SUHT Wessex Website 2008

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					SpR Gastroenterology                                                            Wessex Rotation

                 Wessex Specialist Gastroenterology Rotation

                 Southampton University Hospitals NHS Trust
Southampton General Hospital is a large regional teaching hospital with 1100 beds that
provides services to a local population of 500,000 people. Gastrointestinal disease is
identified as a key area in the Southampton University Hospitals Trusts’ 2020 Vision strategy
document which sets the framework for the development of the SGH site as a regional centre
of clinical excellence, teaching and research. The medical GI service is divided into specialist
gastroenterology and hepatology groups which work closely with the departments of surgery,
radiology and pathology to deliver a secondary/tertiary referral service
The gastroenterology and hepatology teams will move to a dedicated GI ward with a 4-
bedded bleeding bay adjacent to the endoscopy unit at the beginning of 2009. Outpatient
clinics are held in a newly developed GI outpatient centre with 16 rooms. A new endoscopy
unit with 3 treatment rooms was opened in 2007. There is a large acute medical unit (AMU)
next to the emergency and radiology departments which is supervised by four acute medical
The Southampton General Hospital has all the on-site facilities of a regional teaching hospital
including specialist radiology, TIPSS, nutrition team, GI physiology and a department of
nuclear medicine. We are a regional pancreatic cancer centre and bowel cancer screening
centre. We have ambitions to provide regional services for intestinal failure and
gastrointestinal motility.
The Southampton General Hospital a major teaching and research centre working in
association with the University of Southampton and other partners including the Medical
Research Council and Wellcome Trust.

GI Trainees in Southampton
Four registrar trainees (usually years 3-5) are allocated to the Southampton General
Hospital. Two of these are attached to the department of gastroenterology for 12 months
while the other two alternate 6 months of hepatology and gastroenterology. The liver team
offer a sub-specialist post for senior trainees wishing to specialise in hepatology. There is a
clinical research fellow post attached to the Institute of Human Nutrition. We would
encourage flexible trainees to consider working with us.

The Department of Gastroenterology
There are currently five full-time and one part-time consultant gastroenterologists each with a
specialist area of interest:
 Dr David Fine (pancreatic disease, IBD)
 Dr Praful Patel (interventional endoscopy)
 Dr Mike Stroud (nutrition, IBD)
 Dr Bernard Stacey (gastro-oesophageal cancer, EUS)
 Dr Nicholas Coleman (functional and motility disorders)
 Dr Fanny Shek (pancreatico-biliary disease)

General description of the posts
There are two gastroenterology firms each led by a consultant with a registrar and two junior
doctors. Two of the three registrars will work on the wards at any one time while the third
registrar provides ward cover when they are absent. These positions will rotate on a two
monthly basis. The two gastroenterology teams alternate a daily pick-up system in which all
new GI patients admitted to the acute medical unit are seen on a post-take round within 24
hours of admission. The pick-up team will also see inpatient referrals within 24 hours. The
other GI team will see any elective admissions.

1106/WI_JOBS_GASTRO_JD                                                                        1
SpR Gastroenterology                                                            Wessex Rotation

Outpatient clinics
Outpatient clinics cover the full range of general luminal gastroenterology with additional
specialist experience in inflammatory bowel disease, GI rheumatology, nutrition,
functional/motility disorders, hepato-biliary/pancreatic disease, cystic fibrosis and HIV
medicine. These clinics provide an excellent case-mix and include many tertiary referrals.
Specialist nurses and dieticians run IBD, dyspepsia and coeliac clinics alongside the
consultant clinics. Patients with stable inflammatory bowel disease are followed up in a novel
virtual clinic. A one-stop flexible sigmoidoscopy service is available alongside many of the
clinics. There are additional clinics at Romsey and Lymington Hospitals although these are
not usually attended by the GI Trainees.

Registrar Timetables
The timetables are flexible and will be developed according to the individual trainees needs.
In keeping with recommendations by the BSG each timetable will include the following
minimum commitments per week:
     1 consultant ward round
     1 registrar ward round
     2 outpatient clinics (gastroenterology and/or liver)
     2 endoscopy lists
     1 day covering emergency GI bleeds (9–5 pm only)
     1 multi-disciplinary team meeting
     1 departmental meeting
     1 study afternoon

Modular Training
There will be an opportunity to undertake specific multi-disciplinary training in the specialist
modules listed below. Each module requires ongoing supervision and assessment and will
take a minimum of 1 session per week for 6-12 months. Further details of the individual
modules are available from Dr Nicholas Coleman (contact details below)
     inflammatory bowel disease
     nutrition
     cancer
     advanced endoscopy
     gastrointestinal motility
     hepato-biliary and pancreatic disease.

There is a joint gastroenterology/hepatology departmental meeting every wednesday
afternoon which starts with a case-based discussion about interesting or difficult inpatients.
This is followed either by a twice monthly GI histopathology meeting or audit, morbidity &
mortality, journal club or case presentations. The registrars will have responsibility for
organising and leading these meetings. There are weekly MDT meetings for colorectal,
hepato-biliary/pancreatic and upper gastrointestinal cancer. An inflammatory bowel disease
MDT will commence in 2009.

Visiting the Gastroenterology Department
Trainees requiring further information or wishing to visit the unit can contact Dr Nicholas
Coleman via telephone (023 8079 6761) or e-mail (

The Department of Hepatology
There are currently three full-time Consultant Hepatologists
 Dr Nick Sheron (alcoholic liver disease)
 Dr Mark Wright (viral hepatitis)

1106/WI_JOBS_GASTRO_JD                                                                        2
SpR Gastroenterology                                                            Wessex Rotation

   Dr Kathryn Nash (liver transplantation)

General description of the post
There is one hepatology firm comprising a consultant, two registrars (one of these being the
subspeciality hepatology post) and one or two junior doctors. The consultants take it in turns
to be responsible for inpatient work rotating on approximately a monthly basis. The team is
responsible for all hepatology inpatients and sees inpatient referrals within 24 hours. In
addition there is a large volume of elective work that the team is responsible for including
patients undergoing paracentesis, liver biopsy, ERCP, interventional radiology and treatment
for hepatocellular carcinoma.

Outpatient clinics
Outpatient clinics cover the full range of general hepatology with additional specialist
experience in viral hepatitis, liver transplantation and hepatobiliary malignancy. These clinics
provide an excellent case-mix and include many tertiary referrals. Specialist nurses run viral
hepatitis and haemochromatosis clinics alongside the consultant clinics. There are a number
of specialist clinics which trainees are encouraged to attend including liver transplantation
and management of portal hypertension.

Hepatology Registar timetables
The timetables are flexible and will be developed according to the individual trainees needs.
In keeping with recommendations by the BSG each timetable will include the following
minimum commitments per week:
     2 consultant ward rounds
     1 registrar ward round
     2 outpatient clinics (hepatology)
     1-2 endoscopy lists
     1 day covering emergency GI bleeds (9–5 pm only)
     1 multi-disciplinary team meeting
     1 departmental meeting
     1 study afternoon

There is a hepatobiliary MDT every wednesday morning. This focuses on hepatobiliary
malignancy but includes radiological review of complex benign disease. There is a weekly
histology meeting on a tuesday afternoon followed by a hepatology educational meeting
including case presentations, journal reviews and mortality meetings. The liver team attend a
joint departmental meeting with the gastroenterologists every wednesday afternoon.

Opportunities for clinically based research exist within the department. Interested registrars
should make early contact with one of the consultants to discuss possible projects.

Visiting the Department of Hepatology
Trainees requiring further information or wishing to visit the unit can contact Dr Kathryn Nash
via telephone (023 8079 4129) or e-mail (

The Endoscopy Unit
Endoscopic training requirements will be assessed during induction and will include a
minimum of 2 lists per week for the gastroenterology trainees. There is a once weekly
therapeutic upper GI training list for trainees wishing to gain experience in advanced
endoscopic techniques including; stricture dilatation, stent insertion, endoscopic mucosal
resection, APC and botox injection. The liver team undertake a once weekly variceal banding

1106/WI_JOBS_GASTRO_JD                                                                        3
SpR Gastroenterology                                                             Wessex Rotation

Colonoscopy training is undertaken on dedicated training lists with consultant supervision
and scope trackers are used whenever possible. Therapeutic training will include hot biopsy,
snare polypectomy and endoscopic mucosal resection for advanced trainees. Training in
capsule endoscopy is also available.
Currently three ERCP lists per week are performed by the gastroenterologists and
hepatologists in the department of radiology although there are plans to provide an additional
list for patients requiring general anaesthesia.

Endoscopy on-call
Each of the five registrar trainees (including the nutrition research registrar) will provide in-
hours cover for emergency inpatient GI bleeds on a fixed day of the week that coincides with
their routine endoscopy list. Trainee bleeding lists are performed at lunchtime (1230-1330
hours) and at the end of the day (1630-1730 hours) with consultant supervision. The majority
of procedures are performed on the endoscopy unit although the registrars will also be
expected to go theatre or intensive care with the portable equipment if required. The full
range of haemostatic equipment including gold-probe, APC, endoclip and variceal bands are
used. Out-of-hours and weekend cover for emergency endoscopy is provided by the
consultants who perform an emergency bleeding list in the morning (0800-0900 hours).

The Motility Unit
Motility studies are performed by an experienced nurse physiologist and overseen by
consultants with special interests in upper and lower GI motility. The upper GI motility service
supervised by the gastroenterologists (Nicholas Coleman) provides conventional
oesophageal manometry and pH studies and impedance/pH has recently been acquired.
There are close links with the upper GI surgeons and a specialist clinic dealing with the
respiratory complications of GORD is run jointly with the respiratory physicians on monthly
basis. The department of nuclear medicine provide oesophageal/gastric scintigraphy and
glycocholate breath testing.
The lower GI motility service is supervised by the colorectal surgeons (Karen Nugent) and
provides ano-rectal physiology, biofeedback and 3D ultrasound. SHAPE transit studies and
both conventional and MR proctography are performed by the department of radiology. We
are one of the few hospitals in the country to hold a regular pelvic floor MDT.

General medicine at SGH
Both the GI and liver registrars will take part in a busy general medical on-call rota and will
provide cover for medical inpatients and the medical HDU. Both teams manage specialty
patients only on the wards with no continuing responsibility for general medical inpatients.

Professional development
Attendance at Wessex regional training days in gastroenterology and general medicine is
compulsory. All trainees have a protected study half-day built into their timetables. The
Wessex Institute based in the Postgraduate Centre runs a number of courses relevant to
registrar training including management and teaching. Trainees will be encouraged to attend
the BSG and other national and international meetings.

In 2000 the Southampton Medical School expanded its intake to 200 students per year. Third
and fifth year medical students are attached to the gastroenterology and liver firms
throughout the academic year. The registrars are expected to participate in bedside teaching
sessions for at least one hour per week with additional teaching on ward rounds and in the
outpatient clinics. Registrars will also be asked to give seminar and lecture-based teaching
on the 3rd year gastroenterology/liver student selected units, GI nurse training days and
Wessex SpR training days.

1106/WI_JOBS_GASTRO_JD                                                                         4
SpR Gastroenterology                                                              Wessex Rotation

The Southampton General Hospital is an active research centre that has close links with the
University of Southampton, in particular with the divisions of infection, inflammation & repair
and cancer sciences. We also work in partnership with the MRC and Wellcome Trust.
Southampton also hosts one of the Cancer Research UK clinical centres. We recently
became the only biomedical research unit in the UK dedicated to studying human nutrition
with a specific aim to conduct studies related to nutrition in gastrointestinal and liver disease.
We have an established track record of training Wessex registars in GI research with
currently 5 working towards an MD. Ongoing research interests include:
     Inflammation and the development and resolution of fibrosis in the pancreas and liver
      with a particular emphasis on the role of pancreatic myofibroblastic stellate cells
     The role of matrix metalloproteinases and their inhibitors on inflammation, tissue re-
      modelling and fibrosis in diseases of the gut
     Aspects of inflammatory bowel disease particularly interactions between inflammation,
      nutritional status and bone health
     The role of chronic inflammation in the development of upper GI cancer
     Clinical endoscopy studies and GI epidemiology
     Liver fibrosis, in-vivo measurements of liver function; viral, alcoholic and non-alcoholic
     Surgical Research into liver metastasis and pancreatic cancer.

1106/WI_JOBS_GASTRO_JD                                                                          5