We can now offer patients procedures which, 20 yrs ago were unthinkable. Procedures which improves health, reduces morbidity and saves lives. But, these procedures are longer and more uncomfortable and therefore patients require deeper sedation than before. Unfortunately, at the same time, patients are older and with more comorbidities. This dual problem of frail patients requiring deeper sedation for longer procedures, has narrowed our ‘sedation window’.

The old way of monitoring patients, with a nurse and an oxygen saturation monitor, is no longer enough. It's for this reason that the Academy of Medical Royal Colleges in February 2021, updated their guidelines on Safe Sedation practises. Now they recommend that patients requiring 'moderate sedation' should be monitored more closely, not only by a dedicated nurse and oxygen saturation monitor but also with ECG, BP and Capnography.

Of course, this is a huge change for endoscopy units. Our staff are now asked to do three things at the same time; maintain the airway, listen to the pitch of the oxygen saturation monitor and interpret that ECG and Capnography traces.

Dr Martin Lees , Clinical Director of Cardiac Anaesthesia and Perioperative Medicine at St Barts Heart Centre in London and Nurse Specialist Andreia Trigo with SedateUK, discuss the new guidelines and the implications it has for endoscopy units around the World.

COVID never posed an existential threat but nevertheless had a devastating impact, including on our Endoscopy services. Now we do have an existential threat which Endoscopy is actively driving us towards. Endoscopy is the third greatest hospital contributor to Global Warming !!!

You may be tempted to 'cop out', deciding that you can do nothing, but you would be wrong. There are 3 things which you can do; Reduce Reuse and Recycle. Listen to the suggestions, read the NHS Net Zero document and join By Hayee at Kings College as a 'Green Endoscopists'. By the way, we have had statements from all the main Endoscopy organisations on COVID but apart from BSG and the World Gastroenterology Organisation, very little on 'future sustainability'. Isn't it about time that we all 'Look UP'?

Topics included artificial intelligence, an overview of bariatric endoscopy, the less than straightforward management of early rectal cancer, how safe is spiral enteroscopy?, should we place a duodenal or a hot Axios stent in gastric outlet obstruction and why would you take papillary biopsies in FAP? What would you say to a patient, with a germline E-cadherin mutation, who decline a prophylactic gastrectomy?

As usual, the most interesting findings are hidden in the details. For example, did you know that the introduction of colonic cancer screening doesn't appear to have had any impact on mortality rates ...