4. Mrs B complains the Trust failed to correctly diagnose her husband with a bowel mass between April 2019 and February 2021. Mrs B says this is because the Trust failed to arrange a colonoscopy.
5. Mrs B says Mr B experienced unnecessary pain and suffering in the last months of his life while living with symptoms of the bowel mass. Mrs B says this caused her distress.
6. Mrs B would like to see the Trust accept its failings and make service improvements to prevent this happening again.
7. Mr B had a history of oesophageal cancer that resulted in an Ivor Lewis oesophagectomy (surgery to remove part of the oesophagus) in February 2018.
8. He developed diarrhoea in May 2019 and had a colonoscopy. He was referred to gastroenterology (specialising in the digestive system) with a change in bowel habit and weight loss since the colonoscopy.
9. A gastroenterologist at the Trust saw Mr B in July 2019 and again in January 2020. He had a phone consultation with the gastroenterologist in November.
10. Mr B had a detailed 3D scan in March 2020. Unfortunately, that showed local recurrence of his oesophageal cancer. The oncology (cancer) team gave Mr B high dose palliative radiotherapy in May.
11. Mrs B reports that Mr B’s bowel symptoms got worse in November and December 2020, but the gastroenterology and oncology teams did not have any concerns.
12. On 12 January 2021, a hospice admitted Mr B. A CT scan was arranged for 14 January.
13. The CT scan showed evidence of disease progression with spread of his cancer to his lungs and pelvis. It was noted that he had bowel thickening, which was either a new cancer or had spread from his existing cancer.
14. The Trust had a meeting on 21 January. It felt there was no need for more tests or intervention and that Mr B should be treated with palliative care (end of life care).
15. Mr B sadly died in February 2021.
19. Mrs B says that between April 2019 and February 2021 the Trust did not refer Mr B for a colonoscopy which may have picked up a mass in his bowel.
20. GMC guidance says: ‘You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must: • adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient • promptly provide or arrange suitable advice, investigations or treatment where necessary’.
21. Our gastroenterology adviser noted that it is important to consider that colonoscopy is a major procedure. Bowel preparation is required and some significant risks are associated with it. It is important, in keeping with GMC guidance above, that investigations should take into account the patient’s history.
22. Our adviser explained that when investigating symptoms in someone with advanced cancer, the aim should be to avoid unnecessary procedures and maintain quality of life.
23. Mr B developed diarrhoea in May 2019 and had a colonoscopy with biopsies (when samples of tissue are taken to examine) that showed mild inflammation (swelling) in the terminal ileum (the end of the small bowel) and right colon.
24. Our gastroenterology adviser explained that this inflammation was not visible to the clinician looking directly at the bowel through a camera, but only seen under the microscope. In the medical records, the Trust’s gastroenterologist noted that cutting down on milk seemed to settle Mr B’s symptoms and they arranged a review for six months’ time.
25. In September 2019, Mr B saw his oncologist who noted symptoms of diarrhoea and weight loss. They arranged a gastroscopy (camera to look at the oesophagus and stomach).
26. When his oncologist saw him again in December 2019, they noted his diarrhoea had settled with a medication called salofalk (used to reduce inflammation in the bowels). The gastroenterologist documented the same comment on review in January 2020.
27. After discussion with our gastroenterology adviser, we have found the Trust acted in accordance with GMC guidance during this phase of Mr B’s care. It carried out assessments of his symptoms, provided treatment where appropriate and arranged investigations when necessary.
28. Our gastroenterology adviser explained that Mr B’s symptoms settled with medication. This evidence suggests Mr B may have had a mild form of inflammatory bowel disease. Because of this, we understand from speaking to our gastroenterology advise that, a colonoscopy was not needed.
29. In March 2020, Mr B had a detailed 3D scan and this sadly showed return of his oesophageal cancer.
30. The oncology team gave Mr B high dose palliative radiotherapy in May. He had an eight-day hospital admission during this period with diarrhoea. The medical records show that symptoms seemed to coincide with stopping the salofalk medication. He had a CT scan that showed no evidence of problems with his bowels.
31. Mr B completed his course of radiotherapy. The Trust discharged him when his symptoms improved. Our gastroenterology adviser again noted there would be no reason for a colonoscopy in these circumstances. Mr B’s symptoms returned when he stopped his medications and there was nothing of concern in his bowels on the CT scan.
32. In November 2020, the records show Mr B was opening his bowels once a day with no diarrhoea or bleeding. His symptoms seemed to be under control again with the salofalk medication.
33. Our oncology adviser told us NICE guidance on oesophago-gastric cancer is also relevant to Mr B’s care. This guidance does not say that colonoscopies should routinely be carried out as follow up.
34. Our oncology adviser confirmed that a colonoscopy was not needed at any point during Mr B’s follow up of his cancer.
35. After careful consideration of all the evidence, we do not think the Trust should have done a colonoscopy on Mr B. We have not found any failings in the care.
36. We hope Mrs B is reassured that the evidence shows the Trust acted in line with relevant standards. Based on the evidence, we do not uphold this complaint.
37. We are sorry to hear of the circumstances leading to Mrs B’s complaint and we understand it is still a difficult time for her.
38. In our consideration of her complaint, we also got information from our advisers that we want to share with Mrs B to give her more reassurance. This is not directly related to the decision on the case.
39. Our oncology adviser commented that had the Trust discovered Mr B’s bowel mass any earlier, his treatment would have still been to give the same supportive measures.
40. The CT scan in January 2021 stated there was wall thickening of the bowel which was either a new cancer or a spread from his existing cancer. Our gastroenterology adviser explained this meant the mass was sitting in the outer, deeper tissues of the bowel wall.
41. They explained that the inner bowel lining (which is what a colonoscopy looks at) is often normal in these situations. They explained the bowel mass may not have even been visible on a colonoscopy.
42. Both our oncology adviser and gastroenterology adviser commented there would have been nothing more the Trust could have done to relieve Mr B’s symptoms.
43. We thank Mrs B for bringing her complaint to us. We hope we have been able to fully explain how we have reached our final decision.
1. We are very sorry to hear about the circumstances of Mrs B’s complaint. She told us the suffering and death of her husband, Mr B, had a large impact on her. We are sorry for her loss.
2. We have carefully considered Mrs B’s complaint about Barking, Havering and Redbridge University Hospitals NHS Trust (the Trust). We found the Trust acted in line with relevant standards and we found no failings in its decision not to arrange a colonoscopy (a test to check inside your bowels for any problems).
3. We do not uphold Mrs B’s complaint. This report fully explains the reasons for our decision.