Diagnosis and treatment

Endoscopy procedures

Endoscopic procedures are performed at both the University Hospital of North Tees and University Hospital of Hartlepool within dedicated purpose-built units.

There are five rooms at North Tees and three rooms at Hartlepool. The trust is an accredited bowel cancer screening unit and fully JAG accredited.

Within the unit, a full range of endoscopic procedures and therapies are performed including:

• Variceal Band ligation

• Endoscopic retrograde cholangiopancreatography (ERCP)

• Endoscopic ultrasound (EUS)

There is a fully consultant-staffed 24/7 Emergency endoscopy rota and any out of hours endoscopy is done in our theatres.

Fibroscan

Fibroscan clinics occur at both hospital sites and in the Tees Valley Community Diagnostic Centre.

Fibroscan is a type of ultrasound scan which measures the amount of scar tissue (fibrosis) and fat in your liver which helps us to assess your liver and plan treatment. It is a painless test and is non-invasive, which means that it does not break the skin or enter your body.

Day case paracentesis (drainage of ascites)

If you have a build-up of fluid (ascites) in your abdomen, you may need drainage of the fluid using a procedure called paracentesis (or abdominal tap).

Our liver nurse specialists perform the paracentesis procedure on the medical day unit at North Tees as a day procedure. This avoids the need for you to stay in hospital overnight. Some patients may need admission for other reasons and so have a paracentesis procedure as an inpatient on the ward.

During a paracentesis, a small drainage tube is placed through the skin into the fluid. A local anaesthetic will be injected under the skin to numb the area before the drain is inserted. The drain remains for up to six hours.

Some patients with recurrent ascites and who need frequent paracentesis may be offered a more permanent drain, called an indwelling peritoneal catheter.

Liver biopsy

In order to diagnose some liver diseases a liver biopsy may be required, especially if your blood tests, fibroscan or imaging of your liver is inconclusive.

A liver biopsy is a procedure that removes a small sample of liver tissue for microscopic examination to diagnose, stage or treat liver diseases.  When you are seen in clinic or on the ward you will be told if you need a liver biopsy. The risks and benefits will be discussed with you.

The procedure is usually performed using a needle through the skin (percutaneous) under ultrasound guidance in the ultrasound department.

Alcohol care

We work in partnership with the alcohol care team, led by Sister Hayley Tranter, to provide a variety of support for patients:

• Helping patients manage their withdrawal from alcohol

• Assessing patients for alcohol misuse and harmful or hazardous drinking behaviours

• Working closely with patients who are frequently admitted with alcohol-related harm

• Advice and support on alcohol detoxification

• Helping patients to access the Community alcohol support services

The alcohol care team also supervise an inpatient bed for patients undergoing an elective admission for detoxification from alcohol. Access to this bed is strictly via the Community alcohol services from certain areas.

Hepatocellular cancer surveillance

People with liver scarring (cirrhosis) are at a higher risk of developing HCC and if detected early (stage 1 or 2) it is more likely to respond to treatment.

In accordance with NICE guidance, we recommend that these patients with cirrhosis are enrolled into a screening programme for regular checks. 

All patients diagnosed with cirrhosis are invited to attend an ultrasound scan every six months to check for early signs of liver cancer.

Ultrasounds are performed at:

• University Hospital of North Tees
• University Hospital of Hartlepool
• One Life Centre (Hartlepool)
• Tees Valley Community Diagnostic Centre (Stockton)

Palliative care

Patients with very advanced liver disease may require extra support for the management of their symptoms and are usually referred to the palliative care team and placed on the palliative care register.

Dr Lucy Lowery, one of our palliative care physicians attends the monthly Liver multi-disciplinary team (MDT) meetings.