Evaluating Endoscopic Outcomes and Performance Metrics for Incarcerated Patients in University Hospitals of Leicester NHS Trust

Aims Access to healthcare is a fundamental human entitlement, yet incarcerated individuals often confront significant disparities in health, resulting in heightened morbidity and mortality rates in contrast to the broader populace. British and European guidelines set standards and performance indicators for endoscopy quality in the general population, but it is unclear whether prisoners are receiving this same high standard. we aim to review endoscopy procedures and outcomes for incarcerated patients, ensuring that national standards are being met for this complex but often underserved population.

Methods Patients referred for endoscopy from prison, between 2020 and 2023, weere retrospectively audited. Demographic data and endoscopy findings were collected and analyzed against Joint Advisory Group (JAG) performance standards.

Results 85 patients (100% males, median age 46 years) were referred to our gastroenterology department, with 46 undergoing endoscopy. Gastroscopy (n=26); Most common indication was Dysphagia (11/26 – 42%) with 100% complete procedures and abnormalities detected on 16/26 (62%). Lower GI endoscopy (LGE) (14 colonoscopies and 12 sigmoidoscopies); 57% of procedure were done un-sedated, median midazolam dose=2mg and median dose of Fentanyl=50ug. Six patients had Entonox. Bowel preparation reported as adequate in 88% (23/26), poor in 3% (1/26) and 7% (2/26) had no clear bowel preparation status. Abnormal LGE was reported in 20/26 (77%) of patients. In the 14 colonoscopies 92% (13/14) were complete to the caecum. Polyps were detected in 28% (4/14) and retrieved in 50% (2/4), withdrawal time was recorded in 4/14 patients, median=7.5 minutes. Inflammatory bowel disease (IBD) was the most common diagnosis in lower GI endoscopy 7/26 (27%), 6/7 have not been followed up following a positive diagnosis, 5/6 due to missing multiple appointments and one was discharged without any treatment.

Conclusions here is limited evidence on endoscopic quality in prison populations, and recent reports suggest that incarcerated patients often do not receive standard medical treatment. In our study, we observed a significant disease burden within the prison population in Leicester, with abnormalities found in 77% of lower GI endoscopies and 62% of upper GI endoscopies. In our unit the endoscopic key performance indicators for upper and lower GI endoscopy were satisfactory. However, bowel preparation remains a challenge as well as follow up. No clear follow-up plans were established for 6 out of 7 patients with IBD, and many of these individuals missed multiple appointments without any subsequent follow-up arrangements.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025