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Udine M, Huff ML, Tsay K, Diab ARF, Sujka J, DuCoin C, Docimo S. Disposable Gastrointestinal Scopes: A Systematic Review. Surg Laparosc Endosc Percutan Tech 2024; 34:321-329. [PMID: 38767593 DOI: 10.1097/sle.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/26/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Endoscopes are an essential tool in the diagnosis, screening, and treatment of gastrointestinal diseases. In 2019, the Food and Drug Administration issued a news release, recommending that duodenoscope manufacturers and health care facilities phase out fully reusable duodenoscopes with fixed endcaps in lieu of duodenoscopes that are either fully disposable or those that contain disposable endcaps. With this study, we systematically reviewed the published literature on single-use disposable gastrointestinal scopes to describe the current state of the literature and provide summary recommendations on the role of disposable gastrointestinal endoscopes. MATERIALS AND METHODS For our inclusion criteria, we searched for studies that were published in the year 2015 and afterward. We performed a literature search in PubMed using the keywords, "disposable," "reusable," "choledochoscope," "colonoscope," "duodenoscope," "esophagoscope," "gastroscope," and "sigmoidoscope." After our review, we identified our final article set, including 13 articles relating to disposable scopes, published from 2015 to 2023. RESULTS In this review, we show 13 articles discussing the infection rate, functionality, safety, and affordability of disposable gastrointestinal scopes in comparison to reusable gastrointestinal scopes. Of the 3 articles that discussed infection rates (by Forbes and colleagues, Ridtitid and colleagues, and Ofosu and colleagues), each demonstrated a decreased risk of infection in disposable gastrointestinal scopes. Functionality was another common theme among these articles. Six articles (by Muthusamy and colleagues, Bang and colleagues, Lisotti and colleagues, Ross and colleagues, Kang and colleagues, and Forbes and colleagues) demonstrated comparable functionality of disposable scopes to reusable scopes. The most reported functionality issue in disposable scopes was decreased camera resolution. Disposable scopes also showed comparable safety profiles compared with reusable scopes. Six articles (by Kalipershad and colleagues, Muthusamy and colleagues, Bang and colleagues, Lisotti and colleagues, Luo and colleagues, and Huynh and colleagues) showed comparable rates of AEs, whereas 1 article (by Ofosu and colleagues) demonstrated increased rates of AEs with disposable scopes. Lastly, a cost analysis was looked at in 3 of the articles. Two articles (by Larsen et al and Ross and colleagues) remarked that further research is needed to understand the cost of disposable scopes, whereas 1 article (by Kang and colleagues) showed a favorable cost analysis. CONCLUSIONS After a review of the literature published since the 2015 Food and Drug Administration safety communication, disposable scopes have been shown to be effective in decreasing infection risks while maintaining similar safety profiles to conventional reusable scopes. However, more research is required to compare disposable and reusable scopes in terms of functionality and cost-effectiveness.
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Affiliation(s)
| | | | | | - Abdul-Rahman F Diab
- Department of Surgery, Division of Bariatric and Metabolic Surgery, University of South Florida, Tampa, FL
| | - Joseph Sujka
- Department of Surgery, Division of Bariatric and Metabolic Surgery, University of South Florida, Tampa, FL
| | - Christopher DuCoin
- Department of Surgery, Division of Bariatric and Metabolic Surgery, University of South Florida, Tampa, FL
| | - Salvatore Docimo
- Department of Surgery, Division of Bariatric and Metabolic Surgery, University of South Florida, Tampa, FL
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Patel J, Sohal A, Chaudhry H, Kalra S, Kohli I, Singh I, Dukovic D, Yang J. Predictors and impact of aspiration pneumonia in patients undergoing esophagogastroduodenoscopy: national inpatient sample 2016-2020. Eur J Gastroenterol Hepatol 2024; 36:298-305. [PMID: 38179867 DOI: 10.1097/meg.0000000000002698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Aspiration pneumonia is a rare but feared complication among patients undergoing esophagogastroduodenoscopy (EGD). Our study aims to assess the incidence as well as risk factors for aspiration pneumonia in patients undergoing EGD. METHODS National Inpatient Sample 2016-2020 was used to identify adult patients undergoing EGD. Patients were stratified into two groups based on the presence of aspiration pneumonia. Multivariate logistic regression analysis was performed to identify the risk factors associated with aspiration pneumonia. We adjusted for patient demographics, Elixhauser comorbidities and hospital characteristics. RESULTS Of the 1.8 million patients undergoing EGD, 1.9% of the patients developed aspiration pneumonia. Patients with aspiration pneumonia were mostly males (59.54%), aged >65 years old (66.19%), White (72.2%), had Medicare insurance (70.5%) and were in the lowest income quartile (28.7%). On multivariate analysis, the age >65 group, White race, congestive heart failure (CHF), neurological disorders and chronic obstructive pulmonary disease were associated with higher odds of aspiration pneumonia. This complication was associated with higher in-hospital mortality (9% vs. 0.8%; P < 0.001) and longer length of stay (10.54 days vs. 4.85 days; P < 0.001). CONCLUSION Our study found that rates of post-EGD aspiration pneumonia are increasing. We found a significant association between various comorbidities and aspiration pneumonia. Our data suggests that we need to optimize these patients before EGD, as the development of aspiration is associated with worsened outcomes. Further prospective studies are needed to clarify these associations.
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Affiliation(s)
- Jay Patel
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, Washington
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco-Fresno, California, USA
| | - Shivam Kalra
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Isha Kohli
- Department of Graduate Public Health, Icahn School of Medicine, Mount Sinai, New York
| | - Ishandeep Singh
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Dino Dukovic
- Department of Internal Medicine, Ross University School of Medicine, Bridgetown, Barbados
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, The University of Texas Medical Branch, Galveston, Texas, USA
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McWhirter A, Mahmood S, Mensah E, Nour HM, Olabintan O, Mrevlje Z. Evaluating the Safety and Outcomes of Oesophagogastroduodenoscopy in Elderly Patients Presenting With Acute Upper Gastrointestinal Bleeding. Cureus 2023; 15:e47116. [PMID: 38021747 PMCID: PMC10647938 DOI: 10.7759/cureus.47116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS In the absence of evidence-based guidelines regarding the safety and appropriateness of emergency endoscopy in elderly, co-morbid and frail patients, we aimed to find clinical outcomes in elderly patients who have undergone gastroscopy following an acute upper gastrointestinal bleeding (UGIB). METHODS We carried out a retrospective observational study of patients aged 70 years and older who had undergone emergency oesophagogastroduodenoscopy (OGD) at the Royal Sussex County Hospital, Brighton, United Kingdom, between May 2020 and January 2022. Data collected for analysis included Glasgow-Blatchford score, age, gender, endoscopic findings, endoscopic treatments, immediate complications, 90-day complications, 30-day and 90-day survival, length of hospital stay and re-bleeding. RESULTS A total of 248 study participants were categorised into two groups: age 70-79 years (n=102) and ≥80 years (n=146). Melaena (n=226, 91%, p=0.0001) was the commonest indication for emergency OGD in both groups, with the majority of patients presenting with a Glasgow-Blatchford score of ≥1 (n=200, 80.6%, p=0.2). Endoscopy findings were normal in 26.4% (n=27) of those 70-79 years and 32% (n=47) of those ≥80 years (p=0.01). Duodenal ulcer, oesophagitis and gastric ulcer were the commonest abnormal findings (n=50, 20%; n=29, 11.7%; and n=28, 11.3%, respectively). Of the participants, 93.8% (n=212) had no immediate complications. Bleeding and hypotension occurred in 2.7% (n=6) and 2% (n=5) of patients, respectively. At 90 days post-procedure, 83.3% (n=85) of those 70-79 years and 67.8% (n=99) of those ≥80 years had survived (p=0.180). CONCLUSIONS We conclude that OGD is largely a safe procedure in older adults with acute UGIB; however, the high proportion of OGDs with normal findings reinforces the importance of careful selection of patients.
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Affiliation(s)
- Alexandra McWhirter
- General Internal Medicine, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
| | - Saba Mahmood
- General Internal Medicine, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
| | - Ekow Mensah
- Geriatrics, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
| | - Hussameldin M Nour
- General Surgery, Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Brighton, GBR
| | - Olaolu Olabintan
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, GBR
| | - Ziva Mrevlje
- Gastroenterology, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
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Gangu K, Basida S, Awan RU, Butt MA, Reed A, Afzal R, Shekhar R, Chela HK, Daglilar ES, Sheikh AB. July effect in clinical outcomes of esophagogastroduodenoscopy performed at teaching hospitals in the United States. Proc AMIA Symp 2023; 36:478-482. [PMID: 37334097 PMCID: PMC10269412 DOI: 10.1080/08998280.2023.2204804] [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: 03/17/2023] [Accepted: 04/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background Esophagogastroduodenoscopy (EGD) is a common procedure used for both diagnosis and treatment, but carries risks such as bleeding and perforation. The "July effect"-described as increased complication rates during the transition of new trainees-has been studied in other procedures, but has not been thoroughly evaluated for EGD. Methods We used the National Inpatient Sample database for 2016 to 2018 to compare outcomes in EGD performed between July to September and April to June. Results Approximately 0.91 million patients in the study received EGD between July to September (49.35%) and April to June (50.65%), with no significant differences between the two groups in terms of age, gender, race, income, or insurance status. Of the 911,235 patients, 19,280 died during the study period following EGD, 2.14% (July-September) vs 1.95% (April-June), with an adjusted odds ratio of 1.09 (P < 0.01). The adjusted total hospitalization charge was $2052 higher in July-September ($81,597) vs April to June ($79,023) (P < 0.005). The mean length of stay was 6.8 days (July-September) vs 6.6 days (April-June) (P < 0.001). Conclusions The results of this study are reassuring as the July effect on inpatient outcomes for EGDs was not significantly different according to our study. We recommend seeking prompt treatment and improving new trainee training and interspecialty communication for better patient outcomes.
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Affiliation(s)
- Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Sanket Basida
- Department of Internal Medicine, University of Missouri System, Columbia, Missouri
| | - Rehmat Ullah Awan
- Department of Internal Medicine, Ochsner Rush Medical Center, Meridian, Mississippi
| | - Mohammad Ali Butt
- Department of Internal Medicine, Allegheny General Hospital – Western Pennsylvania Hospital Medical Education Consortium, Pittsburgh, Pennsylvania
| | - Austin Reed
- Department of Internal Medicine, University of Missouri System, Columbia, Missouri
| | - Rao Afzal
- Department of Internal Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Harleen Kaur Chela
- Department of Internal Medicine, West Virginia University Health Sciences Center Charleston Division, Charleston, West Virginia
| | - Ebubekir S. Daglilar
- Department of Internal Medicine, West Virginia University Health Sciences Center Charleston Division, Charleston, West Virginia
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Caira-Chuquineyra B, Fernandez-Guzman D, Soriano-Moreno DR, Fernandez-Morales J, Flores-Lovon K, Medina-Ramírez SA, Gonzales-Uribe AG, Pelayo-Luis IP, Gonzales-Zamora JA, Huaringa-Marcelo J. Fecal Microbiota Transplantation for People Living with Human Immunodeficiency Virus: A Scoping Review. AIDS Res Hum Retroviruses 2022; 38:700-708. [PMID: 35451337 DOI: 10.1089/aid.2022.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of this scoping review was to determine the characteristics of studies evaluating fecal microbiota transplantation (FMT), as well as its effects and safety as a therapeutic intervention for people living with human immunodeficiency virus (HIV). We conducted a scoping review following the methodology of the Joanna Briggs Institute. We searched the following databases: PubMed, Web of Science, Scopus, Embase, Cochrane Library, and Medline until September 19, 2021. Studies that used FMT in people living with HIV and explored its effects on the health of these people were included. Two randomized and 2 uncontrolled clinical trials with a total of 55 participants were included. Participants were well-controlled HIV-infected people. Regarding microbiota changes, three studies found significant post-FMT increases in Fusobacterium, Prevotella, α-diversity, Chao index, and/or Shannon index, and/or decreases in Bacteroides. Regarding markers of intestinal damage, one study found a decrease in intestinal fatty acid binding protein post-FMT, and another study found an increase in zonulin. Other outcomes evaluated by the studies were as follows: markers of immune and inflammatory activation, markers of immunocompetence (CD4+, and CD8+ T lymphocytes), and HIV viral load; however, none showed significant changes. Clinical outcomes were not evaluated by these studies. Regarding the safety of FMT, only mild adverse events were appreciated. No serious adverse event was reported. The clinical evidence for FMT in people living with HIV is sparse. FMT appears to have good tolerability and, no serious adverse event has been reported so far. Further clinical trials and evaluation of clinically important biomedical outcomes for FMT in people living with HIV are needed.
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Affiliation(s)
- Brenda Caira-Chuquineyra
- Peruvian Epidemiological Research Group, Unit for the Generation and Synthesis of Health Evidence, San Ignacio de Loyola University, Lima, Peru.,Faculty of Medicine, National University of San Agustín, Arequipa, Peru
| | - Daniel Fernandez-Guzman
- Peruvian Epidemiological Research Group, Unit for the Generation and Synthesis of Health Evidence, San Ignacio de Loyola University, Lima, Peru.,Professional School of Human Medicine, National University of San Antonio Abad del Cusco, Cusco, Peru
| | - David R Soriano-Moreno
- Clinical and Epidemiological Research Unit, School of Medicine, Peruvian Union University, Lima, Peru
| | - Jared Fernandez-Morales
- Clinical and Epidemiological Research Unit, School of Medicine, Peruvian Union University, Lima, Peru
| | | | | | - Antony G Gonzales-Uribe
- Clinical and Epidemiological Research Unit, School of Medicine, Peruvian Union University, Lima, Peru
| | - Isabel P Pelayo-Luis
- Clinical and Epidemiological Research Unit, School of Medicine, Peruvian Union University, Lima, Peru
| | - Jose A Gonzales-Zamora
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miller School of Medicine, Miami, Florida, USA.,Peruvian American Medical Society, Albuquerque, New Mexico, USA
| | - Jorge Huaringa-Marcelo
- Faculty of Human Medicine, Scientific University of the South, Lima, Peru.,Archbishop Loayza National Hospital, Lima, Peru
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Adverse events associated with EGD and EGD-related techniques. Gastrointest Endosc 2022; 96:389-401.e1. [PMID: 35843754 DOI: 10.1016/j.gie.2022.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 01/10/2023]
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Shiratori Y, Miller SD, Hutfless S. Editorial: seeing the light at the end of gastroscope-Complications after elective procedures are ready for NICE, bright decision aid tools. Aliment Pharmacol Ther 2022; 56:155-156. [PMID: 35689318 DOI: 10.1111/apt.16961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Yasutoshi Shiratori
- Division of Gastroenterology, Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
| | - Steven D Miller
- Division of Gastroenterology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan Hutfless
- Division of Gastroenterology, Johns Hopkins University, Baltimore, Maryland, USA
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