ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis

Each year choledocholithiasis results in biliary obstruction, cholangitis, and pancreatitis in a significant number of patients. The primary treatment, ERCP, is minimally invasive but associated with adverse events in 6% to 15%. This American Society for Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP) Guideline provides evidence-based recommendations for the endoscopic evaluation and treatment of choledocholithiasis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to rigorously review and synthesize the contemporary literature regarding the following topics: EUS versus MRCP for diagnosis, the role of early ERCP in gallstone pancreatitis, endoscopic papillary dilation after sphincterotomy versus sphincterotomy alone for large bile duct stones, and impact of ERCP-guided intraductal therapy for large and difficult choledocholithiasis. Comprehensive systematic reviews were also performed to assess the following: same-admission cholecystectomy for gallstone pancreatitis, clinical predictors of choledocholithiasis, optimal timing of ERCP vis-à-vis cholecystectomy, management of Mirizzi syndrome and hepatolithiasis, and biliary stent therapy for choledocholithiasis. Core clinical questions were derived using an iterative process by the ASGE SOP Committee. This body developed all recommendations founded on the certainty of the evidence, balance of risks and harms, consideration of stakeholder preferences, resource utilization, and cost-effectiveness.

Clinical Practice Guidelines for the Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy (PEG/PEJ) in Adult Patients: An Executive Summary.

Enteral nutrition (EN) is the introduction of nutrients into the gastrointestinal tract through a tube placed in a natural or artificial stoma. Tubes may be passed into the stomach (gastrostomy) or the jejunum (jejunostomy) in patients who cannot obtain adequate nourishing via oral feeding. Following placement, nurses are typically responsible for management of gastrostomy or other enteral tube devices in both the acute and home care settings. This article summarizes guidelines developed for nursing management of percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEJ) and gastrojejunostomy (PEGJ) tubes, developed by the Italian Association of Stoma care Nurses (AIOSS-Associazione Italiana Operatori Sanitari di Stomaterapia) in collaboration with the Italian Association of Endoscopic Operators (ANOTE-Associazione Nazionale Operatori Tecniche Endoscopiche) and the Italian Association of Gastroenterology Nurses and Associates (ANIGEA-Associazione Nazionale Infermieri di Gastroenterologia e Associati). The guidelines do not contain recommendations about EN through nasogastric tubes, indications for PEG/PEJ/PEGJ positioning, composition of EN, selection of patients, type of tube, modality of administration of the EN, and gastrointestinal complications.

Implantação da consulta de enfermagem num centro endoscópico / Implantación de la consulta de enfermería en un centro endoscópico / Implementation of nursing consultation at an endoscopy center

RESUMO Objetivou-se relatar a experiência de implantação da Consulta de Enfermagem no serviço de endoscopia do Hospital Universitário da Universidade Federal de Santa Catarina. Desde que enfermeiros foram lotados exclusivamente no setor do Centro Endoscópico da instituição, percebeu-se a necessidade de formular diretrizes que caracterizassem e documentassem o papel desse profissional no setor. Nesse quesito, várias providências foram tomadas pela gerência de enfermagem ambulatorial em parceria com os enfermeiros do setor, dentre as quais a implantação da consulta de enfermagem, com o intuito de contribuir para aperfeiçoar o registro da assistência prestada e melhorar a comunicação entre os membros da equipe de enfermagem daquele setor. Instituído o processo de enfermagem, notou-se maior segurança para o paciente e equipe de enfermagem durante todos os procedimentos realizados. A conscientização e o conhecimento sobre a relevância da atuação profissional do enfermeiro nesse tipo de serviço devem ser pautados na qualidade da assistência prestada e no diferencial que a enfermagem traz para a qualidade do atendimento ao usuário.

RESUMEN El objetivo fue de relatar la experiencia de implantación de la Consulta de Enfermería en el servicio de endoscopia del Hospital Universitario de la Universidad Federal de Santa Catarina. Desde que enfermeros fueron destinados exclusivamente al sector del Centro Endoscópico de la institución, se percibió la necesidad de formular directrices que caracterizaran y documentaran el papel de este profesional en el sector. Respecto a ello, varias providencias fueron llevadas a cabo por la gerencia de enfermería ambulatoria en asociación con los enfermeros del sector, entre ellas la implementación de la consulta de enfermería, con el fin de contribuir para perfeccionar el registro de la atención prestada y mejorar la comunicación entre los miembros del equipo de enfermería de aquel sector. Se estableció de enfermería y se percibió mayor seguridad para el paciente y equipo de enfermería durante todos los procedimientos realizados. La concienciación y el conocimiento sobre la relevancia de la actuación profesional del enfermero en este tipo de servicio deben ser basados en la calidad de la asistencia prestada y en el diferencial que la enfermería trae para la calidad de la atención al usuario.

ABSTRACT The objective of this study was to report the experience of implementing Nursing Consultation into the endoscopy service at the Federal University of Santa Catarina's University Hospital. Ever since nurses have been assigned an exclusive place at the institution's Endoscopy Center, there has been a need to elaborate guidelines so as to characterize and document the role of this professional at the sector. In this regard, several actions have been taken by the outpatient nursing management in partnership with nurses at the sector, including implementation of nursing consultation aimed at enhancing the registering of provided assistance and improving communication between nursing team members of that sector. Once the nursing process was instituted, both patient and nursing team were provided greater security during all procedures performed. Awareness and knowledge about the relevance of a nurse's professional practice at this type of service should be based on the quality of the provided assistance and on the difference nursing makes to the quality of user service.

Percepción del paciente oncológico sobre la calidad del cuidado de enfermería durante el procedimiento endoscópico en el Servicio de Endoscopía y Cirugía Menor del Instituto Nacional de Enfermedades Neoplásicas. Año 2015 / Perception of the cancer patient about the quality of the nursing care during the endoscopic procedure in the Service of Endoscopy and Minor Surgery of the National Institute of Neoplastic Diseases. Year 2015

Objetivos: Determinar la percepción del paciente acerca de la calidad de atención que brinda la enfermera en el componente interpersonal y de confort, en el Servicio de endoscopia y cirugía menor del INEN durante los meses de enero a diciembre del 2014. Material y Método: El presente estudio es de un nivel aplicativo, tipo cuantitativo, método descriptivo, prospectivo transversal. El estudio se realiza en el instituto Nacional de Enfermedades Neoplásicas en el Servicio de endoscopia y cirugía menor. La muestra se obtuvo mediante el muestreo aleatorio siempre conformado por 100 pacientes ambulatorios del servicio de endoscopia y cirugía menor. Resultados: la calidad percibida e atención de la enfermera por los pacientes del servicio de endoscopia es mejor de lo que se esperaba ya que un 83 por ciento está satisfecho con dicha atención integral y un 20 por ciento esta medianamente favorable con tendencia a desfavorable, en cuanto al sexo se puede evidenciar que un 72 por ciento son varones y un 17 por ciento son mujeres. En cuanto a la edad se puede ver que entre los 40-59 años hay un porcentaje elevado de 58 por ciento siguiéndole los de 60-70 años con 28 por ciento y finalizando con los que tienen 20-39 con 14 por ciento. Conclusiones: De acuerdo a la Teoría de la Desconfirmación de Expectativas de Oliver y los postulados de Parasuranan et al, el 83 por ciento de los pacientes evidenció altos niveles de calidad percibida de la Atención de Enfermería, el 20 por ciento modestos niveles de calidad percibida y cuyos resultado son coherente con otros estudios, los cuales muestran que la Calidad Percibida como buena oscila entre el 100 por ciento.

Objectives: To determine the patient's perception about the quality of care provided by the nurse in the interpersonal component and comfort in the service endoscopy and minor surgery INEN during the months of January to December 2014. Material and Methods: This study is a cross-application level, quantitative type, descriptive method, prospective. The study was conducted at the National Institute of Neoplastic Diseases in the Department of endoscopy and minor surgery. The sample was obtained by random sampling always made up of 100 outpatient endoscopy service and minor surgery. Results: perceived quality and care nurse for patients endoscopy service is better than expected and that 83 per cent are satisfied with such comprehensive care and 20 per cent is fairly favorable prone to unfavorable as to sex may show that 72 per cent are male and 17 per cent are women. In terms of age it can be seen that there are between 40-59 years a high percentage of 58 per cent following in the 60-70 years with 28 per cent and ending with those 20-39 with 14 per cent. Conclusions: According to the theory of disconfirmation of Expectations Oliver and postulates of Parasuranan et al, 83 per cent of patients showed high levels of perceived quality of nursing care, 20 per cent modest levels of perceived quality and whose results are consistent with other studies, which show that the perceived quality as good ranges from 100 per cent.

Endoscopy nurse-administered propofol sedation performance. Development of an assessment tool and a reliability testing model.

OBJECTIVE: A gold standard of skills required for nurse-administered propofol sedation (NAPS) for gastroenterological endoscopic procedures has been proposed but not established. Due to the potentially hazardous nature of NAPS, an assessment tool is needed to objectively judge the adequacy of training and for future certification. The aim of this study was to develop an assessment tool for measuring competency in propofol sedation and to explore the reliability and validity of the tool. MATERIAL AND METHODS: The nurse-administered propofol assessment tool (NAPSAT) was developed in a Delphi-like fashion. Consensus was achieved on 17 items. Validity evidence was gathered in a case-control study in a full-scale simulation setting. Six experienced nurses and six novice nurses were filmed in two scenarios for assessment according to the assessment tool by three content expert raters. RESULTS: A total of 72 NAPSAT assessment forms were analyzed. Inter-rater reliability, Cronbach's α = 0.54 and generalizability coefficient = 0.68. The experienced nurses scored higher than the novices, 52.8 versus 62.7, p = 0.009. The provided pass/borderline/fail assessment showed significant difference, p = < 0.001, Cronbach's α = 0.80, with the novices being more likely to fail and the experienced more likely to pass. CONCLUSION: Assessing sedation skills in a simulator is possible. Video assessment requires expert knowledge of the procedure and the rating matrix. Overall, NAPSAT showed fair inter-rater reliability and good construct validity. This makes NAPSAT fit for formative assessment and proficiency feedback; however, high stakes and summative assessment cannot be advised.

Physical attributes of endoscopy nurses related to musculoskeletal problems.

The purpose of this research study was to determine whether specific attributes of endoscopy nurses such as age, body mass, or height contribute to neck, shoulder, or back problems. Study participants included endoscopy nurses who physically assist with endoscopic procedures (hands-on assist). Participants with preexisting neck, shoulder, or back injury prior to employment in endoscopy were excluded. Study participants completed the Standardized Nordic Questionnaire. Results suggested that age or height of less than 68 inches were not contributing factors to neck, shoulder, or back problems. Nurses with a body mass index (BMI) of 25 or more had significantly more upper back problems in the past 12 months. Nurses with BMI of 25 or more and/or those who were taller than 68 inches had a significantly higher incidence of upper and lower back problems that prevented work in the previous 12 months and occurred within the previous 7 days. Nurses with a BMI of 25 or more and/or who are 68 inches or taller should be aware of their higher risk for upper and lower back problems, and adjustments need to be made to their work practice and environment.

Endoscopy during a missile attack: a military dilemma for civilians.

In modern warfare, civilian populations may find themselves under immediate personal danger with very little warning. While there are ways to minimize this danger, there is a paucity of literature discussing this modern dilemma, and it is therefore important to try to address these situations in advance both logistically and ethically. Discussion of this case includes several relevant ethical principles.

Quality assurance in endoscopy nursing.

Since the 1960s quality assurance has become an integral part of medicine and nursing. The aims of quality assurance cover patient and staff safety and satisfaction, economical factors and the implementation of health care policy. Endoscopy units can be established in hospitals, primary care or ambulatory endoscopy centres. The quality of endoscopy facilities should be the same irrespective where endoscopy is carried out. Endoscopy staff is responsible for individualised, comprehensive patient care, technical assistance including reprocessing, documentation and management of endoscopy units. Quality criteria for endoscopy nursing cover pre, intra and post procedure care. However, a complete separation between clinical medical and nursing outcome criteria is often difficult in Endoscopy, as the clinical interventions are a combination of both medical and nursing actions. It is the combined effort of all staff with the support from the health care provider that leads to a high quality of patient care in Endoscopy.

The incidence of upper extremity injuries in Canadian endoscopy nurses.

Work-related musculoskeletal injuries occur at an epidemic rate in Canada. Many thousands of workers are temporarily or permanently removed from the workforce annually because of this type of injury. Workers who are most susceptible to this type of injury are those who perform physical, repetitive work involving sustained activity in awkward positions and cramped environments. Workers in the healthcare sector experience one of the highest rates of this type of injury annually. Injury prevention programs are being developed and instituted by government agencies and employers in an attempt to reduce the frequency of occurrence of this type of injury. In spite of attempts to prevent these injuries, musculoskeletal injuries of the upper extremity, neck, and back continue to occur in healthcare workers including nurses. Endoscopy nurses experience upper extremity injuries at work. The purpose of this study was to explore whether the occurrence of upper extremity injuries is common in this population of nurses and to identify factors that may be associated with these injuries. Results reveal that for this sample of Canadian nurses, older endoscopy nurses are at greater risk of injury. Nurses with injuries tended to self-prescribe treatment of their injuries. They also took anti-inflammatory medications and painkillers for their symptoms and saw their doctors for their conditions. Physiotherapist involvement was not common. Thirty-two percent of the endoscopy nurses in this study missed work because of upper extremity pain. Considering the number of nurses working in Canada, this percentage suggests a significant number of sick days, indicating a cause for concern, exploration, and further prevention measures.

Multimedia article. Successful endoscopic wire-guided balloon dilatation of angulated and tight ileal pouch strictures without fluoroscopy.

BACKGROUND: Ileal pouch strictures that are visually inaccessible by an endoscope may be balloon-dilated by exchange guide wire across the stricture with the aid of fluoroscopy. We present a technique of wire-guided balloon dilation without fluoroscopy to navigate strictures in the ileal pouch. METHODS: A 50-year-old Caucasian female presented with a 24-year history of ulcerative colitis (UC) with restorative proctocolectomy and ileal pouch anal anastomosis (IPAA) for 7 years. She developed Crohn's disease (CD) of the pouch with multiple strictures at the afferent limb of the pouch and a pouch-vaginal fistula. On pouchoscopy, the patient had two strictures at the distal neoterminal ileum, at 10 cm and 15 cm proximal to the pouch inlet. In retrospect, the distal stricture was angulated and 1 cm in length, and the proximal one was ulcerated and pinhole in size, which prevented the passage of an endoscope (9.8-mm single-channel, GIF-H180; Olympus Optical, Tokyo, Japan). The stricture number and locations were confirmed by retrograde water-soluble contrast X-ray. There was great difficulty in negotiating the strictures with balloon dilation and hence concern that blind passage of the balloon into the strictures might induce mucosal trauma or perforation. A controlled radial expansion (CRE) wire-guided balloon dilation catheter (CRE TM Single-Use Wire Guided Balloon Dilator; Boston Scientific Microvasive, Natick, MA) was introduced through the scope. Wire exchange technique was applied with help of our endoscopy nurse (A.O.). The guide wire was passed through the strictures without any resistance under endoscopy view. Subsequently, the balloon was introduced across the strictures, and both were successfully dilated to 16 mm (Videos 1 and 2). RESULTS: The procedure and postprocedure course were uneventful, and patient reported great symptomatic relief. CONCLUSION: Endoscopic guide-wire balloon dilation without fluoroscopic guidance appears to be feasible for CD-related strictures in experienced hands.