Biofilm accumulation in new flexible gastroscope channels in clinical use.

OBJECTIVE: Assess the accumulation of protein and biofilm on the inner surfaces of new flexible gastroscope (FG) channels after 30 and 60 days of patient use and full reprocessing. DESIGN: Clinical use study of biofilm accumulation in FG channels. SETTING: Endoscopy service of a public hospital. METHODS: First, we tested an FG in clinical use before the implementation of a revised reprocessing protocol (phase 1 baseline; n = 1). After replacement of the channels by new ones and the implementation of the protocol, 3 FGs were tested after 30 days of clinical use (phase 2; n = 3) and 3 FGs were tested after 60 days of clinical use (phase 3; n = 3), and the same FGs were tested in phase 2 and 3. Their biopsy, air, water, and air/water junction channels were removed and subjected to protein testing (n = 21), bacteriological culture (n = 21), and scanning electron microscopy (SEM) (n = 28). Air-water junction channels fragments were subjected to SEM only. RESULTS: For the FGs, the average number of uses and reprocessing cycles was 60 times. Extensive biofilm was detected in air, water, and air-water junction channels (n = 18 of 28). All channels (28 of 28) showed residual matter, and structural damage was identified in most of them (20 of 28). Residual protein was detected in the air and water channels of all FG evaluated (phases 1-3), except for 1 air channel from phase 2. Bacteria were recovered from 8 of 21 channels, most air or water channels. CONCLUSIONS: The short time before damage and biofilm accumulation in the channels was evident and suggests that improving the endoscope design is necessary. Better reprocessing methods and channel maintenance are needed.

Enzymatic detergent reuse in gastroscope processing: a potential source of microorganism transmission.

OBJECTIVE: to evaluate the potential contamination of enzymatic detergent from its reuse and to identify the microbiological profile in the solution used to clean gastrointestinal endoscopic devices. METHOD: cross-sectional study based on microbiological analysis of 76 aliquots of 19 different enzymatic detergent solutions used to clean endoscopic devices. The aliquots were homogenized, subjected to Millipore® 0.45 µm membrane filtration and the presumptive identification of microorganisms was performed by biochemical-physiological methods according to previously established specific bacterial groups that are of clinical and epidemiological relevance. RESULTS: the mean values, as well as the standard deviation and the median, of the enzymatic detergent microbial load increased as the solution was reused. There was a significant difference between the means of after first use and after fifth reuse. A total of 97 microorganisms were identified, with predominance of the coagulase-negative Staphylococcus, Pseudomonas spp., Klebsiella spp., Enterobacter spp. genus, and Escherichia coli species. CONCLUSION: the reuse of the enzymatic detergent solution is a risk to the safe processing of endoscopic devices, evidenced by its contamination with pathogenic potential microorganisms, since the enzymatic detergent has no bactericidal property and can contribute as an important source for outbreaks in patients under such procedures.

The Clinical Utility of Evaluating the Luminal Upper Gastrointestinal Tract During Linear Endoscopic Ultrasonography.

BACKGROUND: The clinical utility of performing esophagogastroduodenoscopy (EGD) before linear endoscopic ultrasonography (L-EUS) to evaluate the luminal upper gastrointestinal (GI) tract is not well established. GOALS: The study was aimed to determine the prevalence of clinically meaningful luminal abnormalities (any luminal finding requiring further evaluation with mucosal biopsy or initiation of treatment) in patients undergoing L-EUS. The study also sought to compare the ability of the gastroscope and the linear echoendoscope in identifying these lesions. STUDY: A prospective, multicenter cohort study enrolled patients undergoing L-EUS for nonluminal indications. All patients underwent EGD followed by L-EUS by 2 different endoscopists. The second endoscopist was blinded to the results of the initial EGD. The identification of clinically meaningful luminal lesions and quality of endoscopic visualization of the upper GI tract were measured. RESULTS: In the cohort of 175 patients, 52 (29.7%) patients had clinically meaningful luminal findings seen in the upper GI tract. There was no significant difference in the number of clinically meaningful lesions identified on EGD and L-EUS (25.1% vs. 22.9%, P=0.39). No significant difference was found in the miss rate of clinically meaningful lesions between the 2 modalities (EGD: 4.5% vs. EUS: 6.9%, P=0.39). CONCLUSIONS: A substantial minority of patients undergoing L-EUS for nonluminal indications will have clinically meaningful luminal findings. The endoscopic evaluation of the luminal upper GI tract can be adequately achieved using the linear echoendoscope.

Effectiveness of flexible gastrointestinal endoscope reprocessing.

The practice of reprocessing endoscopes and its effectiveness was evaluated in 37 services. Contamination of at least 1 endoscope could be identified in 34 (91.6%) of 37 services. Bacteria, fungi, and/or mycobacteria were isolated from 84.6% (33/39) of the colonoscopes (110-32,000 colony-forming units [CFUs]/mL) and from 80.6% (50/62) of the gastroscopes (100-33,000 CFUs/mL). Not all services followed recommended guidelines. Therefore, patients who underwent gastrointestinal endoscopies were exposed to diverse pathogens.

Totally NOTES (T-NOTES) transvaginal cholecystectomy using two endoscopes: preliminary report.

BACKGROUND: Clinical applications of transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) are still limited in the literature, mostly case reports performed by hybrid procedures with laparoscopic assistance. Avoiding complications from incisions is the main goal for natural orifice surgery. This study reports on a technique developed at our institution that uses two endoscopes inserted into the vagina to perform a Totally NOTES (T-NOTES) transvaginal cholecystectomy, and describes preliminary results. METHODS: IRB approval was obtained at the institution for transvaginal NOTES clinical trials, and informed consent was obtained. The technique of T-NOTES transvaginal cholecystectomy was clinically applied in four female patients with symptomatic cholelithiasis, and data were prospectively documented. Transvaginal NOTES access was obtained by direct vaginal incision, and two endoscopes were simultaneously introduced in the abdominal cavity. Dissection was accomplished with available endoscopic instruments. Ligation of cystic duct and artery was performed using endoscopic clips. Vaginal closure was achieved using the direct-vision sutured technique. RESULTS: The technique was successfully performed in the four patients. Insufflation and spatial orientation was of good quality. Mean operative time was 210 min. There were no complications during the 30-day follow-up. Postoperative course was uneventful, and patients were released from the hospital on the first postoperative day. CONCLUSION: Tranvaginal T-NOTES using two endoscopes provides a feasible method for natural orifice cholecystectomy using available technology. Large-series studies are needed to evaluate the results with respect to safety of the approach.

Endoscopic findings in the excluded stomach after Roux-en-Y gastric bypass surgery.

HYPOTHESIS: After gastric bypass surgery performed because of morbid obesity, the excluded stomach can rarely be endoscopically examined. With the advent of a new apparatus and technique, possible mucosal changes can be routinely accessed and monitored, thus preventing potential benign and malignant complications. DESIGN: Prospective observational study in a homogeneous population with nonspecific symptoms. SETTING: Outpatient clinic of a large public academic hospital. PATIENTS: Forty consecutive patients (mean +/- SD age, 44.5 +/- 10.0 y ears; 85.0% women) were seen at a mean +/- SD of 77.3 +/- 19.4 months after Roux-en-Y gastric bypass surgery. INTERVENTION: Elective double-balloon enteroscopy of the excluded stomach was performed. MAIN OUTCOME MEASURES: Rate of successful intubation, endoscopic findings, and complications. RESULTS: The excluded stomach was reached in 35 of 40 patients (87.5%). Mean +/- SD time to enter the organ was 24.9 +/- 14.3 minutes (range, 5-75 minutes). Endoscopic findings were normal in 9 patients (25.7%), whereas in 26 (74.3%), various types of gastritis (erythematous, erosive, hemorrhagic erosive, and atrophic) were identified, primarily in the gastric body and antrum. No cancer was documented in the present series. Tolerance was good, and no complications were recorded during or after the intervention. CONCLUSIONS: The double-balloon method is useful and practical for access to the excluded stomach. Although cancer was not noted, most of the studied population had gastritis, including moderate and severe forms. Surveillance of the excluded stomach is recommended after Roux-en-Y gastric bypass surgery performed because of morbid obesity.

Cáncer gástrico precoz: reporte de dos casos y revisión de la literatura: Servicio de Cirugía General del Hospital Universitario de Los Andes-Mérida / Early gastric cancer: report of a two cases and review of the literature: Service General of Surgery del Hospital Universitario de Los Andes-Mérida

Presentar dos casos clínicos de una patología frecuente, pero con diagnóstico precoz infrecuente. Revisión de la literatura y descripción de dos casos clínicos tratados en el Servicio de Cirugía General del Instituto Autónomo Hospital Universitario de Los Andes, Mérida-Venezuela, uno de ellos con el diagnóstico de cáncer gástrico precoz III antral, histológicamente adenocarcinoma bien diferenciado con compromiso de la submucosa, y otro con el diagnóstico de cáncer gástrico precoz lla + llc en cuerpo, histológicamente adenocarcinoma bien diferenciado que infiltra hasta la mitad superior de la submucosa sin linfoadenopatías, al que se le hizo ganglio centinela con azul patente infiltrado intramucoso, ambos fueron tratados quirúrgicamente con gastrectomía subtotal distal 75 por ciento D2 con una buena evolución post-operatoria y una sobrevida a los 5 años y 16 meses respectivamente. El carcinoma gástrico precoz de la clasificación de la Sociedad Japonesa de Gastroenterología se define como aquella neoplasia maligna confinada a la mucosa o submucosa del órgano, independientemente de la presencia de metástasis. Los programas de pesquisa para cáncer gástrico en zonas de alta incidencia, como Japón y China han permitido el diagnóstico de lesiones incipientes cercanas al 50 por ciento, pero en países subdesarrollados como el nuestro, estas lesiones se diagnóstican tan sólo en alrededor de 7-10 por ciento de los casos. El diasnóstico es basado en el examen histopatológico del fragmento resecado endoscópicamente o quirúrgicamente. Por considerarse como curable, es que su diagnóstico revise fundamental importancia en el pronóstico y sobrevida, la cual a los 5 años es mayor del 90 por ciento.

[Microbiological evaluation of gastroscope decontamination by electrolysed acid water (Clentop WM-1)]. / Análise microbiológica de gastroscópios descontaminados em aparelho Cleantop WM-1 por uso de água eletrolítica ácida.

BACKGROUND: The manual disinfection of endoscopes with glutharaldeyde is widely employed. The great routine in gastroenteroscopy services, low number of equipment and the lack of technical knowledge about the decontamination processes are factors that stimulate the inadequate endoscope disinfection, intensifying the risk of transmission of microorganisms. The electrolysed acid water has been effective in the inactivation and destruction of microorganisms. AIM: The purpose of this investigation was to verify the microbicidal efficiency of electrolyzed acid water (Cleantop WM-1) to decontaminate gastroscopes after their using in patients. MATERIAL AND METHODS: Samples from biopsy channel of flexible endoscopes collected after patient use (n = 20) and after disinfection (n = 20) were cultivated in tryptic soy agar, MacConkey agar and Sabouraud dextrose agar. RESULTS: Seventeen of the 20 samples collected after patients examination yielded gram-negative bacilli, gram-positive coccus and yeast cells in contamination of 3 to 5 log10 ufc/mL. Microbial growth was not verified in samples collected after the decontamination process. Conclusion - In this preliminary study, the mechanical disinfection carried through the Cleantop device with electrolyzed acid water showed satisfactory results for the elimination of microorganisms and time optimization in the reprocessing of gastroscopes.

Análise microbiológica de gastroscópios descontaminados em aparelho Cleantop WM-1 por uso de água eletrolítica ácida / Microbiological evaluation of gastroscope decontamination by electrolysed acid water (Clentop WM-1)

RACIONAL: O método com utilização manual de glutaraldeído é amplamente empregado para desinfecção de endoscópios. A elevada rotina nos serviços de gastroscopia, pequena quantidade de equipamentos e a falta de conhecimento técnico sobre os processos de descontaminação contribuem para desinfecção inadequada dos endoscópios, intensificando o risco de transmissão de microrganismos. A água eletrolítica ácida tem apresentado eficácia na inativação e destruição de microrganismos e vem sendo usada na descontaminação de endoscópios. OBJETIVO: Verificar a eficiência microbicida da água eletrolítica ácida, produzida pelo aparelho Cleantop WM-1, em 20 gastroscópios contaminados após uso em pacientes. MATERIAL E MÉTODOS: Amostras coletadas do canal de biopsia dos endoscópios, após uso em pacientes (n = 20) e depois da desinfecção (n = 20), foram cultivadas em ágar tripticaseína de soja, MacConkey e Sabouraud dextrose. RESULTADOS: Dezessete das 20 amostras coletadas após o uso do aparelho em pacientes revelaram a presença de bacilos gram-negativos, cocos gram-positivos e leveduras em taxas de 103 a 105 ufc/mL. Nenhuma amostra, das 20 coletadas após a descontaminação, apresentou contaminação microbiana. CONCLUSÃO: Nesse estudo preliminar, a desinfecção mecânica realizada pelo aparelho Cleantop com água eletrolítica ácida revelou resultados satisfatórios pela eliminação de microrganismos e otimização no tempo de processamento dos gastroscópios.

Evaluación endoscópica de la mucosa gástrica del canino después de la administración oral de ácido acetil-salicílico en dosis terapéuticas durante 28 días / Canine gastric mucosal endoscopic evaluation after oral acetil-salicylic acid administration at therapeutic doses during 28 days

La mucosa gástrica de 18 caninos sanos fue examinada con un gastroscopio cada 7 días, durante la administración oral de ácido acetil-salicílico (aspirina) dos veces al día por un período de 28 días. Los caninos fueron divididos en 3 grupos, cada grupo constituido por seis. El grupo A como grupo control al cual no se le administró tratamiento. El grupo B al cual se le administró aspirina a dosis de 10mg/kg. El grupo C quienes recibieron una dosis de 20mg/kg. Los signos clínicos observados fueron anorexia y hematemesis, este último estuvo presente en un solo canino. Las lesiones gástricas fueron observadas sólo en los grupos B y C, las cuales aparecieron como lesiones petequiales, de petequiales a víbices, víbices, víbices a esquimóticas y úlcera. Utilizando el modelo estadístico de Kruskall-Wallis se observó que la presencia de lesiones en los grupos experimentales B y C con respecto al grupo control se debieron a la administración de aspirina. De acuerdo al modelo estadístico U de Mann-Whitney con respecto a la presencia de lesiones entre grupos B y C, no hubo diferencia significativa, es decir, ambas dosis ocasionaron efectos similares. Con respecto a la ubicación de la lesión las mismas fueron observadas en el cardias, cuerpo, fundus, antro, píloro e incisura angularis

[Percutaneous endoscopic gastrostomy. An alternative for long-term enteral feeding]. / Gastrostomía endoscópica percutánea. Una alternativa para la alimentación enteral a largo plazo.

This study shows that, in our environment, percutaneous endoscopic gastrostomy is feasible in most patients who need it, and at the same time it is a fast, safe and inexpensive procedure. The complication rate is low and most can be resolved rapidly medically or endoscopically. It also allows the placement of a permanent means for the administration of nutrients and for drainage of gastroduodenal secretions in those patients who warrant it.

Gastrostomía endoscópica percutánea: una alternativa para la alimentación enteral a largo plazo / Percutaneous endoscopic gastrostomy: an alternative for long-term enteral feeding

This study shows that, in our environment, percutaneous endoscopic gastrostomy is feasible in most patients who need it, and at the same time it is a fast, safe and inexpensive procedure. The complication rate is low and most can be resolved rapidly medically or endoscopically. It also allows the placement of a permanent means for the administration of nutrients and for drainage of gastroduodenal secretions in those patients who warrant it

[Endoscopic resection in early gastric cancer]. / Resección endoscópica en cáncer gástrico precoz.

Development of therapeutic endoscopy has permitted the treatment of early gastric cancer (EGC) in its different macroscopic forms. In this paper we present 9 cases of EGC treated endoscopically in our Institution. We describe the criteria we follow to perform this procedure. The patients selected were of advanced age and high surgical risk. Seven cases were macroscopically Type I and two were Type IIa. According to localization six were proximal tumors (body and fundus) and three were located in the antrum. Six of the nine patients are alive after resection, one more than 6 years and 3 more than 3 years. Three patients died of ailments no related to cancer.