Occupational risk prevention in endoscopy units: a pending issue.

UNLABELLED: The degree of Knower and compliance with occupational risk prevention measures in the Spanish gastrointestinal endoscopy units is unknown. AIM: 1. To assess compliance with occupational risk prevention measures in GIE units. 2. To determine which factors influence the fulfillment of occupational risk prevention measures. METHODS: a validated survey was supplied to 300 GIE units, including questions on: 1. General occupational risk prevention measures; 2. occupational risk prevention measures during disinfection; 3. occupational risk prevention measures during examination. The following Hospital or GIE Unit characteristics were evaluated: Type of hospital according to the Spanish National Health Service; Number of hospital beds; Advanced diagnostic and therapeutic procedures performed and; Centers providing training in the field of endoscopy. RESULTS: response: 196 GIE units (65%). 104 GIE units (53% CI95%: 46-60) fulfill less than 50% of the occupational risk prevention measures studied.The RR of less than 50% of the ORP measures being fulfilled is 1.975 times higher at public hospitals than at private facilities (CI95%: 1.11-3.52). None of the remaining factors analyzed proved to have a significant influence. CONCLUSIONS: compliance with occupational risk prevention measures in Spanish GIE units is inadequate and must be improved. Public hospitals in Spain comply with fewer occupational risk prevention measures than their private counterparts.

Prevención de riesgos laborales en unidades de endoscopia. Una asignatura pendiente / No disponible

En la actualidad desconocemos el grado de conocimiento y aplicación de medidas de prevención de riesgos laborales en las Unidades de Endoscopia Españolas. Objetivo: valorar la aplicación de la prevención de riesgos laborales en las unidades de endoscopia y establecer los factores que determinan su cumplimiento. Diseño: se pasó un cuestionario validado a 300 unidades de endoscopia. Se incluían preguntas sobre: Medidas generales de pre - vención de riesgos laborales, medidas de prevención durante la desinfección y medidas de prevención durante las exploraciones. Se valoraron el tipo de hospital en función de su adscripción al sistema público de salud, el tamaño de los hospitales según el número de camas, la realización o no de técnicas avanzadas y la realización de docencia de endoscopia o no. Se estimó el porcentaje de cumplimiento de cada medida con un intervalo de confianza del 95% y se realizó una regresión logística para determinar los factores que determinan su cumplimiento. Resultados: respondieron 196 unidades (65%). 104 (53% CI95%: 46-60) cumplían menos del 50% de las medidas de PRL estudiadas. Los Hospitales Españoles de titularidad pública tienen un RR 1,975 veces mayor (IC95%: 1.11-3.52) de aplicar menos del 50% de las medidas de PRL frente a los privados. El resto de los factores estudiados no mostraron influencia significativa. Conclusiones: la aplicación de medidas de prevención de riesgos laborales en las unidades de endoscopia españolas no es adecuada y debe ser mejorada. Los hospitales públicos cumplen con menor número de medidas que los privados(AU)

The degree of Knower and compliance with occupational risk prevention measures in the Spanish gastrointestinal endoscopy units is unknown. Aim: 1. To assess compliance with occupational risk prevention measures in GIE units. 2. To determine which factors influence the fulfillment of occupational risk prevention measures. Methods: a validated survey was supplied to 300 GIE units, including questions on: 1. General occupational risk prevention measures; 2. occupational risk prevention measures during disinfection; 3. occupational risk prevention measures during examination. The following Hospital or GIE Unit characteristics were evaluated: Type of hospital according to the Spanish National Health Service; Number of hospital beds; Advanced diagnostic and therapeutic procedures performed and; Centers providing training in the field of endoscopy. Results: response: 196 GIE units (65%). 104 GIE units (53% CI95%: 46-60) fulfill less than 50% of the occupational risk prevention measures studied. The RR of less than 50% of the ORP measures being fulfilled is 1.975 times higher at public hospitals than at private facilities (CI95%: 1.11-3.52). None of the remaining factors analyzed proved to have a significant influence. Conclusions: compliance with occupational risk prevention measures in Spanish GIE units is inadequate and must be improved. Public hospitals in Spain comply with fewer occupational risk prevention measures than their private counterparts(AU)

[Internet use to obtain health information among patients attending a digestive diseases office]. / Uso médico de Internet entre los pacientes de una consulta general de enfermedades del aparato digestivo.

INTRODUCTION: The use of the Internet to gain health information has increased in Spain. This is changing the way patients access medical information and, in turn, the physician-patient relationship. OBJECTIVES: To analyze the use of the Internet for medical purposes by patients attending a digestive diseases office and to determine the profile of patients seeking this information. MATERIAL AND METHODS: A questionnaire was administered to consecutive patients attending a general digestive diseases office for the first time. RESULTS: Four hundred twenty-three patients completed the questionnaire (56% women, 44% men, mean age 42.63 [15.994] years). A total of 2.4% had only not completed basic education, 14% had completed basic education, 32.8% had completed high school, 50.6% had university degrees, and 0.2% did not answer. More than three-quarters (76.4%) had a computer at home and 72% had internet access. Forty-two percent looked for health information on the internet. Seventeen percent had searched for specific information on their illnesses before consulting and 66% believed the internet is a good resource for obtaining medical information. Seventy percent would be interested in a specific web page on digestive disease topics and 75% would use e-mail to consult with their physicians. The group that most frequently looked for medical information consisted of patients aged 45 years or younger with secondary school or university education. CONCLUSIONS: In our environment, patients with digestive diseases routinely use the Internet to search for medical information. These patients have a high degree of confidence in the information obtained and would be interested in a specific website devoted to diseases of the digestive system. The patients that most frequently searched for health information were aged less than 45 years old and had secondary school education or university degrees.

Uso médico de Internet entre los pacientes de una consulta general de enfermedades del aparato digestivo / Internet use to obtain health information among patients attending a digestive diseases office

No disponible

Hematoma disecante de esófago: una rara complicación de la hemodiálisis / Dissecting hematoma of the esophagus: a rare complication of hemodialysis

No disponible

Reliability of the Spanish version of a brief questionnaire on patient satisfaction with gastrointestinal endoscopy.

BACKGROUND: There has not been a validated questionnaire available in Spanish to evaluate patient satisfaction with gastrointestinal endoscopy. Our aim was to evaluate the external validity and internal consistency of the Spanish version of a questionnaire on patient satisfaction with gastrointestinal endoscopy elaborated by the American Society for Gastrointestinal Endoscopy. DESIGN: Prospective questionnaire validation study. PATIENTS AND METHODS: A total of 485 consecutive patients referred to two different hospitals for endoscopy were interviewed by telephone. Internal consistency was studied using Cronbach's alfa test and corrected item-total correlations (CITC). External validity was determined using a mailed questionnaire completed by 185 patients-correlations between telephone and postal responses were calculated, as well as the correlation with the total score obtained. RESULTS: Cronbach's alfa was 0.82 and mean CITC was 0.59. Weighted kappa values for the same questionnaire items performed by telephone or mail varied between 0.51 and 0.81. Total score correlation was 0.78. Internal consistency and external validity were not affected by differences in the administration of the questionnaire (mail or by telephone), different interviewers, type of endoscopy, or source of patients. CONCLUSIONS: The Spanish version of the ASGE questionnaire on satisfaction with endoscopy is valid, reliable, and reproducible.

Validación de un cuestionario breve sobre satisfacción del paciente en endoscopia digestiva / Reliability of the Spanish version of a brief questionnaire on patient satisfaction with gastrointestinal endoscopy

Objetivos: no se dispone en castellano de un cuestionario validadopara la valoración de la satisfacción del paciente en endoscopiadigestiva. Evaluar la validez externa y la consistencia internade la versión en castellano del cuestionario recomendado por laAmerican Society for Gastrointestinal Endoscopy sobre satisfacciónen endoscopia.Diseño experimental: estudio de validación de un cuestionario,recogida de datos prospectiva.Pacientes y métodos: cuatrocientos ochenta y cinco pacientesconsecutivos remitidos para endoscopia a dos hospitales diferentesfueron entrevistados telefónicamente. La validez interna seestudió mediante alfa de Cronbach y correlación total inter-ítemmedia. Para estimar la validez externa se remitió un cuestionarioanónimo a 185 pacientes y se calcularon las correlaciones entrelas respuestas dadas telefónicamente y por correo, así como la correlaciónen la puntuación global obtenida mediante la suma delos valores para las siete cuestiones del cuerpo principal del cuestionario.Resultados: la alfa de Cronbach fue de 0,82 y la CTITM de0,59. La kappa ponderada entre las mismas cuetiones en loscuestionarios administrados telefónica o anónimamente variaronentre 0,51 y 0,81. La correlación en la puntuación total fue de0,78. La validez interna y externa no se vio afectada por diferenciasen la administración del cuestionario (correo o telefónico), losdiferentes entrevistadores, el tipo de endoscopia o la procedenciade los pacientes.Conclusiones: la versión en castellano del cuestionario recomendadopor la ASGE sobre satisfacción en endoscopia es válida,fiable y reproducible

Background: there has not been a validated questionnaireavailable in Spanish to evaluate patient satisfaction with gastrointestinalendoscopy. Our aim was to evaluate the external validityand internal consistency of the Spanish version of a questionnaireon patient satisfaction with gastrointestinal endoscopy elaboratedby the American Society for Gastrointestinal Endoscopy.Design: prospective questionnaire validation study.Patients and methods: a total of 485 consecutive patients referredto two different hospitals for endoscopy were interviewed bytelephone. Internal consistency was studied using Cronbach’s alfatest and corrected item-total correlations (CITC). External validitywas determined using a mailed questionnaire completed by 185 patients–correlations between telephone and postal responses werecalculated, as well as the correlation with the total score obtained.Results: Cronbach´s alfa was 0.82 and mean CITC was 0.59.Weighted kappa values for the same questionnaire items performedby telephone or mail varied between 0.51 and 0.81. Totalscore correlation was 0.78. Internal consistency and external validitywere not affected by differences in the administration of thequestionnaire (mail or by telephone), different interviewers, typeof endoscopy, or source of patients.Conclusions: the Spanish version of the ASGE questionnaireon satisfaction with endoscopy is valid, reliable, and reproducible

[Utility of routine use of reversion after sedation in outpatient colonoscopy]. / Utilidad en la práctica clínica habitual de la reversión tras sedación en colonoscopia ambulatoria.

INTRODUCTION: Randomized clinical trials have demonstrated the effectiveness of flumazenil in reducing recovery time in the endoscopy unit after conscious sedation with midazolam and meperidine. However, its effectiveness in routine clinical practice has not been proved and therefore its use is debated. AIM: To determine the effectiveness of reversion with flumazenil after conscious sedation with midazolam and pethidine in outpatient colonoscopy and to evaluate its cost-effectiveness. MATERIAL AND METHOD: Two hundred consecutive outpatients scheduled for colonoscopy with conscious sedation with midazolam and pethidine in 2 endoscopy units were prospectively included. According to routine clinical practice in each unit, 100 patients were reverted with flumazenil and 100 were not. Medical and demographic data, indications for endoscopy, doses of the medications used and endoscopic findings were collected. Three weeks after the colonoscopy each patient was interviewed by telephone to determine discomfort and complications associated with the endoscopy and/or with the use of sedation. The cost-effectiveness of the use of flumazenil was analyzed. RESULTS: There were no differences between the two groups in age (52.9 +/- 15.5 vs 52.7 +/- 18.3, p = NS), indications for colonoscopy, findings, percentage of full colonoscopies (93 vs 95%; p = NS) or in the doses of sedatives used. The recovery time in each endoscopy unit was similar (19.2 +/- 11.7 vs 15.5 +/- 10.1 minutes, p = NS). In the reversion group there were fewer patients with prolonged stays, defined as those > 20 minutes (23 vs 11%, p < 0.001). The number of patients who remembered discomfort during the colonoscopy was significantly greater in the reversion group (23 vs 13%; p < 0.05). There were no differences in the number of patients who reported discomfort in the days following the endoscopy. The best cost-effectiveness ratio was obtained for a mean stay of 25 min. CONCLUSION: Routine use of reversion does not decrease the mean stay in the endoscopy unit but does decrease the number of prolonged stays. Unpleasant memories of the colonoscopy were more frequent in reverted patients. The effectiveness of the routine use of reversion with flumazenil after conscious sedation with midazolam and pethidine depends on the ratio between the number of daily colonoscopies and the capacity of the recovery room.

Utilidad en la práctica clínica habitual de la reversión tras sedación en colonoscopia ambulatoria / Utility of routine use of reversion after sedation in outpatient colonoscopy

Introducción: La reversión con flumazenilo ha demostrado, en ensayos clínicos aleatorizados, su eficacia para disminuir el tiempo de estancia de los pacientes en la sala de recuperación tras sedación con midazolam y meperidina. Sin embargo, su efectividad en la práctica clínica diaria no ha sido demostrada, por lo que su uso es muy debatido. Objetivo: Determinar la efectividad de la reversión con flumazenilo tras la sedación consciente con midazolam y petidina en colonoscopia ambulatoria y valorar su relación coste-efectividad. Material y método: Se estudió prospectivamente a 200 pacientes ambulatorios remitidos para colonoscopia y sedados con midazolam y meperidina, procedentes de 2 unidades de endoscopia. Siguiendo la práctica habitual de cada una de las unidades, 100 pacientes fueron revertidos con flumazenilo y 100 no. Se recogieron los datos demográficos y médicos, las indicaciones de la colonoscopia, la dosis de fármacos utilizada y los hallazgos de la endoscopia. Tres semanas después se realizó una encuesta telefónica para determinar las molestias y complicaciones asociadas a la endoscopia o la sedación. Se estudió la relación coste-efectividad. Resultados: No hubo diferencias entre ambos grupos en la edad (52,9 ± 15,5 frente a 52,7 ± 18,3 años; p = NS), en las indicaciones de la colonoscopia, en los hallazgos de la prueba, en el porcentaje de colonoscopias completas (el 93 frente al 95%; p = NS) ni en las dosis de midazolam y meperidina utilizadas. La estancia media en la unidad tras la exploración fue similar (19,2 ± 11,7 frente a 15,5 ± 10,1 min; p = NS). En el grupo de reversión había menos pacientes con estancias prolongadas –estancias de más de 20 min– (el 23 frente al 11%; p < 0,001). El número de pacientes que recordaban molestias durante la exploración era significativamente mayor en el grupo de reversión (el 23 frente al 13%; p < 0,05). No existían diferencias en el número de pacientes con molestias en días posteriores. La mejor relación coste-efectividad se conseguía cuando se buscaba una estancia media de 25 min. Conclusión: La reversión no disminuyó la estancia media en la unidad de endoscopia, pero bajó el número de estancias prolongadas. Los pacientes revertidos experimentan mayores recuerdos desagradables de la exploración. La efectividad del uso de la reversión con flumazenilo tras la sedación con midazolam y meperidina depende de la relación entre el número de exploraciones diarias de la unidad de endoscopia y la capacidad de su unidad de recuperación

Introduction: Randomized clinical trials have demonstrated the effectiveness of flumazenil in reducing recovery time in the endoscopy unit after conscious sedation with midazolam and meperidine. However, its effectiveness in routine clinical practice has not been proved and therefore its use is debated. Aim: To determine the effectiveness of reversion with flumazenil after conscious sedation with midazolam and pethidine in outpatient colonoscopy and to evaluate its cost-effectiveness. Material and method: Two hundred consecutive outpatients scheduled for colonoscopy with conscious sedation with midazolam and pethidine in 2 endoscopy units were prospectively included. According to routine clinical practice in each unit, 100 patients were reverted with flumazenil and 100 were not. Medical and demographic data, indications for endoscopy, doses of the medications used and endoscopic findings were collected. Three weeks after the colonoscopy each patient was interviewed by telephone to determine discomfort and complications associated with the endoscopy and/or with the use of sedation. The cost-effectiveness of the use of flumazenil was analyzed Results: There were no differences between the two groups in age (52.9 ± 15.5 vs 52.7 ± 18.3, p = NS), indications for colonoscopy, findings, percentage of full colonoscopies (93 vs 95%; p = NS) or in the doses of sedatives used. The recovery time in each endoscopy unit was similar (19.2 ± 11.7 vs 15.5 ± 10.1 minutes, p = NS). In the reversion group there were fewer patients with prolonged stays, defined as those > 20 minutes (23 vs 11%, p < 0.001). The number of patients who remembered discomfort during the colonoscopy was significantly greater in the reversion group (23 vs 13%; p < 0.05). There were no differences in the number of patients who reported discomfort in the days following the endoscopy. The best cost-effectiveness ratio was obtained for a mean stay of 25 min. Conclusion: Routine use of reversion does not decrease the mean stay in the endoscopy unit but does decrease the number of prolonged stays. Unpleasant memories of the colonoscopy were more frequent in reverted patients. The effectiveness of the routine use of reversion with flumazenil after conscious sedation with midazolam and pethidine depends on the ratio between the number of daily colonoscopies and the capacity of the recovery room

[Appropriateness of indications for upper gastrointestinal endoscopy in open-access endoscopy units]. / Idoneidad de las indicaciones de la endoscopia digestiva alta en unidades de acceso abierto.

INTRODUCTION: The indication for upper gastrointestinal endoscopy (UGE) by the general practitioner may significantly reduce the waiting time list for the exploration and accelerates the process of taking decisions in patients with upper gastrointestinal pathology. The objective of this study is to compare the appropriateness of indications for diagnostic UGE between general practitioners and gastroenterologists in open-access endoscopy units. PATIENTS AND METHODS: General practitioners were previously updated on the main indications, risks and benefits for UGE, and instructions for submitting patients to open-access units were given. The indications for UGE were analysed by means of the ASGE 1997 and EPAGE guidelines for the appropriate use of upper gastrointestinal endoscopy. RESULTS: There were no statistical differences between patients referred by general practitioners or gastroenterologists with respect to gender, age, indication of UGE or the presence of alarm symptoms. According to the ASGE guidelines overuse of UGE was observed in 25 (18.4%) of 136 patients submitted by general practitioners and in 32 (18.6%) of 172 patients submitted by gastroenterologists (NS). According to the EPAGE guidelines a non-appropriated UGE was present in 16 (11.8%) of patients referred by general practitioners and by 19 (11%) of patients submitted by gastroenterologists (NS). CONCLUSION: The level of appropriateness for UGE indication obtained by general practitioners is similar to that reached by gastroenterologists. This finding should be considered for the implementation of open-access endoscopy units in our country.

Effectiveness of endoscopic sphincterotomy in complicated hepatic hydatid disease.

BACKGROUND: The aim of this study was to evaluate the results of endoscopic sphincterotomy in patients with hepatic hydatid cysts that have ruptured into the biliary tract. METHODS: Over a 10-year period, 25 patients (11 men, 14 women, mean age 60 years) underwent treatment; 13 with no prior surgery were treated for biliary obstruction. Postoperative treatment was undertaken in 12 cases because of persistent drainage (8), duct obstruction (3), and postoperative pancreatitis (1). RESULTS: In patients who had not undergone previous surgery, cholangiographic findings were hydatid vesicles in the biliary tract (6), dilation of the biliary tract (3), biliary fistula (2), distal stenosis (1), and purulent bile content after sphincterotomy (1). In all of these cases, sphincterotomy resolved duct obstruction with no complications. All patients with persistent postoperative drainage had a fistula tract between the biliary duct and the cavity, which was resolved by endoscopic treatment in all 8. The 3 patients with postoperative biliary obstruction had hydatid vesicles in the biliary tract, one with a long stenosis resembling sclerosing cholangitis, whereas the patient with postoperative pancreatitis had a distal stenosis. Satisfactory results were obtained with endoscopic sphincterotomy, although 1 patient required a biliary prosthesis. CONCLUSION: Endoscopic sphincterotomy resolves biliary obstruction and postoperative fistulae in most patients with hepatic hydatid cysts that have ruptured into the biliary tract. In some cases, a biliary prosthesis may be required.

Endoscopic polypectomy in the treatment of colonic adenomas containing adenocarcinoma.

Fifty-seven adenomas containing adenocarcinoma were removed endoscopically from the colons of 56 patients (36 males and 20 females) with a mean age of 64.5 years. The 13 polyps containing carcinoma in situ were satisfactorily treated by endoscopic resection. In 29 cases, the carcinoma had invaded the head, neck or stalk of the polyp. The outcome was good in every case, including one involving invasion of the resection margin. Follow-up or intraoperative studies disclosed the presence of residual lesion in only 4 patients out of 15 with submucosal invasion. All four had invaded resection margins and incomplete endoscopic excision. Endoscopic polypectomy is a suitable therapeutic option for most colonic adenomas containing a carcinoma provided a complete resection is achieved with wide resection margins, particularly in those cases in which the submucosa is not reached.