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.
