1
|
Fukuda A, Tominaga T, Matsumoto T, Nonaka T, Kosai K, Yanagihara K, Inoue T, Irie H, Miyoshi Y, Sugio T, Sakai T, Sakae E, Hamada M, Matsumoto K, Nagayasu T. Feasibility and efficacy of newly developed eco-friendly, automatic washer for endoscope using electrolyzed alkaline and acidic water. Asian J Endosc Surg 2024; 17:e13245. [PMID: 37724691 DOI: 10.1111/ases.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION As well as preventing nosocomial and healthcare-associated infections, a reliable and eco-friendly washer for medical equipment would also be safe for the global environment. The aim of this study was to evaluate the efficacy of a newly developed automatic washing system (Nano-washer) that uses electrolyzed water and ultrasonication without detergent for washing endoscopes. METHODS Patients who underwent laparoscopic lobectomy or laparoscopic colectomy at Nagasaki University between 2018 and 2022 were included. A total of 60 cases of endoscope use were collected and classified according to endoscope washing method into the Nano-washer group (using no detergent) (n = 40) and the manual washing group (n = 20). Protein and bacterial residues were measured before and after washing, using absorbance spectrometry and 16S rRNA polymerase chain reaction. The effectiveness of protein and bacterial removal and endoscope surface damage after washing were compared under specular vision between the groups. RESULTS Nano-washer did not use detergent unlike manual washing. There was no difference in demographic or clinical characteristics between the groups except for the presence of comorbidities in the lobectomy group (Nano-washer, 85%; manual washing, 40%, P = .031). Compared with the manual washing group, residual protein levels in the Nano-washer group were significantly reduced after washing (lobectomy, 0.956 mg/mL vs 0.016 mg/mL, P < .001; colectomy, 0.144 mg/mL vs 0.002 mg/mL, P = .008). Nano-washer group showed a significant reduction in bacteria between before and after lobectomy (9437 copies/cm2 vs 4612 copies/cm2 , P = .024). CONCLUSION Nano-washer is a promising, effective, and eco-friendly automatic washing device that is safer and more efficient than manual washing.
Collapse
Affiliation(s)
- Akiko Fukuda
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takamune Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kosuke Kosai
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takumi Inoue
- Department of Materials, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiromi Irie
- Department of Materials, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | | | | | | | | | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
2
|
Tumino E, Visaggi P, Bolognesi V, Ceccarelli L, Lambiase C, Coda S, Premchand P, Bellini M, de Bortoli N, Marciano E. Robotic Colonoscopy and Beyond: Insights into Modern Lower Gastrointestinal Endoscopy. Diagnostics (Basel) 2023; 13:2452. [PMID: 37510196 PMCID: PMC10378494 DOI: 10.3390/diagnostics13142452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Lower gastrointestinal endoscopy is considered the gold standard for the diagnosis and removal of colonic polyps. Delays in colonoscopy following a positive fecal immunochemical test increase the likelihood of advanced adenomas and colorectal cancer (CRC) occurrence. However, patients may refuse to undergo conventional colonoscopy (CC) due to fear of possible risks and pain or discomfort. In this regard, patients undergoing CC frequently require sedation to better tolerate the procedure, increasing the risk of deep sedation or other complications related to sedation. Accordingly, the use of CC as a first-line screening strategy for CRC is hampered by patients' reluctance due to its invasiveness and anxiety about possible discomfort. To overcome the limitations of CC and improve patients' compliance, several studies have investigated the use of robotic colonoscopy (RC) both in experimental models and in vivo. Self-propelling robotic colonoscopes have proven to be promising thanks to their peculiar dexterity and adaptability to the shape of the lower gastrointestinal tract, allowing a virtually painless examination of the colon. In some instances, when alternatives to CC and RC are required, barium enema (BE), computed tomographic colonography (CTC), and colon capsule endoscopy (CCE) may be options. However, BE and CTC are limited by the need for subsequent investigations whenever suspicious lesions are found. In this narrative review, we discussed the current clinical applications of RC, CTC, and CCE, as well as the advantages and disadvantages of different endoscopic procedures, with a particular focus on RC.
Collapse
Affiliation(s)
- Emanuele Tumino
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
| | - Pierfrancesco Visaggi
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Valeria Bolognesi
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
| | - Linda Ceccarelli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Christian Lambiase
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Sergio Coda
- Digestive Disease Centre, Division of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM70AG, UK
| | - Purushothaman Premchand
- Digestive Disease Centre, Division of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM70AG, UK
| | - Massimo Bellini
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Emanuele Marciano
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
| |
Collapse
|
3
|
Merchan MFS, de Moura DTH, de Oliveira GHP, Proença IM, do Monte Junior ES, Ide E, Moll C, Sánchez-Luna SA, Bernardo WM, de Moura EGH. Antibiotic prophylaxis to prevent complications in endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis of randomized controlled trials. World J Gastrointest Endosc 2022; 14:718-730. [PMID: 36438881 PMCID: PMC9693690 DOI: 10.4253/wjge.v14.i11.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/22/2022] [Accepted: 10/26/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography (ERCP) is still controversial.
AIM To assess whether antibiotic prophylaxis reduces the rates of complications in patients undergoing elective ERCP.
METHODS This systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A comprehensive search of multiple electronic databases was performed. Only randomized controlled trials were included. The outcomes analyzed included bacteremia, cholangitis, sepsis, pancreatitis, and mortality. The risk of bias was assessed by the Cochrane revised Risk-of-Bias tool for randomized controlled trials. The quality of evidence was assessed by the Grading of Recommendation Assessment, Development, and Evaluation. Meta-analysis was performed using the Review Manager 5.4 software.
RESULTS Ten randomized controlled trials with a total of 1757 patients that compared the use of antibiotic and non-antibiotic prophylaxis in patients undergoing elective ERCP were included. There was no significant difference between groups regarding incidence of cholangitis after ERCP [risk difference (RD) = -0.02, 95% confidence interval (CI): -0.05, 0.02, P = 0.32], cholangitis in patients with suspected biliary obstruction (RD = 0.02, 95%CI: -0.08 to 0.13, P = 0.66), cholangitis on intravenous antibiotic prophylaxis (RD = -0.02, 95%CI: -0.05 to 0.01, P = 0.25), septicemia (RD = -0.02, 95%CI: -0.06 to 0.01, P = 0.25), pancreatitis (RD = -0.02, 95%CI: -0.06 to 0.01, P = 0.19), and all-cause mortality (RD = 0.00, 95%CI: -0.01 to 0.01, P = 0.71]. However, the antibiotic prophylaxis group presented a 7% risk reduction in the incidence of bacteremia (RD= -0.07, 95%CI: -0.14 to -0.01, P = 0.03).
CONCLUSION The prophylactic use of antibiotics in patients undergoing elective ERCP reduces the risk of bacteremia but does not appear to have an impact on the rates of cholangitis, septicemia, pancreatitis, and mortality.
Collapse
Affiliation(s)
- Maria Fernanda Shinin Merchan
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | | | - Igor Mendonça Proença
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Epifanio Silvino do Monte Junior
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Edson Ide
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Caroline Moll
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Sergio A Sánchez-Luna
- Department of Internal Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35233, United States
| | - Wanderley Marques Bernardo
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | | |
Collapse
|
4
|
Jing W, Qinghua L, Zhiwen Y. Postpolypectomy fever in patients with serious infection: a report of two cases. BMC Gastroenterol 2022; 22:156. [PMID: 35350984 PMCID: PMC8966367 DOI: 10.1186/s12876-022-02218-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Postpolypectomy fever (PPF) is a rare complication in patients after colonoscopy. Because of the absence of evidence of microperforation and abdominal tenderness, patients with PPF usually present mild clinical symptoms with a good prognosis. Case presentation In this study, all patients who underwent colonoscopic examination in our hospital between January 2019 and December 2019 were enrolled. Of these, two patients developed PPF after polypectomy, exhibiting serious infection without definitive fever foci. One patient experienced rapidly aggravated type 1 respiratory failure and abnormal hepatic function, which were attributed to colonoscopy-associated infection. After active antibiotic therapy, both patients were discharged without any complications. Conclusions In summary, our study provides novel insights into patients with PPF who develop serious infections with life-threatening complications.
Collapse
Affiliation(s)
- Wang Jing
- Department of Gastroenterology, Songjiang District Central Hospital, Shanghai, China
| | - Li Qinghua
- Department of Gastroenterology, Songjiang District Central Hospital, Shanghai, China
| | - Yang Zhiwen
- Department of Pharmacy, Songjiang District Central Hospital, Shanghai, 201600, China.
| |
Collapse
|
5
|
Kwakman JA, Erler NS, Vos MC, Bruno MJ. Risk evaluation of duodenoscope-associated infections in the Netherlands calls for a heightened awareness of device-related infections: a systematic review. Endoscopy 2022; 54:148-155. [PMID: 33915575 DOI: 10.1055/a-1467-6294] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The risk of exogenous infections from endoscopic procedures is often cited as almost negligible (1 infection in 1.8 million procedures); however, this risk is based on older literature and does not seem to match the number of infectious outbreaks due to contaminated duodenoscopes reported after endoscopic retrograde cholangiopancreatography (ERCP). Using Dutch data, we aimed to estimate the minimum risk of duodenoscope-associated infection (DAI) and colonization (DAC) in patients undergoing ERCP. METHODS A systematic literature search identified all DAI outbreaks in the Netherlands reported between 2008 and 2019. Included cases were confirmed by molecular matching of patient and duodenoscope cultures. Risk ratios were calculated based on the total number of ERCPs performed during the study period. RESULTS Three outbreaks were reported and published between 2008 and 2018, including 21 confirmed DAI cases and 52 confirmed DAC cases. The estimated number of ERCPs performed during the same period was 181 209-227 006. The calculated minimum estimated DAI risk was approximately 0.01 % and the minimum estimated DAC risk was 0.023 %-0.029 %. CONCLUSIONS The estimated risk of DAI in Dutch ERCP practice was at least 180 times higher than previously published risk estimates. The actual risk is likely to be (much) higher due to underreporting of infections caused by multidrug-resistant organisms and sensitive bacteria. Greater awareness by healthcare personnel involved in endoscopy and endoscope cleaning is required, as well as innovative technical solutions to contain and ultimately eliminate DAIs.
Collapse
Affiliation(s)
- Judith A Kwakman
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Microbiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Margreet C Vos
- Department of Microbiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
6
|
Microbiological Surveillance of Endoscopes in a Southern Italian Transplantation Hospital: A Retrospective Study from 2016 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063057. [PMID: 33809670 PMCID: PMC8002344 DOI: 10.3390/ijerph18063057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/13/2021] [Indexed: 11/24/2022]
Abstract
Endoscopes are medical instruments that are used routinely in health structures. Due to their invasive nature and contact with many patients, they may cause hospital-acquired infections if not disinfected correctly. To ensure a high-level disinfection procedure or reprocessing, since the methods currently adopted in our institute are adequate, we evaluated retrospectively the presence of microorganisms in our endoscopes after reprocessing. Microbiological surveillance was performed from January 2016 to December 2019 in the instruments in use in our endoscopic room after reprocessing. In total, 35 endoscopes (3 duodenoscopes, 3 echoendoscopes, 12 bronchoscopes, 5 colonoscopes, and 12 gastroscopes) were evaluated for the presence of microorganisms, including multidrug-resistant pathogens and indicator microorganisms (IMOs). Our procedures were in agreement with an internal protocol based on Italian, international, and the Center for Disease Control and Prevention (CDC) recommendations. Of a total of 811 samples, 799 (98.5%) complied with the regulatory guidelines, while 9 (1.1%) were positive for IMOs, and 3 (0.4%) displayed more than 10 colony-forming units (CFU) of environmental and commensal pathogens. Our results show that the internal reprocessing protocol is very efficient, leading to a very low number of observed contaminations, and it could be easily implemented by other health facilities that face a huge number of hospital-acquired infections due to incorrectly disinfected endoscopes.
Collapse
|
7
|
Omidbakhsh N, Manohar S, Vu R, Nowruzi K. Flexible gastrointestinal endoscope processing challenges, current issues and future perspectives. J Hosp Infect 2021; 110:133-138. [PMID: 33549767 DOI: 10.1016/j.jhin.2021.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND At present, the most frequent method for processing flexible gastrointestinal (GI) endoscopes is cleaning followed by high-level disinfection as terminal sterilization is often not practicable. Post-processing monitoring studies consistently show high levels of positive cultures remaining on endoscopes, which can lead to patient infection and even fatality. The processing deficiency is attributed to the complex design of endoscopes, incomplete cleaning, formation of biofilms and lack of margin of safety with high-level disinfection. OBJECTIVE To demonstrate that flexible GI endoscopes can be practicably terminally sterilized. METHODS An endoscope sterilization cycle was developed in a vaporized hydrogen peroxide sterilization system. The cycle was used to study the sterilization of flexible GI endoscopes which included colonoscopes and duodenoscope and material compatibility for both original flexible GI endoscopes and those experimentally modified endoscopes using compatible materials. RESULTS Testing demonstrated that the vaporized hydrogen peroxide can sterilize flexible GI endoscopes (colonoscopes, duodenoscope) with a sterility assurance level of 10-6. Additionally, no recoverable survivors were detected when devices were artificially soiled with hard water and serum. Material compatibility test results demonstrated that replacing molybdenum disulphide lubricant with a graphite-based inert lubricant can make them compatible with vaporized hydrogen peroxide sterilizers. CONCLUSION Flexible GI endoscopes can be practicably terminally sterilized using vaporized hydrogen peroxide sterilization technologies if their materials are revised to become compatible.
Collapse
Affiliation(s)
- N Omidbakhsh
- Research & Development Department, Advanced Sterilization Products, Irvine, CA, USA.
| | - S Manohar
- Research & Development Department, Advanced Sterilization Products, Irvine, CA, USA
| | - R Vu
- Research & Development Department, Advanced Sterilization Products, Irvine, CA, USA
| | - K Nowruzi
- Research & Development Department, Advanced Sterilization Products, Irvine, CA, USA
| |
Collapse
|
8
|
Abstract
Patient and procedural factors can increase the risk of infectious adverse events during endoscopy. Prophylactic antibiotic use must be judicious and individualized in the era of antibiotic resistance. New and emerging procedures require high-quality studies to elucidate appropriate risk profiles.
Collapse
Affiliation(s)
- Brian P H Chan
- Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Tyler M Berzin
- Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| |
Collapse
|
9
|
Loraine A. Bowel preparation agent inducing profound shock precolonoscopy. BMJ Case Rep 2020; 13:e233406. [PMID: 32161080 PMCID: PMC7066630 DOI: 10.1136/bcr-2019-233406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/03/2022] Open
Abstract
A 73-year-old woman was admitted to the intensive care unit following vomiting and diarrhoea onset after completing oral bowel preparation prior to colonoscopy to investigate haematochezia. She had a history of severe chronic obstructive pulmonary disease, Crohn's disease, diverticular disease, hypertension and dyslipidaemia. She was resuscitated with intravenous fluids, antibiotics and required epinephrine, norepinephrine and vasopressin infusions. She improved over her 4-day intensive care admission and was discharged to the general medical ward, but ultimately died 19 days after presentation.
Collapse
Affiliation(s)
- Angus Loraine
- Intensive Care Unit, Queensland Health, Gold Coast, Queensland, Australia
| |
Collapse
|
10
|
Jung Y. [Medical Dispute Related to Gastrointestinal Endoscopy Complications: Prevention and Management]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:315-321. [PMID: 31234621 DOI: 10.4166/kjg.2019.73.6.315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022]
Abstract
Because gastrointestinal (GI) endoscopy examinations are being performed increasingly frequently, the rate of detection of cancer and of precancerous lesions has increased. Moreover, development of more advanced endoscopic technologies has expanded the indications for, and thus frequency of, therapeutic endoscopic procedures. However, the incidence of complications associated with diagnostic or therapeutic GI endoscopy has also increased. The complications associated with GI endoscopy can be ameliorated by endoscopic or conservative treatment, but caution is needed as some of the more serious complications, such as perforation, can lead to death. In this chapter, we review the possible complications of GI endoscopy and discuss methods for their prevention and treatment.
Collapse
Affiliation(s)
- Yunho Jung
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| |
Collapse
|
11
|
Kothari ST, Huang RJ, Shaukat A, Agrawal D, Buxbaum JL, Abbas Fehmi SM, Fishman DS, Gurudu SR, Khashab MA, Jamil LH, Jue TL, Law JK, Lee JK, Naveed M, Qumseya BJ, Sawhney MS, Thosani N, Yang J, DeWitt JM, Wani S. ASGE review of adverse events in colonoscopy. Gastrointest Endosc 2019; 90:863-876.e33. [PMID: 31563271 DOI: 10.1016/j.gie.2019.07.033] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/29/2019] [Indexed: 02/07/2023]
Abstract
Colonoscopy is the most commonly performed endoscopic procedure and overall is considered a low-risk procedure. However, adverse events (AEs) related to this routinely performed procedure for screening, diagnostic, or therapeutic purposes are an important clinical consideration. The purpose of this document from the American Society for Gastrointestinal Endoscopy's Standards of Practice Committee is to provide an update on estimates of AEs related to colonoscopy in an evidence-based fashion. A systematic review and meta-analysis of population-based studies was conducted for the 3 most common and important serious AEs (bleeding, perforation, and mortality). In addition, this document includes an updated systematic review and meta-analysis of serious AEs (bleeding and perforation) related to EMR and endoscopic submucosal dissection for large colon polyps. Finally, a narrative review of other colonoscopy-related serious AEs and those related to specific colonic interventions is included.
Collapse
Affiliation(s)
| | - Robert J Huang
- Stanford University Medical Center, Stanford, California, USA
| | - Aasma Shaukat
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Deepak Agrawal
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Douglas S Fishman
- Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | | | | | - Laith H Jamil
- Pancreatic and Biliary Diseases Program, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Terry L Jue
- The Permanente Medical Group, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Joanna K Law
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Jeffrey K Lee
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Mariam Naveed
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals & Clinics, Coralville, Iowa, USA
| | | | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav Thosani
- University of Texas at Houston, Bellaire, Texas, USA
| | - Julie Yang
- Einstein Hospital, New York, New York, USA
| | - John M DeWitt
- Division of Gastroenterology, Indiana University Health Medical Center, Indianapolis, Indiana, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | | |
Collapse
|
12
|
Higa JT. Duodenoscope-related infections: Overview and epidemiology. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.150623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
13
|
Iwakiri R, Tanaka K, Gotoda T, Oka S, Ohtsuka T, Sakata Y, Chiba T, Higuchi K, Masuyama H, Nozaki R, Matsuda K, Shimono N, Fujimoto K, Tajiri H. Guidelines for standardizing cleansing and disinfection of gastrointestinal endoscopes. Dig Endosc 2019; 31:477-497. [PMID: 31241788 DOI: 10.1111/den.13474] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/23/2019] [Indexed: 02/05/2023]
Abstract
As part of the activities toward standardizing endoscopy procedures, the Japan Gastroenterological Endoscopy Society has prepared guidelines for cleansing and disinfection of gastrointestinal endoscopes. The environment of gastrointestinal endoscopy differs between Japan and advanced Western countries. In advanced Western countries, gastrointestinal endoscopy is performed almost exclusively at specialized facilities, where strict provisions are observed for cleansing and disinfecting endoscopes. In Japan, however, gastrointestinal endoscopy is performed even in small clinics, and the annual number of gastrointestinal endoscopy cases is enormous. In addition, the method for cleansing and disinfecting endoscopes differs among hospitals. Although there is a distinct lack of evidence for how gastrointestinal endoscopes are cleaned and disinfected, it is necessary to standardize the method for doing so to advance the field of endoscopic medicine.
Collapse
Affiliation(s)
| | | | - Takuji Gotoda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shiro Oka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takao Ohtsuka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Toshimi Chiba
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Ryoichi Nozaki
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Koji Matsuda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Hisao Tajiri
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| |
Collapse
|
14
|
|
15
|
Wang P, Xu T, Ngamruengphong S, Makary MA, Kalloo A, Hutfless S. Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA. Gut 2018; 67:1626-1636. [PMID: 29777042 DOI: 10.1136/gutjnl-2017-315308] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 04/18/2018] [Accepted: 05/03/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Over 15 million colonoscopies and 7 million osophagogastroduodenoscopies (OGDs) are performed annually in the USA. We aimed to estimate the rates of infections after colonoscopy and OGD performed in ambulatory surgery centres (ASCs). DESIGN We identified colonoscopy and OGD procedures performed at ASCs in 2014 all-payer claims data from six states in the USA. Screening mammography, prostate cancer screening, bronchoscopy and cystoscopy procedures were comparators. We tracked infection-related emergency department visits and unplanned in-patient admissions within 7 and 30 days after the procedures, examined infection sites and organisms and analysed predictors of infections. We investigated case-mix adjusted variation in infection rates by ASC. RESULTS The rates of postendoscopic infection per 1000 procedures within 7 days were 1.1 for screening colonoscopy, 1.6 for non-screening colonoscopy and 3.0 for OGD; all higher than screening mammography (0.6) but lower than bronchoscopy (15.6) and cystoscopy (4.4) (p<0.0001). Predictors of postendoscopic infection included recent history of hospitalisation or endoscopic procedure; concurrence with another endoscopic procedure; low procedure volume or non-freestanding ASC; younger or older age; black or Native American race and male sex. Rates of 7-day postendoscopic infections varied widely by ASC, ranging from 0 to 115 per 1000 procedures for screening colonoscopy, 0 to 132 for non-screening colonoscopy and 0 to 62 for OGD. CONCLUSION We found that postendoscopic infections are more common than previously thought and vary widely by facility. Although screening colonoscopy is not without risk, the risk is lower than diagnostic endoscopic procedures.
Collapse
Affiliation(s)
- Peiqi Wang
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.,Gastrointestinal Epidemiology Research Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tim Xu
- McKinsey & Company, Washington, District of Columbia, USA
| | - Saowanee Ngamruengphong
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Health Policy Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Anthony Kalloo
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan Hutfless
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.,Gastrointestinal Epidemiology Research Center, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
16
|
Duodenoscope-related and echoendoscope-related infections: Is "never" possible? Gastrointest Endosc 2018; 88:314-315. [PMID: 30012411 DOI: 10.1016/j.gie.2018.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 12/11/2022]
|
17
|
Sakudo A, Miyagi H, Horikawa T, Yamashiro R, Misawa T. Treatment of Helicobacter pylori with dielectric barrier discharge plasma causes UV induced damage to genomic DNA leading to cell death. CHEMOSPHERE 2018; 200:366-372. [PMID: 29494918 DOI: 10.1016/j.chemosphere.2018.02.115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/24/2018] [Accepted: 02/19/2018] [Indexed: 06/08/2023]
Abstract
Gastrointestinal endoscopy is an important tool for the indentification and treatment of disorders of the gastrointestinal tract. However, nosocomial infections of Helicobacter pylori have been linked to the use of contaminated endoscopes. Disinfectants such as glutaraldehyde, ortho-phthalaldehyde and peracetic acid are generally used in the reprocesssing of endoscopes, but these chemicals are hazardous to human health. Thus, safer reprocessing and disinfecion methods are needed. In this study, we applied a dielectric barrier discharge (DBD) plasma torch for inactivation of H. pylori to investigate a potential new methodology to disinfect endoscopes. Suspensions of H. pylori in 10% glycerol were subjected to the DBD plasma torch, which reduced the viable cell count to undetectable levels after 2 min of treatment. Furthermore, urease activity of H. pylori was eliminated after 2 min-plasma treatment, while plasma-treatment reduced the intact DNA of H. pylori in a time-dependent manner. Next, we examined several potential bactericidal factors produced by the DBD plasma torch. Two min-plasma treatment resulted in a small temperature rise (4 °C), ultraviolet radiation (UV) generation, and the production of hydrogen peroxide. H. pylori samples were then exposed to equivalent levels of each of these factors in turn. Our results showed that treatment with heat and hydrogen peroxide at the levels produced after 2-min of plasma treatment did not efficiently inactivate H. pylori, whereas exposure to UV had a significant bactericidal effect. Taken together, UV generated by the plasma torch may be crucial for efficient inactivation of H. pylori by damaging the bacterial DNA.
Collapse
Affiliation(s)
- Akikazu Sakudo
- Laboratory of Biometabolic Chemistry, School of Health Sciences, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan.
| | - Hirotoshi Miyagi
- Laboratory of Biometabolic Chemistry, School of Health Sciences, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Takaya Horikawa
- Laboratory of Biometabolic Chemistry, School of Health Sciences, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Risa Yamashiro
- Laboratory of Biometabolic Chemistry, School of Health Sciences, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Tatsuya Misawa
- Department of Electrical and Electronic Engineering, Faculty of Science and Engineering, Saga University, Saga 840-8502, Japan
| |
Collapse
|
18
|
Desai R, Patel U, Goyal H. Does "July effect" exist in colonoscopies performed at teaching hospitals? Transl Gastroenterol Hepatol 2018; 3:28. [PMID: 29971259 DOI: 10.21037/tgh.2018.05.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 12/14/2022] Open
Abstract
Background To compare the outcomes of the colonoscopies between the early (July-September) and the later (April-June) academic year at the urban-teaching hospitals. Methods Our study cluster was derived from the National Inpatient Sample (NIS) database for the years 2010-2014. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) procedure codes were used to identify the adult patients who underwent inpatient colonoscopy at urban-teaching hospitals. Post-colonoscopy outcomes and the complications were recognized using ICD-9 CM codes among any of the secondary diagnoses. Categorical and continuous variables were assessed using Pearson's Chi-square and Student's t-test respectively. Odds of complications during the early vs. later academic year was also evaluated by the two-way hierarchical logistic regression analysis. Results A total of 124,155 (weighted n=617,907) colonoscopy procedures were performed at the urban teaching hospitals in the US from 2010 to 2014. Out of these, 61,272 (weighted n=304,946) and 62,883 (weighted n=312,961) procedures were performed during early (July to September) and later (April to June) academic months, respectively. There was no significant difference in the all-cause mortality (1.4% vs. 1.4%, P=0.208), and the complications such as colonic perforations (3.1% vs. 3.2%, P=0.229) and postoperative infections (0.6% vs. 0.6%, P=0.733) between the two groups. Similarly, the splenic rupture (0.0% vs. 0.0%, P=0.180) was equally infrequent in both the groups. Bleeding/hematoma following colonoscopy (0.9% vs. 0.8%, P=0.004) was marginally higher during the later academic months. There were no statistically distinctions in terms of length of stay (LOS) (days) (7.3±9.1 vs. 7.3±9.1, P=0.918), total hospitalization charges ($60,549.41 vs. $59,918.56, P=0.311) and discharge of patients to other facilities between the early and the later academic months. Colonoscopy performed during the early academic months was not found to be a significant independent predictor for post-colonoscopy complications such as colon perforation (OR =0.99, 95% CI: 0.93-1.06, P=0.760), postoperative bleeding/hematoma (OR =0.92, 95% CI: 0.81-1.04, P=0.196) and postoperative infection (OR =0.99, 95% CI: 0.84-1.15, P=0.850). Conclusions There was no "July effect" on the outcomes of colonoscopies between the early vs. the later academic months.
Collapse
Affiliation(s)
- Rupak Desai
- Research Fellow, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Upenkumar Patel
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University, Macon, GA, USA
| |
Collapse
|
19
|
Calderwood AH, Day LW, Muthusamy VR, Collins J, Hambrick RD, Brock AS, Guda NM, Buscaglia JM, Petersen BT, Buttar NS, Khanna LG, Kushnir VM, Repaka A, Villa NA, Eisen GM. ASGE guideline for infection control during GI endoscopy. Gastrointest Endosc 2018; 87:1167-1179. [PMID: 29573782 DOI: 10.1016/j.gie.2017.12.009] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 02/08/2023]
|
20
|
Oh TH, Han ST, Hong KI, Jeong EH, Lee H, Yun JW, Park KH, Lee JW, Kim YJ, Chang W, Park CY. Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.2.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tae Hoon Oh
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Sang Taek Han
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Kwang Il Hong
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Eun Haeng Jeong
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Hyug Lee
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Jung Won Yun
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Kwang Hyuk Park
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Joon Woo Lee
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Young Joon Kim
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Woonki Chang
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Chang Young Park
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| |
Collapse
|
21
|
Van Remoortel H, Borra V, De Buck E, Compernolle V, Vandekerckhove P. Is an endoscopic examination associated with transfusion-transmissible infections? A systematic review and meta-analysis. Transfusion 2017; 58:507-519. [PMID: 29194668 DOI: 10.1111/trf.14416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The purpose of a donor medical questionnaire is to identify the blood donor's history relative to the current known blood-safety risks. A temporary deferral from blood donation after an endoscopic examination is enforced because of the reusable nature of the endoscope and close contact with the inner body. The objective of this systematic review was to find the best available evidence on the association between an endoscopic examination and the risk of transfusion-transmissible infections. METHODS Studies from five databases investigating the link between an endoscopic examination and transfusion-transmissible infections (hepatitis B virus, hepatitis C virus, human immunodeficiency virus infection, Treponema pallidum) were retained and assessed independently by two reviewers. The association between endoscopy and transfusion-transmissible infections was identified by conducting meta-analyses and calculating pooled effect measures (odds ratios and 95% confidence intervals). The Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to assess the quality of evidence. RESULTS We identified 7571 references and finally included 29 observational studies. A significant association between an endoscopic examination and hepatitis B virus infection (pooled odds ratio [OR], 2.21; 95% confidence interval [CI], 1.26-3.86; p = 0.005) or hepatitis C virus infection (pooled OR 1.76, 95% CI, 1.45-2.14; p < 0.00001) was found. The level of evidence was considered as "very low" due to the type of study design (i.e., observational) and indirect study populations (i.e., no blood donor populations). CONCLUSION An endoscopic examination is associated with an increased hepatitis B virus or hepatitis C virus infection risk. Further high-quality trials are required to formulate stronger evidence-based recommendations on endoscopic examination as a blood donor deferral criterion.
Collapse
Affiliation(s)
- Hans Van Remoortel
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Vere Borra
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Veerle Compernolle
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Blood Services, Belgian Red Cross, Mechelen, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Blood Services, Belgian Red Cross, Mechelen, Belgium
| |
Collapse
|
22
|
Blázquez-Garrido RM, Cuchí-Burgos E, Martín-Salas C, Ruiz-Garbajosa P. Microbiological monitoring of medical devices after cleaning, disinfection and sterilisation. Enferm Infecc Microbiol Clin 2017; 36:657-661. [PMID: 29146038 DOI: 10.1016/j.eimc.2017.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
The use of reusable semi-critical devices has been extended in current medical practice for both diagnostic and therapeutic purposes. However, reuse of these instruments carries the risk of cross-transmission of microorganisms from one patient to another. The process of cleaning and disinfecting these devices is complex, long, expensive and very error-prone. This paper analyses the epidemiological aspects of infections associated with the reuse of semi-critical devices and the role of the Microbiology laboratory in monitoring the cleaning and disinfecting process through microbiological controls. The recommendations of different scientific societies on the relevance of such controls are reviewed and specific recommendations are proposed for the taking and processing of the samples, interpretation of the results and measures to be taken depending on the results obtained.
Collapse
Affiliation(s)
| | | | - Carmen Martín-Salas
- Servicio de Microbiología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | |
Collapse
|
23
|
Tsai MC, Kao LT, Lin HC, Lee CZ, Chung SD. Chronic prostatitis/chronic pelvic pain syndrome is associated with previous colonoscopy. Can Urol Assoc J 2017; 11:E367-E371. [PMID: 29382459 DOI: 10.5489/cuaj.4279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION This study aimed to examine the association between chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and receipt of a prior colonoscopic examination using a population-based database. METHODS We used the Taiwan Longitudinal Health Insurance Database 2005 to retrieve the study sample. This study included 3933 patients with CP/CPPS and 3933 age-matched controls. We designated the date of receiving the first diagnosis of CP/CPPS as the index date for cases. We defined the first an ambulatory care visit occurring in the matched year as the index date for the controls. Conditional logistic regressions was used to calculate the odds ratio (OR) and 95% confidence interval (CI) for having previously received colonoscopy between cases and controls. RESULTS We found that 349 (4.44%) of the 7866 sampled patients had previously undergone colonoscopy, including 223 (5.67%) cases and 126 (3.20%) controls (p<0.001). A conditional logistic regression analysis revealed that the adjusted OR of receiving a colonoscopy within three years before the index date was 1.77 (95% CI 1.42-2.23) for cases compared to controls. Furthermore, we found that the youngest group of cases (<40 years) had the greatest adjusted OR for having received colonoscopy within three years before the index date compared to controls (OR 2.81; 95% CI 1.45-5.44); however, in contrast, no significant difference in the adjusted odds of having previously received colonoscopy was observed between cases and controls among the oldest age group (≥60 years). CONCLUSIONS We concluded that there was an association between antecedent colonoscopy and CP/CPPS.
Collapse
Affiliation(s)
- Ming-Chieh Tsai
- Division of Gastroenterology, Department of Internal Medicine, Cathay General Hospital, Hsinchu Branch, Hsinchu; Taiwan.,School of Health Care Administration, Taipei Medical University, Taipei; Taiwan
| | - Li-Ting Kao
- Graduate Institute of Life Science, National Defense Medical Centre, Taipei; Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University, Taipei; Taiwan.,Research Centre of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei; Taiwan
| | - Cha-Ze Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei; Taiwan
| | - Shiu-Dong Chung
- Research Centre of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei; Taiwan.,Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Banciao, Taipei; Taiwan.,Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chungli; Taiwan
| |
Collapse
|
24
|
López-Picazo J, Alberca de Las Parras F, Sánchez Del Río A, Pérez Romero S, León Molina J, Júdez FJ. Quality indicators in digestive endoscopy: introduction to structure, process, and outcome common indicators. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:435-450. [PMID: 28553719 DOI: 10.17235/reed.2017.5035/2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification.
Collapse
Affiliation(s)
- Julio López-Picazo
- Servicio de Calidad Asistencial, Hospital Clínico Universitario Virgen de la Arrixaca
| | | | | | - Shirley Pérez Romero
- Servicio de Calidad Asistencial, Hospital Clínico Universitario Virgen de la Arrixaca
| | | | | |
Collapse
|
25
|
Rahmani G, Moran AM. Pyogenic Liver Abscess Following an Uncomplicated Colonoscopy. Eur J Case Rep Intern Med 2017; 4:000565. [PMID: 30755933 PMCID: PMC6346875 DOI: 10.12890/2017_000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 01/12/2017] [Indexed: 12/02/2022] Open
Abstract
Pyogenic liver abscess is a potentially devastating clinical entity associated with significant morbidity and mortality[1]. A myriad of causes for liver abscess have been described including intra-abdominal infections such as diverticulitis[2]. Due to a non-specific presentation, clinicians often require a high level of suspicion in their diagnosis of this condition. A handful of cases of liver abscess have been described following colonoscopy which was usually a complicated procedure or one where multiple biopsies had been taken[3,4]. The case of a patient presenting pyrexia of unknown origin one week after undergoing an uncomplicated colonoscopy in which no biopsies were taken is reported. She was ultimately diagnosed with a pyogenic liver abscess.
Collapse
Affiliation(s)
- George Rahmani
- Department of Nephrology and General Medicine, Letterkenny General Hospital, Letterkenny, Ireland
| | - Anne-Marie Moran
- Department of Nephrology and General Medicine, Letterkenny General Hospital, Letterkenny, Ireland
| |
Collapse
|
26
|
Petersen BT, Cohen J, Hambrick RD, Buttar N, Greenwald DA, Buscaglia JM, Collins J, Eisen G. Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update. Gastrointest Endosc 2017; 85:282-294.e1. [PMID: 28069113 DOI: 10.1016/j.gie.2016.10.002] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/03/2016] [Indexed: 12/11/2022]
|
27
|
Complications of diagnostic colonoscopy, upper endoscopy, and enteroscopy. Best Pract Res Clin Gastroenterol 2016; 30:705-718. [PMID: 27931631 DOI: 10.1016/j.bpg.2016.09.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/27/2016] [Accepted: 09/06/2016] [Indexed: 01/31/2023]
Abstract
Endoscopy is an inherent and an invaluable tool in every gastroenterologist's armamentarium. The prerequisite for quality and safety remains foremost. Adverse events should be minimized and proactive steps should taken before, during and after the endoscopic procedure. Upper endoscopy and colonoscopy are part of basic endoscopy and their major complications will be reviewed here, together with those of enteroscopy. The most common of all endoscopy related complications are cardiopulmonary and thus they will be addressed in detail first. Colonoscopy's major complications are bleeding and perforation. Their epidemiology, mechanisms/risk factors, diagnosis, treatment and prevention will be addressed. The incidence of both of these complications increases significantly with polypectomy. Thus clinical judgment and experience in both polypectomy techniques and the ways to treat these complications, especially with the advanced endoscopic options advanced in the last decade, are of paramount importance. Post-polypectomy syndrome, infection and gas explosion are less frequent and will be reviewed briefly. Bleeding and perforation are upper endoscopy's major complications as well. Advances in endoscopic techniques in recent years offer endoscopic treatment instead of directly resorting to surgery, as was used to be the case and still is if the first fails. Enteroscopy is generally a more advanced procedure and overall complication rate is often quoted as 1%, most of them have been attributed to the passage of the overtube. Perforation and bleeding are the major complications, and a unique upper enteroscopy-associated complication is pancreatitis.
Collapse
|
28
|
Armellino D. Ongoing Discovery of High-Level Disinfection of Endoscope Practices and the Use of Performance Improvement Methodologies to Improve Processes. Jt Comm J Qual Patient Saf 2016; 42:262-4. [PMID: 27184241 DOI: 10.1016/s1553-7250(16)42034-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Donna Armellino
- Infection Prevention, Northwell Health, Lake Success, New York, USA
| |
Collapse
|
29
|
Neves MS, da Silva MG, Ventura GM, Côrtes PB, Duarte RS, de Souza HS. Effectiveness of current disinfection procedures against biofilm on contaminated GI endoscopes. Gastrointest Endosc 2016; 83:944-53. [PMID: 26408426 DOI: 10.1016/j.gie.2015.09.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/14/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Attention to patient safety has increased recently due to outbreaks of nosocomial infections associated with GI endoscopy. The aim of this study was to evaluate current cleaning and disinfection procedures of endoscope channels with high bioburden and biofilm analysis, including the use of resistant mycobacteria associated with postsurgical infections in Brazil. METHODS Twenty-seven original endoscope channels were contaminated with organic soil containing 10(8) colony-forming units/mL of Pseudomonas aeruginosa, Staphylococcus aureus, or Mycobacterium abscessus subsp bolletii. Biofilms with the same microorganisms were developed on the inner surface of channels with the initial inoculum of 10(5) colony-forming units/mL. Channels were reprocessed following current protocol, and samples from cleaning and disinfection steps were analyzed by bioluminescence for adenosine triphosphate, cultures for viable microorganisms, and confocal microscopy. RESULTS After contamination, adenosine triphosphate levels increased dramatically, and high bacterial growth was observed in all cultures. After cleaning, adenosine triphosphate levels decreased to values comparable to precontamination levels, and bacterial growth was demonstrated in 5 of 27 catheters, 2 with P aeruginosa and 3 with M abscessus. With regard to induced biofilm, a remarkable reduction occurred after cleaning, but significant microbial growth inhibition occurred only after disinfection. Nevertheless, viable microorganisms within the biofilm were still detected by confocal microscopy, more so with glutaraldehyde than with peracetic acid or O-phataladehyde. CONCLUSION After the complete disinfection procedure, viable microorganisms could still be detected within the biofilm on endoscope channels. Prevention of biofilm development within endoscope channels should be a priority in disinfection procedures, particularly for ERCP and EUS.
Collapse
Affiliation(s)
- Marcelo S Neves
- Division of Gastroenterology, Internal Medicine Department, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marlei Gomes da Silva
- Mycobacteria Laboratory, Medical Microbiology Department, Institute of Microbiology, Health Sciences Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Grasiella M Ventura
- Unity of Confocal Microscopy, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Brazil
| | - Patrícia Barbur Côrtes
- Mycobacteria Laboratory, Medical Microbiology Department, Institute of Microbiology, Health Sciences Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Silva Duarte
- Mycobacteria Laboratory, Medical Microbiology Department, Institute of Microbiology, Health Sciences Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Heitor S de Souza
- Division of Gastroenterology, Internal Medicine Department, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| |
Collapse
|
30
|
Gluck N, Melhem A, Halpern Z, Mergener K, Santo E. A novel self-propelled disposable colonoscope is effective for colonoscopy in humans (with video). Gastrointest Endosc 2016; 83:998-1004.e1. [PMID: 26391735 DOI: 10.1016/j.gie.2015.08.083] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/19/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The self-propelled disposable colonoscope (SPDC) with a 360° view is designed to enhance visualization, minimize risks of perforation and infection transmission, and shorten operator training time associated with conventional colonoscopy (CC). We evaluated SPDC efficacy for cecal intubation and safety. METHODS Prospective patients presenting for colorectal cancer screening underwent SPDC immediately followed by CC. Initial patients necessary for SPDC operators to achieve proficiency comprised the training cohort. Subsequent enrolled patients comprised the study cohort. SPDC colonoscopy was performed up to the cecum, where anatomic landmarks were photographed and mucosal suction marks were placed. During SPDC withdrawal, polyps were recorded and similarly marked. On the second pass (by using CC), any potential mucosal damage and suction marks from the SPDC as well as polyps were recorded. Main endpoints included SPDC cecal intubation rates, confirmed by anatomic landmarks and residual marks seen on subsequent CC, and frequency and severity of adverse events and mucosal damage with SPDC. The secondary endpoint was subjective procedure proficiency, evaluated by the operator based on the training cohort. The tertiary endpoint was documenting pathologies visualized with SPDC. RESULTS Fifty-six of 58 enrolled subjects completed the study. Proficiency with SPDC was attained after 8 to 10 procedures. Cecal intubation was successful in 98.2% (55/56 subjects; 95% confidence interval [CI], 90.4%-99.9%), including 100% (95% CI, 90.7%-100%) of the study cohort and 94.4% (95% CI, 72.7%-99.9%) of the training cohort. No mucosal damage or adverse events were reported. SPDC detected 87.5% of polyps seen in tandem CC, including all polyps larger than 5 mm. CONCLUSIONS SPDC was highly successful, simple to use, and safe in achieving complete colonoscopy (cecal intubation). ( CLINICAL TRIAL REGISTRATION NUMBER 0692-12-TLV.).
Collapse
Affiliation(s)
- Nathan Gluck
- Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alaa Melhem
- Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zamir Halpern
- Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Erwin Santo
- Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
31
|
Oh HJ, Kim JS. Clinical Practice Guidelines for Endoscope Reprocessing. Clin Endosc 2015; 48:364-8. [PMID: 26473117 PMCID: PMC4604272 DOI: 10.5946/ce.2015.48.5.364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/05/2015] [Accepted: 09/06/2015] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal endoscopy is effective and safe for the screening, diagnosis, and treatment of gastrointestinal disease. However, issues regarding endoscope-transmitted infections are emerging. Many countries have established and continuously revise guidelines for endoscope reprocessing in order to prevent infections. While there are common processes used in endoscope reprocessing, differences exist among these guidelines. It is important that the reprocessing of gastrointestinal endoscopes be carried out in accordance with the recommendations for each step of the process.
Collapse
Affiliation(s)
- Hyun Jin Oh
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Su Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
32
|
Complications during colonoscopy: prevention, diagnosis, and management. Tech Coloproctol 2015; 19:505-13. [PMID: 26162284 DOI: 10.1007/s10151-015-1344-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/07/2015] [Indexed: 02/08/2023]
Abstract
Colonoscopy is largely performed in daily clinical practice for both diagnostic and therapeutic purposes. Although infrequent, different complications may occur during the examination, mostly related to the operative procedures. These complications range from asymptomatic and self-limiting to serious, requiring a prompt medical, endoscopic or surgical intervention. In this review, the complications that may occur during colonoscopy are discussed, with a particular focus on prevention, diagnosis, and therapeutic approaches.
Collapse
|
33
|
Evaluation of the Quality of Reprocessing of Gastrointestinal Endoscopes. Infect Control Hosp Epidemiol 2015; 36:1017-23. [PMID: 26022365 DOI: 10.1017/ice.2015.123] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the quality of gastrointestinal endoscope reprocessing and discuss the advantages of microbiological surveillance testing of these endoscopes. METHODS Retrospective analysis of the results of endoscope sampling performed from October 1, 2006, through December 31, 2014, in a gastrointestinal endoscopy unit of a teaching hospital equipped with 89 endoscopes and 3 automated endoscope reprocessors, with an endoscopy quality assurance program in place. The compliance rate was defined as the proportion of the results classified at target or alert levels according to the French guidelines. A multivariate analysis (logistic regression) was used to identify the parameters influencing compliance. RESULTS A total of 846 samples were taken. The overall compliance rate was 86% and differed significantly depending on the sampling context (scheduled or not scheduled), the type of endoscope, and the season. No other parameter was associated with compliance. A total of 118 samples carried indicator microorganisms such as Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Enterobacteriaceae, and Candida sp. CONCLUSION The systematic use of an automated endoscope reprocessor does not provide totally satisfactory compliance. Microbiological surveillance is indispensable to monitor reprocessing, reinforce good practices (endoscopes, reprocessing units), and detect endoscopes requiring early technical maintenance.
Collapse
|
34
|
Brock AS, Steed LL, Freeman J, Garry B, Malpas P, Cotton P. Endoscope storage time: assessment of microbial colonization up to 21 days after reprocessing. Gastrointest Endosc 2015; 81:1150-4. [PMID: 25484321 DOI: 10.1016/j.gie.2014.09.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/22/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Insufficient data exist for how long endoscopes can be stored after reprocessing. Concern about possible microbial colonization has led to various recommendations for reprocessing intervals among institutions, with many as short as 5 days. A significant cost savings could be realized if it can be demonstrated that endoscopes may be stored for as long as 21 days without risk of clinically significant contamination. OBJECTIVE To demonstrate whether flexible endoscopes may be stored for as long as 21 days after reprocessing without colonization by pathogenic microbes. DESIGN Prospective, observational study. SETTING Tertiary care center. ENDOSCOPES Four duodenoscopes, 4 colonoscopes, and 2 gastroscopes. INTERVENTION Microbial testing of endoscope channels. MAIN OUTCOME MEASUREMENTS Culture results at days 0, 7, 14, and 21. RESULTS There were 33 positive cultures from 28 of the 96 sites tested (29.2% overall contamination rate). Twenty-nine of 33 isolates were typical skin or environmental contaminants, thus clinically insignificant. Four potential pathogens were cultured, including Enterococcus, Candida parapsilosis, α-hemolytic Streptococcus, and Aureobasidium pullulans; all were likely clinically insignificant as each was only recovered at 1 time point at 1 site, and all grew in low concentrations. There were no definite pathogenic isolates. LIMITATIONS Single center. CONCLUSION Endoscopes can be stored for as long as 21 days after standard reprocessing with a low risk of pathogenic microbial colonization. Extension of reprocessing protocols to 21 days could effect significant cost savings.
Collapse
Affiliation(s)
- Andrew S Brock
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lisa L Steed
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Janice Freeman
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bernadette Garry
- Department of Quality Management and Patient Safety/Infection Control, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Phyllis Malpas
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Peter Cotton
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
35
|
Zhang QS, Han B, Xu JH, Gao P, Shen YC. Antimicrobial prophylaxis in patients with colorectal lesions undergoing endoscopic resection. World J Gastroenterol 2015; 21:4715-4721. [PMID: 25914483 PMCID: PMC4402321 DOI: 10.3748/wjg.v21.i15.4715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/25/2014] [Accepted: 01/21/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of prophylaxis with antibiotics on clinical adverse events in patients who underwent endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) for colorectal lesions.
METHODS: From June 2011 to December 2013, a total of 428 patients were enrolled into the study, of which 214 patients admitted to hospital underwent EMR or ESD procedures. These patients were randomized to an antibiotic group, in which patients were given cefuroxime 1.5 g iv half an hour before and 6 h after surgery respectively, and a control group, in which patients were not given any antibiotic. A further 214 outpatients with small polyps treated by polypectomy were compared with controls that were matched by age and gender, and operations were performed as outpatient surgery. Recorded patient parameters were demographics, characteristics of lesions and treatment modality, and the size of the wound area. The primary outcome measures were clinical adverse events, including abdominal pain, diarrhea, hemotachezia, and fever. Secondary outcome measures were white blood cell count, C-reactive protein and blood culture. Additionlly, the relationship between the size of the wound area and clinical adverse events was analyzed.
RESULTS: A total of 409 patients were enrolled in this study, with 107 patients in the control group, 107 patients in the antibiotic group, and another 195 cases in the follow-up outpatient group. The patients’ demographic characteristics, including age, gender, characteristics of lesions, treatment modality, and the size of the wound area were similar between the 2 groups. The rates of adverse events in the antibiotic group were significantly lower than in the control group: abdominal pain (2.8% vs 14.9%, P < 0.01), diarrhea (2.0% vs 9.3%, P < 0.05), and fever (0.9% vs 8.4%, P < 0.05) respectively. The levels of inflammatory markers also decreased significantly in the antibiotic group compared with the control group: leukocytosis (2.0% vs 11.2%, P < 0.01), and C-reactive protein (2.0% vs 10.7%, P < 0.05). Additionally, clinical adverse events were related to the size of the surgical wound area. When the surgical wound area was larger than 10 mm × 10 mm, there were more clinical adverse events.
CONCLUSION: Clinical adverse events are not uncommon after EMR or ESD procedures. Prophylactic antibiotics can reduce the incidence of clinical adverse events. This should be further explored.
Collapse
|
36
|
Park JB, Yang JN, Lim YJ, Koo JS, Jang JY, Park SH, Hong SJ, Kim SW, Chun HJ. Survey of endoscope reprocessing in Korea. Clin Endosc 2015; 48:39-47. [PMID: 25674525 PMCID: PMC4323430 DOI: 10.5946/ce.2015.48.1.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/20/2014] [Accepted: 06/02/2014] [Indexed: 01/01/2023] Open
Abstract
Background/Aims There is a growing emphasis on quality management in endoscope reprocessing. Previous surveys conducted in 2002 and 2004 were not practitioner-oriented. Therefore, this survey is significant for being the first to target actual participants in endoscope reprocessing in Korea. Methods This survey comprised 33 self-filled questions, and was personally delivered to nurses and nursing auxiliaries in the endoscopy departments of eight hospitals belonging to the society. The anonymous responses were collected after 1 week either by post or in person by committee members. Results The survey included 100 participants. In the questionnaire addressing compliance rates with the reprocessing guideline, the majority (98.9%) had a high compliance rate compared to 27% of respondents in 2002 and 50% in 2004. The lowest rate of compliance with a reprocessing procedure was reported for transporting the contaminated endoscope in a sealed container. Automated endoscope reprocessors were available in all hospitals. Regarding reprocessing time, more than half of the subjects replied that reprocessing took more than 15 minutes (63.2%). Conclusions The quality management of endoscope reprocessing has improved as since the previous survey. A national survey expanded to include primary clinics is required to determine the true current status of endoscope reprocessing.
Collapse
Affiliation(s)
- Jeong Bae Park
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jae Nam Yang
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Ja Seol Koo
- Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea
| | - Jae Young Jang
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Hoon Park
- Department of Internal Medicine, KEPCO Medical Center, Seoul, Korea
| | - Su Jin Hong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sang-Woo Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hoon Jai Chun
- Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea
| | | |
Collapse
|
37
|
Affiliation(s)
- Young-Seok Cho
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| |
Collapse
|
38
|
Rutala WA, Weber DJ. How to Assess Risk of Disease Transmission to Patients When There Is a Failure to Follow Recommended Disinfection and Sterilization Guidelines. Infect Control Hosp Epidemiol 2015; 28:146-55. [PMID: 17265395 DOI: 10.1086/511700] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 11/03/2006] [Indexed: 11/03/2022]
Abstract
Background.Disinfection and sterilization are critical components of infection control. Unfortunately, breaches of disinfection and sterilization guidelines are not uncommon.Objective.To describe a method for evaluating a potential breach of guidelines for high-level disinfection and sterilization of medical devices.Methods.The appropriate scientific literature was reviewed to determine the frequency of failures of compliance. A risk assessment model was constructed.Results.A 14-step protocol was constructed to aid infection control professionals in the evaluation of potential disinfection and sterilization failures. In addition, a model is presented for aiding in determining how patients should be notified of the potential adverse event. Sample statements and letters are provided for communicating with the public and individual patients.Conclusion.Use of a protocol can guide an institution in managing potential disinfection and sterilization failures.
Collapse
Affiliation(s)
- William A Rutala
- Department of Hospital Epidemiology, University of North Carolina at Chapel Hill, NC 27599, USA.
| | | |
Collapse
|
39
|
Ensuring patient safety and optimizing efficiency during gastrointestinal endoscopy. AORN J 2014; 99:396-406. [PMID: 24581646 DOI: 10.1016/j.aorn.2013.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/18/2013] [Indexed: 01/29/2023]
Abstract
The volume of outpatient gastrointestinal (GI) endoscopy has grown dramatically in the past three decades, fueled by advancing technologies and evolving payment policies. This magnifies the need to ensure high-quality, safe, and cost-effective endoscopic services. In recent years, publicized breaches in standards of care for GI endoscopy have intensified the focus on patient safety. Because of these patient safety concerns and changes in regulatory policies, some ambulatory surgery center surveyors and inspectors have held GI endoscopy suites to the same standards as hospital ORs. The American Society for Gastrointestinal Endoscopy and other endorsing organizations drafted the Guidelines for Safety in the Gastrointestinal Endoscopy Unit, which published in January 2014. These safety guidelines relevant to sedation, infection control, staffing, training, technical equipment, traffic patterns, and personal protective equipment differ from other published guidelines for the outpatient surgical setting.
Collapse
|
40
|
Kim HW. What Is Different between Postpolypectomy Fever and Postpolypectomy Coagulation Syndrome? Clin Endosc 2014; 47:205-6. [PMID: 24944980 PMCID: PMC4058534 DOI: 10.5946/ce.2014.47.3.205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 04/01/2014] [Indexed: 01/28/2023] Open
Affiliation(s)
- Hyung Wook Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| |
Collapse
|
41
|
Calderwood AH, Chapman FJ, Cohen J, Cohen LB, Collins J, Day LW, Early DS. Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointest Endosc 2014; 79:363-72. [PMID: 24485393 PMCID: PMC3980655 DOI: 10.1016/j.gie.2013.12.015] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 12/12/2022]
Abstract
Historically, safety in the gastrointestinal (GI) endoscopy unit has focused on infection control, particularly around the reprocessing of endoscopes. Two highly publicized outbreaks where the transmission of infectious agents were related to GI endoscopy have highlighted the need to address potential gaps along the endoscopy care continuum that could impact patient safety.
Collapse
|
42
|
The polymicrobial Actinomyces naeslundii and Pseudomonas aeruginosa sepsis in a patient with ulcerative colitis 2 months after colonoscopy. Wien Klin Wochenschr 2013; 126:130-2. [PMID: 24297267 DOI: 10.1007/s00508-013-0471-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
Abstract
We describe a case of an abrupt onset of polymicrobial Actinomyces naeslundii/Pseudomonas aeruginosa sepsis in a patient with a previously silent abdominal actinomycosis, developed 2 months after colonoscopy when the diagnosis of a left-sided ulcerative colitis was established. Prolonged high-dose ceftriaxone therapy was clinically effective, albeit accompanied by the development of a reversible pseudocholelithiasis that persisted for 5 months.
Collapse
|
43
|
Ubhayawardana DLNL, Kottahachchi J, Weerasekera MM, Wanigasooriya IWMP, Fernando SSN, De Silva M. Residual bioburden in reprocessed side-view endoscopes used for endoscopic retrograde cholangiopancreatography (ERCP). Endosc Int Open 2013; 1:12-6. [PMID: 26135507 PMCID: PMC4440374 DOI: 10.1055/s-0033-1359234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND AND STUDY AIM Worldwide some endoscopy units routinely continue to use manual reprocessing techniques for disinfection of side-view endoscopes. The aim of this study was to evaluate the outcome quality of manual reprocessing techniques for removal and inactivation of the bioburden from side-view endoscopes used for endoscopic retrograde cholangiopancreatography (ERCP) in a tertiary referral endotherapy unit in Sri Lanka. METHODS 102 samples obtained from two different flexible side-view endoscopes (Olympus TJF Q 180V and Olympus TJF 160 R) were tested for microbial growth. Three samples were collected each time; one swab from the tip before and another after manual reprocessing. The third sample was collected by flushing the working channel with sterile normal saline after manual reprocessing. Microorganisms were identified by culturing the samples. RESULT : After reprocessing, culture-positive rates were 20 % and 9 % for the samples obtained from the tip and the working channel of the side-view endoscopes, respectively. Klebsiella spp. and Candida spp. were found to be the commonest microorganisms in the samples from the tips and from the working channels, respectively, of the reprocessed side-view endoscopes. CONCLUSION There is a high culture-positive rate after reprocessing of the side-view endoscopes using the manual reprocessing procedure, despite strict adherence to the protocol for reprocessing.
Collapse
Affiliation(s)
- D. L. N. L. Ubhayawardana
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - J. Kottahachchi
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka,Corresponding author: J. Kottahachchi Department of Microbiology, University of Sri Jayewardenepura,Gangodawila, Nugegoda Western 10250Sri Lanka
| | - M. M. Weerasekera
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - S. S. N. Fernando
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - M. De Silva
- Endo-Therapy Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka
| |
Collapse
|
44
|
Rolanda C, Caetano AC, Dinis-Ribeiro M. Emergencies after endoscopic procedures. Best Pract Res Clin Gastroenterol 2013; 27:783-98. [PMID: 24160934 DOI: 10.1016/j.bpg.2013.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 07/25/2013] [Accepted: 08/11/2013] [Indexed: 02/08/2023]
Abstract
Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.
Collapse
Affiliation(s)
- Carla Rolanda
- Department of Gastroenterology, Hospital Braga, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | | | | |
Collapse
|
45
|
Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 2013; 26:231-54. [PMID: 23554415 DOI: 10.1128/cmr.00085-12] [Citation(s) in RCA: 290] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by rinsing and drying before storage. Most contemporary flexible endoscopes cannot be heat sterilized and are designed with multiple channels, which are difficult to clean and disinfect. The ability of bacteria to form biofilms on the inner channel surfaces can contribute to failure of the decontamination process. Implementation of microbiological surveillance of endoscope reprocessing is appropriate to detect early colonization and biofilm formation in the endoscope and to prevent contamination and infection in patients after endoscopic procedures. This review presents an overview of the infections and cross-contaminations related to flexible gastrointestinal endoscopy and bronchoscopy and illustrates the impact of biofilm on endoscope reprocessing and postendoscopic infection.
Collapse
|
46
|
Ofstead CL, Dirlam Langlay AM, Mueller NJ, Tosh PK, Wetzler HP. Re-evaluating endoscopy-associated infection risk estimates and their implications. Am J Infect Control 2013; 41:734-6. [PMID: 23318092 DOI: 10.1016/j.ajic.2012.10.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 10/10/2012] [Accepted: 10/10/2012] [Indexed: 01/24/2023]
|
47
|
Lee YK, Park JB. Steps of reprocessing and equipments. Clin Endosc 2013; 46:274-9. [PMID: 23767039 PMCID: PMC3678066 DOI: 10.5946/ce.2013.46.3.274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 01/29/2023] Open
Abstract
With the increasing interest in endoscopy and the rising number of endoscopic examinations in hospitals, the importance of endoscopic reprocessing is also increasing. Cure facilities that are understaffed and ill-equipped are trying to cope with the problems of insufficient cleaning and high infection risks. To prevent endoscopy-associated infection, the endoscope cleaning, and disinfection guidelines prepared by the Korean Society of Gastrointestinal Endoscopy must be followed. In this review, the steps of endoscopic reprocessing and the equipments required in each step are discussed.
Collapse
Affiliation(s)
- Yong Kook Lee
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | | |
Collapse
|
48
|
Grandval P, Hautefeuille G, Marchetti B, Pineau L, Laugier R. Evaluation of a storage cabinet for heat-sensitive endoscopes in a clinical setting. J Hosp Infect 2013; 84:71-6. [DOI: 10.1016/j.jhin.2013.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 01/02/2013] [Indexed: 01/09/2023]
|
49
|
Rutala WA, Weber DJ. New developments in reprocessing semicritical items. Am J Infect Control 2013; 41:S60-6. [PMID: 23622752 DOI: 10.1016/j.ajic.2012.09.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 09/07/2012] [Accepted: 09/10/2012] [Indexed: 10/26/2022]
Abstract
Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (eg, gastrointestinal endoscopes). Such medical devices require minimally high-level disinfection. Because many of these items are temperature sensitive, low-temperature chemical methods must be used rather than steam sterilization. Strict adherence to current guidelines is required because more outbreaks have been linked to inadequately cleaned or disinfected endoscopes undergoing high-level disinfection than any other medical device.
Collapse
|
50
|
Bajolet O, Ciocan D, Vallet C, de Champs C, Vernet-Garnier V, Guillard T, Brasme L, Thiefin G, Cadiot G, Bureau-Chalot F. Gastroscopy-associated transmission of extended-spectrum beta-lactamase-producing Pseudomonas aeruginosa. J Hosp Infect 2013; 83:341-3. [DOI: 10.1016/j.jhin.2012.10.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
|