Infection prevention in endoscopy practice: comparative evaluation of re-usable vs single-use endoscopic valves.

Re-usable air/water and suction valves used in endoscopes often demonstrate risk of infection. To the authors' knowledge, the safety and efficacy of re-usable and single-use valves have not been compared to date. As such, a laboratory investigation was undertaken to compare the safety and efficacy of re-usable and single-use valves at 11 Italian endoscopy sites. Safety was evaluated by analysing the rinse liquid of reprocessed re-usable valves ready for use, and efficacy was assessed based on the completion of endoscopic procedures without valve malfunction. This study found significantly lower contamination of single-use valves compared with re-usable valves (0 vs 29.1%, respectively; P=0.007) and similar efficacy (97.6 vs 98.8%, respectively; P=ns). Microbiological analysis of the rinse liquid of reprocessed re-usable valves identified various surviving micro-organisms and highlighted their potential pathogenicity. Such data suggest that sterile single-use valves may be safer than re-usable valves, and have comparable performance.

Screening for and surveillance of Barrett's esophagus is clinically indicated.

Barrett's esophagus (BE) is a complication of chronic gastroesophageal reflux disease (GERD) and is the precursor of esophageal adenocarcinoma (EA), through a progression from intestinal metaplasia (IM), through high-grade dysplasia (HGD). Although the progression from BE to EA seems to be infrequent (0.5% per year), endoscopic and bioptic surveillance would play a significant role in the evaluation of HGD and the detection of EA in early, curable stage, improving survival rates after treatments. The severity and the duration of GERD could be helpful in the assessment of the risk for BE and to enroll these subjects into screening protocols to detect any dysplastic or neoplastic change. The benefits of screening-surveillance programs could be furthermore enhanced by an improvement in diagnostic methods, such as high-resolution endoscopic techniques and the use of biomarkers for the histological examination seems to play a primary role in the cancer risk stratification; in such way, endoscopic resection techniques (mucosal resection and submucosal dissection) can be considered as a helpful method to stage dysplastic changes in BE.

Dilated intercellular spaces as markers of reflux disease: histology, semiquantitative score and morphometry upon light microscopy.

BACKGROUND AND AIMS: A recent electron microscopy study suggested that dilated intercellular spaces (DIS) are specific for acid reflux-damaged esophageal epithelium. Electron microscopy is, however, expensive and difficult to apply to routine biopsies. The aims of this study are to establish a method for assessing DIS on light microscopy of esophageal biopsies and to estimate its association with current clinicopathological parameters of esophagitis. MATERIALS AND METHODS: 21 patients with reflux symptoms were investigated. Light microscopy biopsies were assessed for DIS size by a semiquantitative method and computer-assisted, static morphometry. A DIS score accounting for DIS size and distribution was assigned to each patient and its association with 30 clinicopathological variables investigated by univariate and multivariate logistic regression. RESULTS: Both the semiquantitative method and static morphometry identified 4 different classes of DIS size. The DIS score was significantly and independently associated with the esophageal symptoms score, the histological score of esophagitis and the relevant morphometry data. CONCLUSIONS: DIS may be efficiently assessed during light microscopy of routine esophageal biopsies. Since correlation with both the histology and the symptoms of esophagitis, the DIS score may be considered a novel parameter of esophagitis and is suggested for the routine evaluation of esophageal biopsies in patients with reflux disease.