THE TUBE Volume 49 Issue 1

INSIDE

Ustekinumab in New Zealand

World Congress of Gastroenterology Dubai

December 2022

Lower Anterior Resection Syndrome (LARS)

WELCOME TO THE OLYMPUS CORNER

Olympus NZ National Service Centre

Olympus offers a range of medical imaging systems across all medical specialties that utilise minimally invasive techniques, including 4K and 3D surgical imaging platforms, providing unparalleled confidence and vision without compromise.

The Auckland facility incorporates an expanded National Service Centre allowing Olympus New Zealand to deal with increasing repair capacity and to subsequently service New Zealand customers with improved turnaround times. In addition, the National Service Centre has been designed to provide walk-through visibility to both customers and visitors who’ll be able to directly observe how products are serviced and repaired, as well as providing facilities that will enable hands-on education for our customers.

Our commitment to enhance our customer experience via the education offerings that Olympus Academy Auckland presents, whilst improving our repair capacity to directly influence our dayto-day support levels for our customers and their businesses, showcases Olympus’ strong commitment to the NZ market.

The Olympus Academy team is dedicated to educating the specialists of tomorrow. Olympus Academy offers courses and webinars for reprocessing and endoscope training, specific topics include infection control, reducing the risk of cross contamination, and other adverse events related to the reprocessing of flexible endoscopes and surgical instruments. To view course calendar and make bookings visit Olympus Academy website.

Upcoming Olympus Academy Courses & Webinars:

Olympus Gastroscope and Colonoscope Cleaning In-Service Webinar

Tuesday, 6th December | 15:30 NZST

This webinar will provide participants with an overview of the procedure and recommendations for reprocessing Olympus flexible gastroscopes /colonoscopes. Our Clinical Educator will be conducting a live demonstration of the cleaning steps with the opportunity for questions during the cleaning process.

Olympus EUS Cleaning In-Service Webinar

Wednesday, 7th December | 14:30 NZST

This webinar will provide the attendees with a thorough understanding of the steps required to ensure the Linear and Radial ultrasound endoscopes are cleaned correctly and patient-ready, covering the cleaning steps from leak testing procedure through to storage, following the Olympus recommendations. Our Clinical Educator will be conducting a live demonstration of the cleaning steps with the opportunity for questions during the cleaning process.

To book, visit: www.olympusacademy.co.nz

Committee

Chairperson

Merrilee Williams merrilee.williams@southerndhb.govt.nz

Secretary

Holly Weale secretaryofnzgnc@gmail.com

Treasurer

Kirsten Arnold treasurerofnzgnc@gmail.com

Committee Members

Marian O’Connor - IBD Specialty marian.o’connor@tdhb.org.nz

Jessica Southall - Hepatology Specialty Jessica.Southall@cdhb.health.nz

Karen Kempin - Nurse Endoscopist Karen.kempin@huttvalleydhb.org.nz

Kiran Joseph - Registered Nurse kiran.joseph@southerndhb.govt.nz

Julia Anderson - NZNO Professional Nurse Advisor Julia.Anderson@nzno.org.nz

Justin Augustine - Registered Nurse justin.augustine@wcdhb.health.nz

Life Members

• Kaye Hay

• Kate Bydder

• Barbara Miller

• Marie Fitzsimons

Contents

April 2023 Chair Report

And just like that- it’s a quarter of the way through 2023!

It’s been an unruly start to the year, particularly for those teams working in the Northern sites, and especially Kerrin and the Hawke’s Bay team. The impact of Cyclone Gabrielle was immense for their communities, and affected their home lives, as well as their work lives.

We have been thinking of you as you pull back together, and return to business as usual to serve the communities health needs- your fortitude and resilience has been truly tested.

Our committee had our face to face meeting at the end of February in Christchurch, where we were able to make progress towards our projects for the year. We have now a number of gastroenterology specific online learning packages developed and awaiting final touches before we can send them out to be tested by users. If you have any learning packages, or presentations that you could share with us so we can create more modules online, this would be really helpful. We look forward to seeing these finalised and available to support the education of our nurses across NZ.

Leaders Day planning is well under way- it will be held in Wellington on Friday 8th September. More details to come as we develop the programme, and then release the link for online registration. In the meantime, keep the date free, and share with any senior nurses in Gastroenterology.

The GENCA conference is in May, in Perth. The programme is exciting, with concurrent sessions to meet everyone’s special interests. GENCA have a scholarship of more than $800 for education, even for new members. So if you are not a GENCA member already, it is worth considering. They have regular online learning, as well as updates in practice to inform and guide us.

I hope you enjoyed our first Panui last month- please give us feedback on this over the year as we continue to develop it into a great, quick-read, publication.

Merrilee Williams Your Chairperson

Ustekinumab in New Zealand

Kaitlyn Doak Specialty clinical nurse, Waitaha, Canterbury Kaitlyn.doak@cdhb.health.nz

Inflammatory bowel disease (IBD) is a lifelong, incurable disease that causes chronic inflammation of your Gastro Intestinal tract. Crohns disease and ulcerative colitis sit under the IBD Umbrella along with IBD unclassified.

New Zealand has one of the highest rates of IBD in the world with well over 20,000 people affected (BPACNZ, 2021). The exact cause of IBD remains unknown but is believed to be prompted by environmental factors in genetically suspected individuals. A change in diet, changes to the gut microbiota, antibiotic use, pollution and allergen exposure are possible environmental factors contributing to the development of Inflammatory Bowel Disease.

Management of IBD includes both pharmacological and surgical interventions, there are four groups of medicines that are used to treat symptoms: amino salicylates, corticosteroids, immunomodulatory medicines and biologics (BPACNZ, 2021). Biologics are used to treat patients with moderate to severe IBD and up until recently the only biologic medications available in NZ were Infliximab and Adalimumab.

Initially up to 30% of patients do not respond to treatment and about 23-46% of patients lose response overtime leaving them with limited medical options (Roda et al., 2016). Ongoing symptoms often leads to reduced quality of life, limited ability to attend work and education and an increase in hospital admissions. Many patients, who are commonly of a young age will require bowel resections with some resulting in a permanent stoma (McCombie et al., 2020).

A burden-of-disease report published in 2017 reported that IBD costs New Zealand an estimated $245,000,000 in healthcare costs and lost productivity (Kahui et al., 2017).

Pharmac announced last year that as of February 2023 two new biologic medications will be made available for the treatment of IBD. One of these, Ustekinumab is funded for treatment of people with IBD disease that has not responded to prior biologic therapies.

Ustekinumab is a human monoclonal antibody first approved for the treatment of psoriasis but is now an effective therapy for IBD patients. It has a different mechanism of action to Infliximab and Adalimumab as it specifically binds to the p40 protein of human cytokines interleukin 12 (IL-12) and interleukin 23 (IL-23) (Medsafe, 2023). It blocks the binding of p40 to the IL12Rbeta1 receptor protein made on the surface of immune cells, consequently inhibiting the bioactivity of human IL-12 and IL-23 which have been associated as important contributors of chronic inflammation in Crohns disease and Ulcerative Colitis (Sandborn et al., 2022).

As these biologics work on the immune system differently to anti-TNF drugs, patients are more likely to respond to Ustekinumab if they have failed Infliximab or Adalimumab.

Ustekinumab is available to patients with moderate to severe Crohns disease or ulcerative colitis who have either lost response, had inadequate response or had a reaction to a TNFa antagonist (Sandborn et al., 2022). It is administered as a one off single initial dosing up to 6 mg/kg IV infusion for the first dose followed by eight weekly sub cutaneous injections of 90mg that people can self-administer at home (Medsafe, 2023).

The IV infusion dose is calculated on the patient’s weight, prepared and administered by a healthcare professional and administered over an hour. The following subcutaneous injections are all 90mg and the patient will come in to see the IBD nurse for training and education on technique, signs of adverse reactions, travel and storage of the drug before continuing to self-administer the injections at home. Ustekinumab therapy is well tolerated with under 4% of patients having an infusion related reaction (Sandborn et al., 2022). The common adverse events from Ustekinumab include vomiting, injection site reactions, bronchitis, pruritis, sinusitis and nasopharyngitis.

Randomised controlled clinical trials were conducted to evaluate the efficacy of Ustekinumab. A double blind,

randomised, placebo controlled 8-week induction phase, then followed by a 44-week maintenance study. They found a favourable clinical response after only a single IV induction dose at 6mg/kg. Half of patients demonstrating response 3 weeks post induction and 65% 6 weeks post infusion (Sandborn et al., 2022). Clinical response was a reduction in the CDAI score of more than 100 points however, Inflammatory markers including C-reactive protein (CRP) a faecal calprotectin significantly decreased during these trials.

In Canterbury alone as of March 2023 we have commenced 21 patients on Ustekinumab who have previously failed adalimumab or Infliximab. One patient with a complex history of Crohns disease and multiple surgeries had this to say “I was first diagnosed with Crohn’s disease at 20 years old and have been managing it for 34 years now.

I’ve had several surgeries in that time, and used treatments such as prednisone, azathioprine, Humira etc. I’ve been using Ustekinumab for several months now, having started with an infusion, and since had four 8-weekly injections. Ustekinumab has been very beneficial, and since starting I have had a less pain and discomfort, more formed bowel motions, and put on several kilograms in weight.

Having been at quite a low ebb and run down with weight heading down towards my all-time low when I started on Ustekinumab, it has certainly proven to be the best and most effective treatment I have used.”

With two new options available and funded in New Zealand we hope to see an increase of patients in remission, less hospital admissions and less surgical treatment for our IBD patients.

Thank you to the NZgNC for their financial support.

References

• Inflammatory bowel disease - a focus on Crohn’s disease and ulcerative colitis | bpacnz. (2021, February 1). Best Practice Advocacy Centre New Zealand. https://bpac.org.nz/2021/ibd.aspx

• Kahui S, Snively S, Ternent M, Crohn’s, Staff CNZ. Reducing the Growing Burden of Inflammatory Bowel Disease in New Zealand: Crohn’s & Colitis New Zealand; 2017.

• McCombie, A., Arnold, M., O’Connor, M., Stein, R., Fulforth, J., Brown, B., & Gearry, R. (2020). Why does Pharmac neglect Inflammatory bowel disease? New Zealand Medical Journal, 133(1527), 111-115. https:// journal.nzma.org.nz/journal-articles/why-doespharmac-neglect-inflammatory-bowel-disease

• Medsafe. Stelara. https://www.medsafe.govt.nz/ profs/datasheet/s/stelarainj.pdf (accessed on March 7th, 2023).

• Roda, G., Jharap, B., Neeraj, N., & Colombel, J. F. (2016). Loss of Response to Anti-TNFs: Definition, Epidemiology, and Management. Clinical and translational gastroenterology, 7(1), e135. https://doi. org/10.1038/ctg.2015.63

• Sandborn, W. J., Rebuck, R., Wang, Y., Zou, B., Adedokun, O. J., Gasink, C., Sands, B. E., Hanauer, S. B., Targan, S., Ghosh, S., De Villiers, W. J., Colombel, J., Feagan, B. G., & Lynch, J. P. (2022). Five-year efficacy and safety of Ustekinumab treatment in Crohn’s disease: The IM-UNITI trial. Clinical Gastroenterology and Hepatology, 20(3), 578-590.e4. https://doi. org/10.1016/j.cgh.2021.02.025

Australasian

Gastro-Intestinal Trials Group

25th Annual Scientific Meeting

13-16

November 2023 asm.gicancer.org.au

Te Pae Christchurch Convention Centre, New Zealand/Aotearoa and online

Co-Convenors: Professor Ben Lawrence and Professor Stephen Ackland

The AGITG Annual Scientific Meeting serves not only as a forum for the presentation of state-of-the art overviews on the pathobiological and clinical aspects of GI cancer, but also affords the opportunity to the Australasian scientific community to explore future directions for research and collaboration.

The meeting provides GI cancer researchers and specialists with the opportunity to present their research and discuss the current challenges and recent innovations in a multidisciplinary setting.

SHOUT OUT TO ALL NURSES WORKING IN ENTERAL FEEDING ROLES:

We are Clinical Nurse Specialists in Enteral Nutrition with a focus on the management of gastrostomy and jejunostomy feeding tubes.

Do you feel like you are sometimes working alone advocating for your patients with enteral feeding tubes?

We have found that there is no network or established group of nurses in the enteral nutrition sub specialty and would like to develop one so that nurses working in this space have an opportunity to share resources and develop national guidelines to improve practice.

We are hoping to establish a sub group with NZgNC to:

• Support high quality care for those with enteral feeding

• To provide a network as a learning, advisory, sharing, supportive professional  resource for clinicians using enteral feeding

• To promote and highlight the role and value of RNs and CNS working in the care of people who have enteral feeding

• Promote the development of nursing staff within enteral nutrition by facilitating access to educational resources

• Discuss difficult/complex case studies

• To standardise care and quality improvement

Please contact us via email if you are interested in joining this group:

Fiona.williams@waitematadhb.govt.nz

Hannah.Dunstan@cdhb.health.nz

Gastroenterological Nurses College of Australia

2023 Workshops

GENCA is hosting three Fundamentals of endoscope reprocessing workshops in New Zealand in 2023 with Practical Skills available.

The content for the Fundamentals Workshops is currently being redeveloped so the dates are later in the year. The face-to-face and Virtual Fundamentals will be listed on the GENCA website when the review is complete and workshops are confirmed, and we encourage you to send your staff and yourself as well.

Registrations are open, register now to secure your spot.

Details:

Date: Friday 4th August 2023

Location: Karstens, 205 Queen Street, Level 4, Tower 1 & Mezzanine, Auckland

Time: 8.30am to 4.00pm

Date: 18th August 2023

Location: Terrace Conference Centre, 114 The Terrace, Wellington

Time: 8.30am to 4.00pm

Date: TBC (September)

Location: Riccarton Park, 165 Racecourse Road, Broomfield, Christchurch Time: 8.30am to 4.00pm

What you will learn?  This is a foundation program that serves as an introduction to the reprocessing of flexible endoscopes incorporating infection control, structure and function, water filtration and workplace health and safety.

Registrations:

Can be made via the GENCA website or contact the GENCA office via email. Simply visit the GENCA calendar to book your place at: https://www.genca. org/education/find-an-event/

A limited number of practical skills assessments are available following each of the Fundamentals workshops.

Please complete the application form and submit to GENCA via fax on 1300 799 439 or via email to fundamentals@genca.org.  Individual times for assessments will be sent via email once the registrations are processed.

World Congress of Gastroenterology –Dubai December 2022

PPI’s vs P-CABs for treating GORD

Kirsten Arnold NZgNC committee member treasurerofnzgnc@gmail.com

In December 2022 I had the opportunity to attend the World Congress of Gastroenterology, which was held in Dubai, UAE. Grateful thanks to the NZgNC for providing me with funding.

Dubai is an amazing city of opulence and extremes. Everything in the city is bright, shiny and often huge!! The Burj Khalifa has been the tallest building in the world since January 2010. In contrast to the opulence of the central business district and Jumeirah, there is the Old Town which is a fascinating mix of homes, mosques, and markets – with every spice you could ever want, in abundance!

The conference itself was held in the (slightly ominously named) World Trade Centre. Despite its unfortunate moniker the conference venue was well appointed and thankfully well air conditioned! I have recently branched out into 24-hour pH monitoring, so I attended some informative sessions on the diagnosis and treatment of Gastro Oesophageal Reflux Disease (GORD). In one of these sessions was a presentation by Professor Ronnie Fass from Case Western Reserve University, regarding the use of a newer class of medication to treat reflux called potassium-competitive acid blockers, or P-CABs.

In New Zealand reflux is treated primarily with proton pump inhibitors (PPI’s) such as omeprazole, lansoprazole and pantoprazole. These medications work on the gastric parietal cells by binding to specific elements within the cell which are required for acid production. PPI’s have shown good efficacy and safety profiles in treating acid reflux conditions; however, they require enteric coating to survive in the stomach and are prodrugs so must be absorbed into the parietal cells before they can inhibit acid expression. This is why they have a 30-minute onset to action time, meaning that for optimal dosing the patient must take the PPI at least 30 minutes prior to eating (Savarino et al, 2021).

P-CABs also target the gastric parietal cells; however they are acid stable so do not require enteric coating, and they are not a prodrug. They therefore act immediately on the proton pump and do not require administration 30 minutes before a meal to be effective. They also have a longer half-life meaning they not only work faster than PPI’s but will also have a longer duration of action (Wong, Reddy & Patel, 2022).

In terms of safety, studies have been done in the most prescribed P-CAB, vonoprazan and these have shown excellent short- and medium-term safety comparable to that of PPI’s. A 2017 Japanese meta-analysis compared vonoprazan to lansoprazole in GORD and showed similar safety outcomes between both treatments (Wong et al, 2022). Studies are continuing and as this class of medication is more widely used, long term safety data will become available.

Proton Pump Inhibitors (PPIs) Potassium Competitive Acid Blockers (P-CABs)

Pro-drugs that need to be transformed to the active form

Binding covalently to H+-K+ ATP-ase

Irreversible binding to the proton pump

Full effect after 3-5 days

Affected by genetic polymorphism

Pharmacodynamic effect greater during the daytime

Direct action on H+-K+ ATP-ase

Binding K+ site of H+-K+ ATP-ase

Reversible binding to the proton pump

Full effect after the first dose

Not affected by genetic polymorphism

Pharmacodynamic effect lasting for both the daytime and nocturnal hours

Wong, N., Reddy, A., & Patel, A. (2022). http://doi.org/10.2147/DDDT.S306371

In my practice, the primary reason that patients come to have a pH study is because their reflux symptoms have not resolved with maximum dose PPI treatment. Often these patients are considering anti-reflux surgery such as a Nissen Fundoplication which is a significant procedure and not without its risk and downsides. It can be difficult for people to remember to take their medication at least 30 minutes before a meal and this will be one reason that PPI therapy is ineffective. It

has also been reported in some studies that between 19-44% of the GORD population may be refractory to PPI treatment, with either partial or complete lack of response to standard dosing (Savarino et al, 2021).

The other indication for PPI use is in the eradication of helicobacter pylori (HP). Currently in New Zealand we treat HP with “triple therapy” which is usually omeprazole, and two antibiotics (clarithromycin plus amoxycillin or metronidazole) given in combination for a 14-day period.

Sometimes one treatment is not sufficient to eradicate HP and patients require a second course. This increases their antibiotic exposure which is a risk for developing antibiotic resistance. A meta-analysis of randomised controlled trials published in 2019 compared PPI based triple therapy with vonoprazan based triple therapy. This showed combined HP eradication rates of 91% in the vonoprazan group and 75% in the PPI group. This correlates with another large study that showed eradication rates of 91% when vonoprazan was used, compared with 68% to 78% in the group using PPI based triple therapy (Wong et al, 2022).

All of this sounds very promising, but a quick search of the New Zealand formulary tells me that these medications are not yet available in this country. Hopefully over time, as P-CABs become more mainstream overseas, we may see them introduced here. Obviously the longer these medications are used, the more long-term safety data will be available. I for one would like us to be able to offer PPI refractory patients another option before they head towards surgery.

References:

• Savarino, V., Marabotto, E., Zentilin, P., Demarzo, M.G., de Bortoli, N., & Savarino, E. (2021). Pharmacological management of gastro-esophageal reflux disease: An update of the state-of-the-art. Drug Design, Development and Therapy (15), 1609-1621. https:// doi.org/10.2147/DDDT.S306371

• Wong, N., Reddy, A., & Patel, A. (2022). Potassiumcompetitive acid blockers: Present and potential utility in the armamentarium for acid peptic disorders. Gastroenterology & Hepatology, 18(12), 693-697. https://doi.org/10.2147/DDDT.S306371

The NZ Hepatology Nurses Group was excited to be able to fund several nurses to attend a course on advanced liver disease in March.

The course was held online over two nights from 8-10.15pm which was a big commitment at the end of a long working day for many. The course was designed for those who work closely with patients with advanced liver disease and covered anatomy and physiology, signs and symptoms of advanced disease, complications, and nursing management.

Some of the feedback received:

“The course was great! Really appreciate the opportunity to have come along and learn. Would love to learn from a future course to develop on the knowledge built from this one should the opportunity arise :) ”

“This x2 2.5 hour course on Advanced Liver Disease for Registered Nurses was well worth the two late evenings. Covering the basics, anatomy and physiology of the liver and associated diseases this was an extremely well-presented course ran by nurses for nurses. Being able to identify and discuss complications of ALD and their nursing management was extremely useful. How lucky was I to receive funding for this informative course. Thank you to the  NZ Hepatology Nurses group and  the Australasian Hepatology Association.”

“Informative and current information that can be applied to daily practice. Great, ‘nurses teaching nurses’ in terminology that is readily understood.”

Inflammatory Bowel Disease Special Interest Group

Report of the NZ IBD Nurses Committee as Sub-Committee to NZgNC

Committee: Marian O’Connor (Chair), Jacqui Stone (past chair), Kirsten Arnold (Co-chair), Karen Murdoch (secretary), Carly Bramley (Education lead)

Report Date: April 2023 Prepared By: Marian O’Connor Reporting Period: Sept 2022 – Apr 2023

The NZIBDNG committee continues to meet every 4-6 weeks virtually (via zoom), on your behalf and have been working on the following:

EDUCATION: IBD Nurses Meeting

• The NZ IBD Nurses meeting took place on Tuesday the 22nd of November 2022 at the Cordis Hotel in Auckland with 28 nurses attending. The theme for the day was ‘Bottom’s up’ with presentations on haemorrhoids & perianal disease, distal IBD, pouch surgery with three clinical case studies presentations on aphthous ulcers, fistulising crohn’s disease and rectal drug therapy.

• The feedback from the study day was overwhelmingly positive with learning for changes to clinical practice which will have a positive impact on patient care.

• The committee are grateful to NZgNC and NZSG for their support as well as Pharmaco and Janssen for educations grants which allows us to financially support this event.

• In addition, we are also grateful to Janssen and Pharmaco whom have generously supported us with education grants to support our costs of this meeting.

• Save the date – 24th of August 2023, Ibis Hotel Hamilton

• The committee are working on our 2023 NZIBD Nurses Education Day and have recently sent out a save the date with request to RSVP.

GENCA & IBDNA

• Marian O’Connor and Carly Bramley as part of the NZ IBD Nurses committee continue to collaborate with IBDNA and GENCA to aid in providing support and resources for AU and NZ

• The IBDNA Education Sub-committee (which Carly is a member of) are currently working on the IGNITE Foundation school set to launch in April 2023 – this will be advertised to the wider NZ IBD Nurse group once the flyers are published

• The IBDNA Education Sub-committee are also working on the Advanced IBD School set to run in September 2023 – again this will be sent out to the wider NZ Nurses group

• Dr. Falk Webinars can also be accessed by GENCA members, and these will be advertised via the GENCA forums

CALL TO ACTION

• A Call to Action (published in Tube, Volume 48 / Issue2 August 2022) was written by the committee and co-signed by Merrilee Williams (chair of NZgNC) to highlight the very low numbers of IBD Nurses nationally and the fact that we have lost staff to resignations over the past 18 months.

• Since then, we have sent a letter to the Minister of Health (Nov ’22) to state the case for a minimum number of IBD nurses per patient population (1 TFE to 600 patients). This resulted in a prompt reply from the minister of health at that time, Hon Andrew Little and a request for Te Whatu Ora to review and respond to our letter

• Te Whatu Ora replied (Nov 2022) in a letter which acknowledged our concerns and outlined a plan to boost the health workforce in Aotearoa. We are currently in the process of replying to this letter with specific requests related to IBD Nurse recruitment in Aotearoa. Once we have sent this letter, we will share this via NZgNC and the IBD Nursing membership

COMMITTEE MEMBERS

• We are delighted to welcome Two new committee members who have self-nominated to join the committee and replace those members whom have requested to step-down – Donna Howe will replace Karen Murdock as secretary – Nideen Visesio will replace Carly Bramley as Education lead

• There will be a transition period over the next few months as the new committee members are supported by the outgoing members

Nurse Endoscopy Subgroup of the NZ Gastroenterology Nurses College

In November 2022 an application was made to the NZ Gastroenterology Nurses College requesting support to establish a Nurse Endoscopist group with the stated goal of bringing together current and future nurse endoscopists to share knowledge and provide support to each other.

This application was accepted by the committee, with confirmation at the 2022 NZGNC AGM at the last NZ Gastroenterology Conference.

Our stated aims include:

• Articulate and promote the nurse endoscopy role to the broader health and patient community.

• Providing professional support to current nurse endoscopists

• Support and facilitate ongoing education and upskilling opportunities for nurse endoscopists

• Becoming a resource and offer mentorship to nurses who want to become nurse endoscopists

• Being utilised by Te Whatu Ora endoscopy unit management to assist with recruitment and mentoring of nurse endoscopists, either locally or overseas trained

• Providing expert consultation to Manatú Hauora, NEQIP, NBSP, EGGNZ and HWNZ around endoscopy workforce issues

The application letter outlined that the first action for the subgroup will be to address the stalled nurse endoscopy training program, including finding the blockages to training more nurse endoscopists and developing solutions with the assistance of NZGNC, NZSG and Ministry of Health.

The immediate next steps for the group are to develop terms of reference for the activities of the group, enrol members and form a committee.

Any nurses who are interested joining this group can make contact through the secretaryofnzgnc@ gmail.com email. Membership will be open to nurses working in or have an interest in the nurse endoscopy role as part of their future career.

Karen Kempin NE/NP Te Whatu Ora Hutt Valley

SIES 2023 – The Best So Far….

Karen Kempin Nurse Endoscopist/Nurse Practitioner Te Whatu Ora Hutt Hospital Endoscopy Unit Hutt Hospital, Lower Hutt, Wellington, karen.kempin@huttvalleydhb.org.nz

Financial Disclosures: Funding provided from NZGNC Education Grant to attend SIES.

recognised experts in the field. This leads to some robust debates in the endoscopy room and the meeting space as contrasting opinions are voiced and challenged. The live sessions were bookended with didactic presentations of updated guidelines and new research findings, with experts presenting and adding to the content with real world experience. With an emphasis on therapeutic endoscopy the question could be asked, why should endoscopy nurses attend? The SIES Board recognises the team work needed for successful completion of endoscopy procedures and nurses attending have a concurrent program of didactic knowledge and hands on skills development in more advanced procedures like ERCP, haemostasis and perioperative nursing care of patients having complex therapeutic procedures. Often during the live cases there is a focus on the nurse role and equipment used, so there is a huge benefit for nurses to attend

Sydney International Endoscopy Symposium (SIES) started in 2008 as the Westmead Endoscopy meeting and has since evolved into an internationally recognised learning opportunity through using live endoscopy demonstrations of simple and complex procedures. The sudden COVID shutdown in March 2020 cancelled SIES days before their planned program and in 2021 and 2022 they gathered experts and pre-recorded procedures for the SIES Series of on-line evening seminars to keep the learning and skills development moving forward. So for 2023 they were very happy to announce they were back to a fully live program with around 650 health professionals and trade representatives gathered together in the same space, which did lead to some COVID transmission but this is the new normal that the world has to manage.

The SIES focus is on transfer of endoscopy skills but there is also an opportunity for live discussion of best practice points and contrasting viewpoints on how to manage the specific patient case from

As a nurse endoscopist my focus was on the live program but I took time to join the nurses program for a session from Elizabeth (Beth) Wardle giving updates in Infection Prevention and Control in Endoscopy including drying cabinets and flow of dirty equipment in relation to patients and clean equipment. One surprising point she made was that ASNZS 4197 was released almost 10 years ago (2014) and that work has commenced on the next version. While it is great to see the review has begun, it is important to note that New Zealand is included in this standard, with NZ experts on the review panel but many facilities here are still struggling to meet the environment and equipment standards that

were mandated in 2014. Big ticket items like drying cabinets and physical works to redesign patient and equipment flows are still not prioritised as vital in New Zealand facilities, but this will come under scrutiny as the update to ASNZS 4187 develops. The Australian Commission on Safety and Quality in Health Care requires compliance by December 2024 with replacement of noncompliant equipment (automated reprocessors and drying cabinets), monitoring of final rinse water by testing, a plan for addressing clean and dirty reusable instrument segregation and design of storage of areas for sterile equipment. While New Zealand does not have a specific group to mandate and monitor these requirements, ASNZS 4187 is a legal document that needs acknowledgement and compliance.

From this year’s program I have made a few changes to my practice, even though I am not attempting EMR/ESD. I am taking more photos, with particular focus on before and after polypectomy. For small polyps with a cold snare I am trying to get a wider margin and irrigating the polypectomy site to flatten the mucosa and check the border for residual polyp tissue. For flatter lesions I am asking to use blue

lifting solution more to get good views of the polyp margins to ensure complete resection. These are all small changes I can do within my current scope of endoscopy practice to reduce polyp recurrence for my patients.

On the social side, Sydney of course is a spectacular place to visit and I walked a few km’s each evening to the harbour and around the shops, keeping in mind my weight allowance for the flight home. Catching up with old Aussie friends was another pleasure that I have missed in the COVID restrictions. I would recommend endoscopy nurses attend SIES at least once to experience a program dedicated to showcasing current techniques and up to date best practice in therapeutic endoscopy.

Use of Transient Elastography (FibroScan®) to Assess Probability of Clinically Significant Portal Hypertension

Judith McLaughlin, MHealSc CNS Hepatology, Waitaha Canterbury. 027 538 3869

Clinically Significant Portal Hypertension

The development of clinically significant portal hypertension (CSPH) is an important prognostic event in the pathology of advanced chronic liver disease. CSPH is the most reliable predictor of decompensation and denotes a point of no return for some patients (Stedman, 2022).

CSPH occurs via two main mechanisms. The first is increased resistance to blood flow in the portal vein (early) from distortion of the liver structure and dysfunction of endothelial cells (decreased vasodilation and increased constriction). The second (later) is increased flow to the portal vein due to splanchnic vasodilation and cardiac output (Stedman, 2022).

Assessment of Clinically Significant Portal Hypertension

Until now, we have assessed for features of portal hypertension by examining ultrasound scan reports and/or performing gastroscopy surveillance for varices. Access to the gold standard of hepatic venous pressure gradient (HVPG) measurement is limited, and besides this is an invasive procedure not without risks.

Use of Liver Stiffness and Platelet Count to assess risk of CSPH

Transient elastography (TE), commonly using FibroScan®, has been shown to reliably identify risk of CSPH in those who have advanced fibrosis secondary to alcohol, viral hepatitis and non-obese (BMI<30)

Metabolic Associated Fatty Liver Disease (MAFLD) (De Franchis et al., 2022). In 2015, the Baveno Group produced consensus-based guidelines (Baveno VI) that used liver stiffness (LS) together with platelet count to rule in or rule out the likelihood of CSPH. If LS was <20kPa and platelet count >150x109/L, gastroscopy could be avoided (De Franchis, 2015).

Patients with a liver stiffness ≤20kPa & platelets ≥150x109/L have very low risk of having varices and gastroscopy can be avoided (De Franchis, 2015).

Rule of 5

In 2021 the Baveno VII workshop expanded the work on previous Baveno VI. Recognising that various stages of compensated advanced chronic liver disease (cACLD) are associated with different outcomes, they introduced a pragmatic approach to stratify risk based on liver stiffness using a rule of 5 (see Figure 1 below). LS <5 kPa has a high probability of being normal; LS <10 kPa, in the absence of other known clinical signs, rules out cACLD. Values between 10 and 15 kPa are suggestive of compensated advanced chronic liver disease but need further tests for confirmation. Values >15 kPa are highly suggestive of compensated advanced chronic liver disease. Values ≥20–25 kPa can rule in CSPH (De Franchis et al., 2022).

Figure 1

Algorithm for the non-invasive determination of cACLD and CSPH

Note. From “Baveno VII – Reviewing consensus in portal hypertension” by De Franchis et al., 2022, Journal of Hepatology, 76(4), p. 963.

A rule of 5 for liver stiffness measurement (LSM) by TE (10-15-20-25kPa) should be used to denote progressively higher relative risks of decompensation and liver related death independent of aetiology of liver disease (De Franchis et al., 2022).

Prevention of First Decompensation

Recent data have shown that identification and treatment of CSPH with a non-selective beta blocker (NSBB) can reduce the risk of decompensation, primarily through reducing the development of ascites (Villanueva et al., 2019). Professor Catherine Stedman delivered a presentation at the New Zealand Society of Gastroenterology/NZNO Gastroenterology Nurses’ College Annual Scientific Meeting in November last year titled “B blockers in cirrhosis – the shifting tides” in which she talked about the use of beta blockers. Carvedilol is now the preferred NSBB since it is more effective at reducing the HVPG, is better tolerated than traditional NSBB (e.g. nadolol) and has a greater benefit in preventing decompensation and improving survival (De Franchis et al., 2022).

Assessing Liver Stiffness Post Treatment

Another big change is that FibroScan® can be used both at diagnosis and during follow-up for assessment of CSPH. Many of us are not in the practice of performing FibroScan® post treatment/suppression of aetiology as risk of hepatocellular carcinoma remains, and it does not change our management. However, now it will determine whether or not patients are commenced on a beta blocker and the recommendation is that liver stiffness is assessed annually, particularly if there are ongoing risk factors (De Franchis et al., 2022).

How does this change my practice?

For me, this represents one of the biggest changes in the management of patients with advanced liver fibrosis that I have seen since the introduction of direct acting anti-viral medications to cure hepatitis C. It represents a big challenge and responsibility for those of us performing liver stiffness assessments and there are still some grey areas. In the Gastroenterology Department at Christchurch Hospital we are developing tools to aid our interpretation and I have included an example below of how we are now reporting liver stiffness and risk of CSPH. There is also a flow chart below that we use to aid our interpretation of LS and platelet count. It is important to note that this guideline only applies to viral hepatitis, alcohol related liver disease and MALFD (BMI<30). For other aetiologies such as PSC and PBC, gastroscopy every 2 years is recommended (De Franchis, 2015). For MAFLD (BMI>30) CSPH risk can be calculated using the ANTICIPATE-NASH nomogram (Rabiee et al., 2022). This is probably best covered in another issue as it is a little more complex and requires further validation.

Examples of Reporting of risk of CSPH

Patient A Pre-treatment (Old Guidelines) Post treatment (Baveno VII)

Hepatitis C (68y male)

18.4kPa (2012) 8.2kPa (2022)

Platelets 179x10(9)/L Platelets 230x10(9)/L

FibroScan® Comment Results consistent with cirrhosis. (Gastroscopy was arranged)

Patient B Pre-treatment (Baveno VII)

Hepatitis C (59y female)

Low risk of CSPH. No PHT follow-up required. Risk of HCC remains. (Gastroscopy not required)

27.3kPa (2022)

Platelets 165x10(9)/L

FibroScan® Comment Highly suggestive of advanced fibrosis and ≥90% risk of CSPH. Consider commencing NSBB. HCC surveillance recommended.

can be repeated post treatment/suppression of aetiology

References

• De Franchis, R. (2015). Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualising care for portal hypertension. Journal of Hepatology, 63(3), 743-752. https://doi.org/10.1016/j.jhep.2015.05.022

• De Franchis, R., Bosch, J., Garcia-Tsao, G., Reiberger, T., Ripoll, C., & Baveno VII Faculty. (2022). Baveno VII – Reviewing consensus in portal hypertension. Journal of Hepatology, 76(4), 959-974. https://doi. org/10.1016/j.jhep.2021.12.022

• Rabiee, A., Deng, Y., Ciarleglio, M., Chan, M., Chan, J., Pons, M., Genesca, J., Garcia-Tsao, G. (2022). Noninvasive predictors of clinically significant porta hypertension in NASH cirrhosis: Validation of ANTICIPATE models and development of a lab based model. Hepatology Communications, 6(12), 33243334. https://doi.org/10.1002/hep4.2091

• Stedman, C. (2022, November 23-25). B blockers in cirrhosis – the shifting tides [Conference presentation]. New Zealand Society of Gastroenterology/NZNO Gastroenterology Nurses’ College Annual Scientific Meeting, Auckland, New Zealand.

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Lower Anterior Resection Syndrome (LARS)

Gendy Bradford, Nurse Manager Gastroenterology Day Service, Waitaha, Canterbury Gendy.bradford@cdhb.health.nz

In August 2022, I was fortunate to receive financial support from the New Zealand Gastroenterology Nurses College (NZgNC) so that I could attend the Gastroenterology Nurses College of Australia (GENCA) conference in Sydney. The theme of the conference was innovation, sustainability and growth. It was the first time I had attended an international conference in a few years, so I was both excited and a little nervous. Whilst at the conference, I was keen to hear presentations on topics that were unfamiliar to me. As a result, I attended a presentation by Carol Chan, a physiotherapist in Sydney, titled ‘Ano-rectal function after anterior resection for Colo-rectal cancer ’.

Carol graduated from the University of Sydney and is a registered physiotherapist with extensive clinical experience in pelvic floor disorders. She is currently undertaking a PhD through the Faculty of Medicine and Health, University of Sydney. Her study investigation is on bowel dysfunction (anterior resection syndrome) after colorectal cancer surgery and treatment, with complex anorectal dysfunction. Carol’s topic of study came about from her experience in clinical practice where she encountered many patients who described bowel symptoms such as increased frequency of defecation, urgency, loose bowel motions, incontinence and constipation after anterior resection surgery. Patients reported that these symptoms significantly affected their quality of life (QoL) and they were frustrated that surgeons didn’t appear to understand the long-term health effects once the surgery had been completed nor did they prepare the patient for this outcome.

What is an Anterior Resection?

An anterior resection (AR) is an operation most commonly performed for bowel cancer, to remove part or all of the rectum and part of the left side of the large bowel. It also includes the removal of the surrounding lymph nodes

to prevent the spread of cancer and its recurrence. After the segment of bowel is removed, along with its blood supply, the two ends of bowel are joined together (anastomosed) with stitches or stapling devices above the pelvic peritoneum. This enables the anal canal to be preserved and the bowel can be brought down to join the rectum or anus without compromising the bowels blood supply (https://www. colorectalsurgeonsnewcastle.com.au).

What is a Low Anterior Resection?

A low anterior resection (LAR) refers to the removal of the diseased portion of the rectum, the sigmoid colon, lymph nodes and fatty tissue with the anastomosis occurring below the pelvic peritoneum but higher than the anal canal (https:// www.ccalliance.org).

What is Low Anterior Resection Syndrome (LARS)?

The term low anterior resection syndrome (LARS) is often used to describe the symptoms and consequences of bowel dysfunction that patients experience after rectal cancer surgery. LARS is a highly prevalent outcome affecting up to 44% of patients and can be long-standing, often persisting up to 18-months after rectal surgery. It is consistently associated with poor quality of life, and ‘as access to rectal cancer treatment improves, it represents a growing burden of disease with significant patient- and healthcare burden’ (Benli et al 2021). However, despite the high prevalence of LARS, the NICE Guideline NG151 (2020) found that ‘patients report they are often not asked about their symptoms’ and their LARS is often not recognised. If not specifically asked, patients do not report their symptoms, assuming it is a normal consequence of their disease and treatment ’.

LARS is often exacerbated by factors such as low anastomotic height, defunctioning of the colon

and neorectum (surgically formed rectum) and radiotherapy (Varghese et al 2022). A recent international patient-provider initiative (cited Keane et al 2020) established a consensus-based definition for LARS as variable or unpredictable bowel function, altered stool consistency, increased stool frequency, repeated painful stools, emptying difficulties, urgency, incontinence, and soiling.

A diagnosis of LARS can be made when patients experience at least one of these symptoms which results in one of the following consequences: toilet dependence, preoccupation with bowel function, dissatisfaction with bowels, strategies and compromises, impact on; mental and emotional wellbeing, social and daily activities, relationships and intimacy, and/or roles, commitments and responsibilities. This standardised definition enables consistent reporting of LARS and more focused investigation into LARS pathophysiology (Keene et al 2020).

Measurement of LARS

A brief review of literature suggests accurately measuring LARS in a standardised manner is essential to better understanding the pathophysiology, as the use of a wide range of validated and unvalidated tools may contribute to the complexity of assessing this syndrome. The NICE Guideline NG151 (2020) suggest the best assessment tool is the LARS score, which is a self-administered questionnaire, is publicly available and is simple to administer and score. The scale is from 0 to 42 points with 0 to 20 points indicating that the patient does not have LARS, 21 to 29 points indicating minor LARS, and 30 to 42 points indicating major LARS. Use of this assessment tool was also supported by Sakr et al (2020) who found it was concise and had the ability to show the impact of a patient’s QoL. However, they believed it failed to accurately assess bowel function and recommended the use of the Memorial Sloan Kettering Bowel Function Instrument (MSK-BFI) as it had a broader scope, covering both the LARS symptoms and their consequences.

To meet the definition a patient must have had an anterior re-section (sphincter-preserving rectal resection) and suffer from at least one of these symptoms that results in at least one of these consequences.

Treatment of LARS

Current management of LARS is most commonly reactive, experimental and symptom based due to a limited evidence base. As a result, the NICE Guideline NG151 (2020) recommends a conservative approach, with the majority of patients requiring non-invasive intervention such as dietary manipulation (laxatives, bulking agents), pharmacological intervention (antidiarrhoeal medication or anti-spasmodic medication) or pelvic floor rehabilitation.

If these treatments are unsuccessful, the NICE Guideline NG151 suggests the patient is referred to secondary care where other options could be discussed such as sacral nerve stimulation and trans-anal irrigation such as peristeen plus.

At present, Carol’s physio team are undertaking a pelvic floor rehabilitation feasibility study. This is a 10week programme specifically designed to treat LARS that requires the patient to participate for only 1 hr per week. During this programme Carol and her team educate patients on what is normal bowel function and what is not, teach good bladder and bowel habits and toileting techniques, provide dietary advice and introduce the patient to pelvic floor muscle exercises supported by a home exercise programme. They also undertake bowel and pelvic floor training with a rectal catheter.

At Christchurch Hospital we are very fortunate to have a passionate and experienced motility team. In discussion with them, it became very clear they were highly knowledgeable and experienced with LARS and have seen significant improvements in a patient’s QoL, by following a similar approach to Carol’s pelvic floor rehabilitation study and the introduction of Peristeen Plus irrigation. They described a feeling of immense satisfaction with the work they do, when a patient says they’ve changed their lives!

Conclusions

In summary, I learnt that low anterior resection syndrome is a very complex patient outcome associated with rectal surgery that patients are often not aware of. Research suggests with more patient and surgical education available prior to and post procedure, with the ability to access LARS specific rehabilitation

programmes could significantly improve a patients quality of life and reduce costs associated with chronic health care. I would encourage you to ask your local colo-rectal surgeons and or colo-rectal clinical nurse specialist how often do they encounter LARS and how do they educate and manage their patients if they develop this complication post-surgery? Perhaps with more knowledge we can better inform our patients and prevent months of poor quality of life.

Thank you to the NZgNC for their financial support, so that I could attend this conference.

References:

• Benli, S. Colak, T. Ozqur, M. ‘Factors influencing anterior/low anterior resection syndrome after rectal or sigmoid resections’ Turkish Journal of Medical Science. 2021; 51(2): 623–630.

• Cancer Council New South Wales (2022): (www. cancercouncil.com.au/bowel-cancer/treatment/ surgery/surgery-for-cancer-in-the-rectum/ )

• Cancer Society New Zealand. ‘Improving bowel function after treatment’ https://www.cancer. org.nz/cancer/types-of-cancer/bowel-cancer/ treatment-of-bowel-cancer

• Colo-rectal Cancer Alliance, United States of America (https://www.ccalliance.org)

• Keane, C. Fearnhead N.S. Bordeianou L.G. Christensen, P. Basany, E. Laurberg, S.  Mellgren, A. Messick, C. Orangio, G.R. Verjee, A. Wing, K. Bissett, I.P. ‘International consensus definition of low anterior resection syndrome’ ANZ Journal of Surgery. Volume 90, Issue3 (March 2020): Pages 300307.

• https://www.colorectalsurgeonsnewcastle.com.au

• National Institute for Health and Care Excellence; Colorectal Cancer (update) ‘Optimal management of low anterior resection syndrome’ NICE Guideline NG151 (2020).

• Sakr, A. Sauri, F. Aless, M. Zakarnah, E. Alawfi, H. Torky, R. Kim, H.S. Yoon Yang, S. Kim N.K. ‘Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer’ Chinese Medical Journal, Vol.133 (2020) pg.1824-1833.

• Varghese, C. Wells, C.I. Bissett, I.P. O’Grady, G. Keane, C. ‘The role of colonic motility in low anterior resection syndrome’, Frontiers in Oncology, 16th September (2022) pg. 01-14.

TUBE Writing Guidelines for Authors

The Tube is the official journal of the NZgNC (New Zealand Gastroenterology Nurses’ College), and is published quarterly. We welcome articles that will be of interest to nurses working in Gastroenterology and related. Our aim is to publish a high quality, professional and educational journal for nurses working within the specialty of Gastroenterology.

All manuscripts received by the editor will be acknowledged, however, reports, area news or letters to the Editor will not. If you have not received confirmation of receipt within six weeks, please contact the Editor.

Suggestions for articles include:

• Recommendations for nursing practice based on current global trends/literature

• Overview of learning achieved through post graduate paper, or conference attendance

• Review of literary article relevant to best practice

• Case study relevant to specialty

• Education for nurses based on sub specialty topic

Editorial review/acceptance

Articles submitted to  The Tube are currently reviewed at a minimum by the editor and co-editor. The review will assess the accuracy of fact, clarity of presentation, use of references and relevance to practice of gastroenterology nursing. The editor/coeditor may also request a committee member review any article, particularly if the article is a sub-specialty of gastroenterology nursing and the committee member area of special interest/ work.

All articles which are being considered for publication may be reviewed and returned to the author with suggestions for revisions and improvement. The author will be provided with a deadline in which to provide the revised article in order to comply with publication schedule.

The Editor’s decision to publish or reject an article is final. You are welcome to email or phone the Editor to discuss your article should it not be accepted for publication.

Structure of Article for submission

The submission should include the following information:

Title Page

• Title of the Paper (20 word max)

• Author(s) name(s) in full

• Qualifications, current position, details of other relevant achievements, and affiliations of author(s)

• Address, contact telephone numbers, email address of the author(s)

• Conflict of interest and / or financial disclosure related to the article or related matter

Body of article

• Title at top of first page

• The body of work should be clearly written in an academic style of writing, and organised with headings/sub-headings (where appropriate)

• Pages numbered consecutively

• Tables, figures (if applicable) should be referred to in the body of the manuscript

• References (APA 6th Edition)

• Written authorisation(s) to publish identifiable person(s)/ institutions and copyright materials

• Word limit is approximately 1000 words. For the purposes of publication all articles should be formatted in Calibri, font size 10.

• All work should be saved as MS-Word (.docx) or text only (.txt) files.

All articles must be fully referenced where appropriate (APA 6th Ed)

Authors should keep an original copy of their article.

Submission

Articles should be submitted to the editor at editorofthetube@ gmail.com

If submission of your article is as a requirement of a NZgNC Education/Travel Grant, please ensure you submit within the required timeframe of your funding application.

Request Further Information

For advice or clarification on any of the above matters please contact the editorofthetube@gmail.com

College committee members’ reports:

The aim of such reports is to inform the national College membership of the business and activities of the College during the last quarter.

These reports should include such activities as:

• College meetings/teleconferences (date and venue)

• Decisions arising from these meetings/teleconferences (can be focused on the minutes of these meetings)

• Plans/development the College is involved in/hopes to develop

• Any external meetings committee members have attended relating to the business of the College, e.g. meetings with NZNO professional nursing adviser/professional services manager

• Any contributions to national NZNO business, e.g. contribution to any submissions/ national guideline development

• These should be a maximum of 600 words and contain people’s correct names and titles.

Case study/clinical practice article:

• Outline the nature of the treatment/procedure/product that forms the basis of the case study

• Provide information on the patient: age, sex, history, any other pertinent clinical/social/cultural aspects. Avoid using information which would clearly identify the patient.

• Tell readers what is new, interesting, different, pioneering, about this treatment/procedure/product

• Outline the actual treatment/procedure or how product works

• Report on the patient’s/client’s response/recovery/

• Tell readers what you have learnt through your involvement with this

Treatment /procedure/product

• Outline any implications/meaning it may have for gastroenterology nurses’ practice

• Provide references to support the article.

TO COMPLY WITH THE PRIVACY CODE: ALL INFORMATION REGARDING YOUR APPLICATION WILL BE CONFIDENTIAL TO THE NZNO GASTROENTEROLOGY NURSES’ COLLEGE NATIONAL COMMITTEE AND THE JUDGES.

GASTROENTEROLOGY UNITS IN NEW ZEALAND

ASHBURTON HOSPITAL

Operating Theatre Endoscopy Unit

Private Bag 801, Ashburton

Ph: 03 308 4149

BELVERDALE HOSPITAL

Endoscopy

5 Campbell Street, Wanganui

Ph: 06 348 1182

Donna Plumridge manager@belverdale.co.nz

BOWEN HOSPITAL

Gastroenterology Department

94 Churchill Downs, Wellington

Ph: 04 479 8261 endoscopy@bowen.co.nz

CHELSEA HOSPITAL

Endoscopy Unit

189 Cobden Street, Gisborne Ph: 06 867 2237

CLUTHA HOSPITAL

Endoscopy Unit

PO Box 46, Balclutha Ph: 03 418 0500

DUNSTAN HOSPITAL

Endoscopy Unit

Clyde, Otago Ph: 03 449 2878 merrilee.williams@southerndhb.govt.nz

GILLIES HOSPITAL

160 Gillies Ave, Epsom

Auckland 1023

Ph: 09 925 4000

OR Mgr: Carol Burnside

AUCKLAND HOSPITAL

Gastroenterology Department, Level 6

Private Bag 92024, Grafton, Auckland

Ph: 09 307 4949 ext: 125570

CNM: Christina Geraldino christinag@adhb.govt.nz

BIDWELL HOSPITAL

Endoscopy Unit: 53 Elizabeth Street, Timaru 7910

Ph: 03 687 1230

Operating Theatre: Bidwill Trust Hospital

Ph: 03 687 1230 ext 225 DD: 03 687 1245

Rachel Pilgrim: theatre@bidwilltrusthospital.co.nz

Carol Campbell: clinicalleader@bidwillhospital.co.nz

BRAEMAR HOSPITAL

Endoscopy Unit

PO Box 972, Hamilton

Ph: 07 839 2166

Sheree Smith: sherees@braemarhospital.co.nz

mereana.laurence@braemarhospital.co.nz

CHARITY HOSPITAL

Endoscopy

349 Harewood Road, Christchurch

Ph: 03 360 2266

Anita Tuck: anita@ccht.org.nz

CREST HOSPITALS

Endoscopy Unit

21 Carroll Street, Palmerston North 4410 PO Box 1622, Palmerston North 4440

Ph: 06 356 5180

OT Mgr: Susie Wright Ward Day Stay Mgr: Pete Baur

ENDOSCOPY AUCKLAND

Endoscopy Unit

148 Gillies Ave, Epsom, Auckland

Ph: 09 623 2020

Sue Valentine sue@endoscopyak.co.nz

GISBORNE/ TAIRAWHITI DHB

421 Ormond Road, Gisborne 4010

Endoscopy Clinical Nurse Co-ordinator

Sue Egan-Cunningham

Ph: 06 869 0500 ext. 8320

Sue Egan-Cunningham

Susanne.egan-cunningham@tdh.org.nz

Dawn Tucker: dawn.tucker@tdh.org.nz

GREENLANE MEDICAL SPECIALISTS

Ph: (09) 9306108, F: (09) 9306109

Building A, Ground Floor, 93 Ascot Ave, Greenlane, Auckland 1051

Ph: (09) 9306108, F: (09) 9306109

Micah Rivera: micah@glms.co.nz

HUTT HOSPITAL

Endoscopy Unit

Private Bag 31 907

Lower Hutt, Wellington

Ph: 04 566 6999

Marie.press@huttvalleydhb.org.nz

GREY HOSPITAL

Endoscopy PO Box 387, Greymouth 7840

Ph: 03 768 0499

Wendy Stuart: w.stuart@westcoastdhb.health.nz deepti.mathew@wcdhb.health.nz (CNS)

INTUS DIGESTIVE AND COLORECTAL CARE

Milford Chambers

St Georges Medical Centre

249 Papanui Road, Christchurch

Ph: 03 977 5977

ginette.campbell@intus.co.nz

AUCKLAND SURGICAL CENTRE

9 St Marks Road,Remuera

Auckland 1050

Theatre Mgr: Tracy McConnochie

BOULCOTT HOSPITAL

Boulcott Endoscopy

PO Box 31459, Lower Hutt, Wellington

Ph: 04 569 7555 ext: 612 khall@boulcotthospital.co.nz

BRIGHTSIDE

3 Brightside Road, Epsom, Auckland 1023

Ph: 09 925 4200

Theatre Mgr: John Drinkwater

CHRISTCHURCH HOSPITAL

Gastroenterology Department

PO Box 4710, Christchurch Ph: 03 364 0925 Gendy.bradford@cdhb.govt.nz

DUNEDIN HOSPITAL

Gastroenterology Department

Dunedin Hospital

Southern District Health Board

Internal Extn: 59326, DDI: 03 470 9326

FORTE HEALTH

Christchurch

Merrilee.Williams@southerndhb.govt.nz (CNM) Genevieve.Cowley@southerndhb.govt.nz (ACNM)

Sarah Watkins: sarah.watkins@fortehealth.co.nz

GRACE HOSPITAL

Endoscopy Room

281 Cheyne Road, Tauranga 3112 PO Box 2320, Tauranga 3140 sarahha@gracehospital.co.nz endoscopy@gracehospital.co.nz

HAWKE’S BAY REG. HOSPITAL

Operating Theatre

Endoscopy Unit, Private Bag, Hastings

Ph: 06 878 8109

Kerrin Bennett: Kerrin.bennett@hbdhb.govt.nz

INTUS LAKES MEDICAL SPECIALISTS

10a Helwick Street Wānaka 9305

Ph: 03 977 5977

Ginette (NM)

GASTROENTEROLOGY UNITS IN NEW ZEALAND

INTUS QUEENSTOWN MEDICAL CENTRE

9 Isle Street Queenstown 9300

Ph: 03 977 5977

Kate.lawrence@intus.co.nz (TL)

KENSINGTON HOSPITAL

Endoscopy Unit

12 Kensington Ave, Whangarei

Ph: 09 437 9080

tshumaemelda@yahoo.com

emaldat@kensingtonhospital.co.nz

MANAKAU HEALTH PARK SUPERCLINIC

Joanne.pawley@middlemore.co.nz

MERCY ASCOT HOSPITAL

Mercy Endoscopy North Shore

46 Taharoto Road, Takapuna, Auckland

Ph: 09 486 4346

Raewyn.paviour@mercyascot.co.nz

ROTORUA HOSPITAL

Operating Theatre Endoscopy Unit

Private Bag 3023, Rotorua

Ph: 07 349 9860 Chrissy.rees@lakesdhb.govt.nz

NELSON HOSPITAL

Endoscopy Unit

Medical Outpatient Department

PO Box 18, Nelson

Ph: 03 546 1833 gillian.clarke@nmdhb.govt.nz endoscopytriagenurse@nmdhb.govt.nz (CNS)

ORMISTON HOSPITAL

125 Ormiston Road, Flat Bush, Howick Manakau City 2016

PO Box 38921, Manakau City, Auckland 2145

Ph: 09 250 1157 ext: 5818 suzannec@ormistonhospital.co.nz

THE RUTHERFORD CLINIC

Level 1, 2 Connolly Street, Lower Hutt 04 903 2900

Kate.broome@rutherfordclinic.co.nz

SOUTHERN CROSS HOSPITALS

Operating Theatre

108 Deveron Street

Invercargill

Ph: 03 214 4269

Hilda.Toole@southerncrosshospitals.co.nz

KAITAIA HOSPITAL

Operating Theatre Endoscopy Unit

Redan Road, Kaitaia

Ph: 09 408 0010

suzie.walker@northlanddhb.org.nz

KEW HOSPITAL

Endoscopy Unit

Invercargill

Ph: 03 218 1949

Mel.kurman@southerndhb.govt.nz

MANUKA STREET HOSPITAL

Operating Theatre Endoscopy Unit

36 Manuka Street, Nelson 7010

Ph: 03 548 8566

Karen.tijsen@manukastreet.org.nz

MERCY ASCOT HOSPITAL ENDOSCOPY

100 Mountain Road, Epsom

PO Box 9911, Newmarket, Auckland

Ph: 09 623 5725

Jennifer Hussong

Jennifer.hussong@mercyascot.co.nz

ROYSTON HOSPITAL

Endoscopy Unit

325 Prospect Road, Hastings

Ph: 06 873 1111

Anna.Harland@royston.co.nz (TL)

NORTH HARBOUR CAMPUS

232 Wairau Road, Glenfield, North Shore 0745

Ph: 09 925 4400

Theatre Mgr: Avril Astrop

KENEPURU HOSPITAL

Outpatients Department Endoscopy Unit

PO Box 50215, Porirua, Wellington

Ph: 04 237 0179

jane.bilik@ccdhb.org.nz (CNM)

LAKES DISTRICT HOSPITAL

Endoscopy Unit

20 Douglas Street, Frankton, Queenstown

Ph: 03 441 0015

Lindsay.jackson@sdhb.govt.nz

MERCY HOSPITAL

Manaaki by Mercy

72 Newington Ave, Maori Hill, Dunedin

Ph: 03 464 0107

Paula.sharp@mercyhospital.org.nz rowena.simons@mercyhospital.org.nz (CNS)

MIDDLEMORE HOSPITAL

Gastroenterology Department

Private Bag 93311, Otahuhu, Auckland

Ph: 09 276 0039 harun.riza@middlemore.co.nz

linda.jamieson@middlemore.co.nz

SHORE SURGERY

181 Shakespeare Road, Milford, Auckland 0602

Ph: 09 486 0113

General Manager – Ginny Ford office@shoresurgery.co.nz

NORTH SHORE HOSPITAL

Gastroenterology Department

Private Bag 93503, Takapuna, Auckland

Ph: 09 486 8920 ext: 43648

Kate.Grigg@waitematadhb.govt.nz

PALMERSTON NORTH HOSPITAL (Mid Central Health)

Gastroenterology Department

PO Box 2056, Palmerston North

Ph: 06 350 8665

Ben Duff – Charge Nurse Midcentral Health gastro@midcentral.co.nz

Michelle.Harman@midcentraldhb.govt.nz (CNS)

RUTHERFORD HEALTHCARE

132 Collingwood Street, Nelson 7010 03 548 8156

Andrew@rutherfordhealthcare.co.nz Lynda@rutherfordhealthcare.co.nz

SOUTHERN CROSS HOSPITALS

Operating Theatre

21 Von Tempsky Street, Hamilton 3216

Ph: 07 838 1059

Evelyn.McMorran@southerncrosshospitals.co.nz (TL)

RODNEY SURGICAL CENTRE

Ph: 09 425 1190

Shelley Scott – Gen. Mgr gm@rodneysurgicalcentre.co.nz

SOUTHERN CROSS HOSPITALS

Operating Theatre

131 Bealey Ave, Christchurch

Ph: 03 379 4433

Wasana.burgess@southerncrosshospitals.co.nz

SOUTHERN CROSS HOSPITALS

Operating Theatre

58 Otonga Road, Rotorua 3015

Ph: 07 348 8156

Chris.Mott@southerncrossqe.co.nz

GASTROENTEROLOGY UNITS IN NEW ZEALAND

SOUTHERN CROSS HOSPITALS

Specialist Centre

90 Hanson Street, Newtown, Wellington 6021

Ph: 04 910 2160

Ropeti.Taito@schl.co.nz

St GEORGES HOSPITAL

St Georges Day Surgery, Endoscopy

249 Papanui Road, Christchurch

Ph: 03 355 6563

Sheryll.Williamson@stgeorges.org.nz

TAURANGA HOSPITAL

Endoscopy

Private Bag 12024, Tauranga

Ph: 07 579 8603

David OConnor: david.oconnor@bopdhb.govt.nz

THE MACMURRAY CENTRE

5 MacMurray Road, Remuera, Auckland 1050

Ph: 09 550 1080 Irit Bialik (NM) iritb@macmurray.co.nz

WAIKATO HOSPITAL Gastroenterology Unit

PO Box 934, Hamilton Ph: 021 549 675 sarah.cook@waikatodhb.health.nz

SOUTHERN ENDOSCOPY CENTRE

Level 1, 21 Caledonian Road, St Albans, Christchurch 8014

Ph: 03 968 9800 Kathy.davenport@southernendoscopy.co.nz

TARANAKI BASE HOSPITAL

Endoscopy Unit

Private Bag 2016, New Plymouth 7861

Ph: 06 753 7777

TE KUITI HOSPITAL

Day Surgery Endoscopy Unit

Alisa Street, Te Kuiti

Ph: 07 878 7333

TIMARU HOSPITAL Endoscopy

Private Bag 911, Timaru Ph: 03 684 4000 endoscopy@scdhb.health.nz

WAIRARAPA HOSPITAL Operating Theatre Endoscopy Unit

PO Box 96, Masterton Ph. 06 9469800 Janette.sigvertsen@wairarapa.dhb.org

STARSHIP HOSPITAL

Operating Theatre Endoscopy Unit

Private Bag 92 024, Grafton, Auckland

Ph: 09 839 0000

TAUPO HOSPITAL

Endoscopy Unit, Lakes DHB

PO Box 841, Taupo

Ph: 07 376 1000

THAMES HOSPITAL ENDOSCOPY UNIT

Day Stay Unit L3, PO Box 707, Thames 3540

Ph: 07 868 6550 Chrissy.rees@lakesdhb.govt.nz

TOKOROA HOSPITAL Endoscopy Unit

Maraetai Road, Tokoroa Ph: 07 886 7239

WAIRAU HOSPITAL Endoscopy Suite

PO Box 46, Blenheim

Ph: 03 578 4099 ext: 8836/8724 Pravidha.david@nmdhb.govt.nz

Bronwyn Lane Bronwyn.Lane@nmdhb.govt.nz

WAITAKERE HOSPITAL Day Surgery Unit Endoscopy Unit

Lincoln Road, Henderson, Auckland

Ph: 09 489 2384 Kate.Grigg@waitematadhb.govt.nz

WANGANUI HOSPITAL Outpatients Department Endoscopy Unit

Private Bag 3003, Wanganui

Ph: 06 348 1235

Dianne Carson endoscopy@wdhb.org.nz

Misty Campbell misty.campbell@wdhb.org.nz

WHANGAREI HOSPITAL Operating Theatre

Maunu Road, Whangarei

Ph: 09 430 4101 ext: 8772

Diandra.Brass@northlanddhb.org.nz (CNM)

WAITEMATA ENDOSCOPY

232 Wairau Road, Glenfield, Auckland 0627

Ph: 09 925 4449 Sihaam Bagus Sihaam@waitemataendoscopy.co.nz

WELLINGTON HOSPITAL

Endoscopy Unit

Private Bag 7902, Newtown, Wellington

Ph: 04 385 5999

Jane.Bilik@ccdhb.org.nz (NM)

WAKEFIELD HOSPITAL Gastroenterology Department

Private Bag 7909, Newtown, Wellington

Ph: 04 381 8110 ext: 5914

Mariev@wakefield.co.nz

WHAKATANE HOSPITAL Operating Theatre Endoscopy PO Box 241, Whakatane

Ph: 07 307 8999

Irene Whitehead: Irene.whitehead@bopdhb.govt.nz

Mary Honan: Mary.Honan@bopdhb.govt.nz

ADVERTISING RATE CARD

THE TUBE is the official journal of the NZNO Gastroenterology Nurses’ College and is published quarterly. It features articles on all aspects of gastroenterological nursing including research, education, new products, new medications and therapies, case studies, infection control in endoscopy and clinical reviews.

NZGNC is the national voice for gastroenterology and endoscopy nursing practice in New Zealand. The membership includes nurses from the specialised areas of endoscopy, Hepatology, Surgery, Inflammatory Bowel Disease, Gastronomy tubes / devices, Primary and Community Health and reprocessing technicians.

NZGNC has a close association with GENCA (Gastroenterological Nurses College of Australia) where ideas, practice and research are shared.

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DEADLINES 2022

Enquiries to: Karen Clarke, Mobile: 021 409 737

Email: editorofthetube@gmail.com

ADVERTISERS

Nurses subscribe to our journal from almost every Endoscopy/ Gastroenterology department in New Zealand.

From feedback we’ve received, we believe it is widely read by Medical, Nursing, Endoscopy assistants and Administrative staff working in these departments.

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