pale pink tracery of tiny blood vessels can be seen.

The good news, Dr Turvill says, is that for the most part there's not much sign of inflammation. So the disease is not active at the moment: a sign Simon's new medication is working. It's not a cure, but at least the disease is under control.

This is great news. For the time being at least, Simon won't need another operation to remove more of his bowel.

Just over 20 minutes after the procedure began, Simon is wheeled through into the recovery room. He's drowsy from the sedative, but pleased. "The medication seems to be working all right," he says.

Next morning, he's positively chipper. "It was really good news," he says. "The doctor said everything seemed all right and I shouldn't have any problem or have to have anything more done." He pauses. "Let's just keep the fingers crossed it stays like that!"

Updated: 11:16 Wednesday, July 03, 2002