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.

Procedure-related complications in gastric variceal obturation with tissue glue.

AIM: To focus on procedure-related complications, evaluate their incidence, analyze the reasons and discuss the solutions. METHODS: Overall, 628 endoscopic gastric variceal obturation (EGVO) procedures (case-times) with NBC were performed in 519 patients in the Department of Endoscopy of the Third Affiliated Hospital of Sun Yat-Sen University from January 2011 to December 2016. The clinical data of patients and procedure-related complications of EGVO were retrospectively analyzed. RESULTS: In the 628 EGVO procedures, sticking of the needle to the varix occurred in 9 cases (1.43%), including 1 case that used lipiodol-diluted NBC and 8 cases that used undiluted NBC (P = 0.000). The needle was successfully withdrawn in 8 cases. Large spurt bleeding occurred in one case, and hemostasis was achieved by two other injections of undiluted glue. The injection catheter became blocked in 17 cases (2.71%) just during the injection, and 4 cases were complicated with the needle sticking to the varix. Large glue adhesion to the endoscope resulted in difficulty withdrawing the endoscope in 1 case. Bleeding from multiple sites was observed in the esophagus and gastric cardia after the endoscope was withdrawn. Hemostasis was achieved by 1% aethoxysklerol injection and intravenous somatostatin. The ligation device stuck to the varices in two cases during the subsequent endoscopic variceal ligation. In one case, the ligation device was successfully separated from the esophageal varix after all bands were released. In another case, a laceration of the vein and massive bleeding were observed. The bleeding ceased after 1% aethoxysklerol injection. CONCLUSION: Although EGVO with tissue glue is usually safe and effective, a series of complications can occur during the procedure that may puzzle endoscopists. There is no standard operating procedure for addressing these complications. The cases described in the current study can provide some reference for others.

Cap-assisted gastroscope versus cap-assisted colonoscope for examination of difficult sigmoid colons in a nonsedated Asian population: a randomized study.

BACKGROUND: Studies have estimated that cecal intubation failure occurs with conventional colonoscopy in about 10% of cases. Various methods have been adopted to improve the cecal intubation rate, including a transparent cap and special colonoscopes. OBJECTIVE: To assess the efficacy of using a cap-assisted gastroscope (E-cap) compared with a cap-assisted colonoscope (C-cap) for the complete examination of the colon in nonsedated patients with technically difficult sigmoid colons. DESIGN: Randomized, controlled study. SETTING: Tertiary-care referral center. PATIENTS: One hundred thirty-nine patients with technically difficult sigmoid colons were studied. INTERVENTION: Colonoscopy with either an E-cap (n = 69) or a C-cap (n = 70). MAIN OUTCOME MEASUREMENTS: Cecal intubation rate, cecal intubation time, patient-assessed pain score, and endoscopist-assessed pain score. RESULTS: The cecal intubation rate was significantly higher in the E-cap (65/69, 94.2%) than in the C-cap group (50/70, 71.4%; P < .0001). Patient-assessed pain (moderate to severe) was more frequently reported in the C-cap (14/70, 20.0%) than in the E-cap group (5/69, 7.2%; P = .029). Endoscopist-assessed pain (moderate to severe) was more frequently reported in the C-cap (13/70, 18.6%) than in the E-cap group (3/69, 7.2%; P = .009). For patients with a low body mass index (≤ 22 kg/m(2)), the cecal intubation rate was significantly higher in the E-cap (37/38, 97.4%) than in the C-cap group (15/29, 51.7%; P < .0001). LIMITATIONS: Single-center experience, lack of a gastroscope control group without a cap. CONCLUSION: The cap-assisted gastroscope is more tolerable and effective than cap-assisted colonoscope for the complete examination of the colon in patients with technically difficult sigmoid colons. ( CLINICAL TRIAL REGISTRATION NUMBER: KCT0000744.).

[Endoscopic complication: unsuspected impact of gastroscope into the oesophagus in a patient with a large hiatal hernia]. / Uventet komplikation ved gastroskopi hos patient med stort hiatushernie.

Gastroscopy is used world-wide and it is considered as a safe procedure. In a case study we describe an impaction of a gastroscope into the oesophagus. A gastroscopy in full narcosis was performed on a patient with a large size hiatal hernia. During the procedure the gastroscope recurved into the oesophagus. With the assistance of another gastroscope and fluoroscopic guidance the gastroscope was removed successfully. This complication may occur more often than described in literature.

[An adult gastroscope instead of an adult colonoscope for colon examination in children].

OBJECTIVE: In some hospitals an adult colonoscope is used for colon examination in children because they do not have child colonscope equipment. This has some disadvantages and this paper reports the experience for colon examination in children with an adult gastroscope instead of an adult colonoscope. METHODS: One hundred and three children aged from 1.3 to 14 years who required routine colon examination were randomly assigned to adult gastroscope (n=49) and adult colonoscope groups (n=54). RESULTS: There were no significant differences in the success rate of implantation into the ileocecum between the gastroscope and colonoscope groups (93.9% vs 94.4%; P>0.05). The average time of implantation into the ileocecum in the gastroscope group was shorter than that of the colonoscope group (5.2+/-1.1 min vs 7.3+/-2.9 min; P<0.05). Seventeen patients showed implantation-related complications in the colonoscope group but only 5 patients in the gastroscope group (P<0.01). CONCLUSIONS: An adult gastroscope appears to be safer and more feasible than an adult colonoscope for colon examination in children.

Transgastric instrumentation and bacterial contamination of the peritoneal cavity.

INTRODUCTION: Natural orifice transluminal endoscopic surgery (NOTES) is a rapidly evolving technique providing access to the peritoneum utilizing an endoscope via a natural orifice. One of the most significant requirements of this technique is the need to minimize the risk of clinically significant peritoneal contamination. We report the bacterial load and contamination of the peritoneal cavity in patients requiring a gastrotomy Roux-en-Y gastric bypass (LSRYGB). METHODS: We prospectively studied 50 patients undergoing a gastrotomy with creation of a gastrojejunostomy during LSRYGB. We recorded the patient's proton-pump inhibitor (PPI) utilization preoperatively and sampled gastric contents without lavage. We also sampled peritoneal fluid prior to and after gastrotomy, noting the length of time the gastrotomy was open to the peritoneum. Each of the three samples was sent for bacterial colony counts, and culture with identification of species. RESULTS: Fifty patients underwent LSRYGB with a mean operative time of 93 min. The gastrotomy was open to the peritoneal cavity for an average of 18 min. Seventeen of 50 patients were on PPIs preoperatively, resulting in a significant difference in postgastrostomy peritoneal bacterial counts. The average number of colony-forming units (CFU) of the gastric aspirate was 22,303 CFU/ml. Peritoneal aspirates obtained for examination prior to creation of a gastrotomy showed no CFUs in 44 of 50 patients. Peritoneal sampling after gastrotomy showed contamination of the abdomen with an average of 1102 CFU/ml. There was no correlation between the bacterial load in the stomach and peritoneal load after gastrotomy. No infectious complications or leaks developed. One complication of rhabdomyolysis in a patient with no peritoneal bacterial contamination developed. CONCLUSIONS: Transgastric instrumentation does contaminate the abdominal cavity but pathogens are clinically insignificant due to species or bacterial load. Patients on PPIs do have an increased bacterial load in the gastric aspirate, with no clinical significant infection.

[Indications for the surgical therapy of obesity with magenband operation (gastric banding)]. / Indikation zur chirurgischen Therapie der Adipositas mit der Magenband-Operation (Gastric Banding).

Morbid obesity is an increasing problem in most of the industrial countries. Conservative treatment strategies are often not very effective. Because of the enormous costs and concomitant diseases of obesity, effective therapeutic strategies are mandatory. Gastric banding is a surgical method to reduce weight in the long run when patients are morbidly obese. A silicone band is used to create a small pouch in the upper part of the stomach leading to early satiety after ingestion only small amounts of food. The benefit of this method is the laparoscopic technique and the reversibility, because the band is easy to remove. In the long run a significant reduction of weight and an amelioration or even prevention of diseases resulting from obesity can be achieved. To assure treatment quality, it makes sense to administer this therapy in an interdisciplinary setting that integrates psychosomatic diagnostics and therapies, too. This paper reviews indications, contraindications as well as pre- and postoperative necessarily care of gastric banding.

[Transnasal gastroscopy]. / Transnasal gastroskopi.

The use of transnasal endoscopy has not been reported earlier in Denmark. This study describes the preliminary experiences with transnasal gastroscopy using the Olympus XGIF-N200 prototype. Patients scheduled for diagnostic gastroscopy were examined transnasally. The patients answered questions regarding anxiety and discomfort, and the endoscopist commented on the quality of the procedure. Of sixty patients included, 56 (93%) were examined transnasally. Two patients did not have nasal passage and were examined orally, and two patients were examined with standard gastroscope because of technical difficulties. Sixty-eight percent of the procedures were unsedated, 55% of the patients did not experience gag-reflexes. The procedure was described by most patients as "slightly uncomfortable". Twenty-five percent had uncomplicated epistaxis. Pulse rate and saturation levels were stable. Transnasal gastroscopy seems to be well tolerated by the patients, as both subjective and objective criteria were better than those for conventional gastroscopy.