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Khirurgiia 2020One of significant achievements of modern endoscopy is development of retrograde biliary stenting for obstructive jaundice. This method ensured widespread application of... (Review)
Review
One of significant achievements of modern endoscopy is development of retrograde biliary stenting for obstructive jaundice. This method ensured widespread application of endoscopic decompression in the treatment of patients with malignant biliary obstruction as preparation before radical surgery and final palliative care. Endoscopic retrograde transpapillary stenting firmly took its place together with antegrade and percutaneous stenting. There are certain advantages of this technique including minimally invasiveness and favorable quality of life. However, this approach is associated with some drawbacks associated with stent occlusion and difficult correction of this complication. The maximum diameter of the plastic stent (PS) is determined by the width of the working channel of the duodenoscope. In this regard, self-expandable metal stents (SEMS) were developed to increase the diameter of bile drainage channel. SEMS are associated with prolonged function. However, there is another problem. It is a germination of SEMS followed by impossible removal of the stent for its subsequent replacement. A further step in development of endoscopic biliary stents was the use of special SEMS coating to exclude tumor or granulation ingrowth. The problem of biliary stent occlusion remains relevant despite some improvement of stenting results. Mechanisms of occlusion of biliary stents and prevention of these events are discussed in this review.
Topics: Cholestasis; Decompression, Surgical; Digestive System Neoplasms; Endoscopy, Digestive System; Humans; Jaundice, Obstructive; Palliative Care; Stents
PubMed: 32500692
DOI: 10.17116/hirurgia202005170 -
Gastrointestinal Endoscopy Clinics of... Apr 2019Direct endoscopic imaging of the biliary tree is increasingly performed by endoscopists since the introduction of digital single-operator cholangioscopy. In parallel,... (Review)
Review
Direct endoscopic imaging of the biliary tree is increasingly performed by endoscopists since the introduction of digital single-operator cholangioscopy. In parallel, there have been several advances to overcome the challenges associated with direct peroral cholangioscopy with development of multibending cholangioscopes and new devices to enable direct placement of an endoscope into the biliary tree without a supporting duodenoscope. The indications for cholangioscopy are also evolving with newer indications, such as intraductal lithotripsy, foreign body (mostly stent) removal, guide wire cannulation of specific ducts, photodynamic therapy for cholangiocarcinoma, and performance of fluoroscopy-free cholangiography. There has also been progress in image enhancement during cholangioscopy and additional imaging techniques, such as intraductal ultrasound, confocal laser endomicroscopy, and optical coherence tomography.
Topics: Bile Duct Diseases; Biliary Tract; Endoscopy, Digestive System; Endosonography; Humans; Microscopy, Confocal; Narrow Band Imaging; Tomography, Optical Coherence
PubMed: 30846148
DOI: 10.1016/j.giec.2018.12.007 -
Gastrointestinal Endoscopy Clinics of... Oct 2020After outbreaks of duodenoscope-transmitted infection with multidrug-resistant organisms, it has become clear that institutions must optimize their endoscope... (Review)
Review
After outbreaks of duodenoscope-transmitted infection with multidrug-resistant organisms, it has become clear that institutions must optimize their endoscope reprocessing programs. Standard endoscope reprocessing practices may not represent the ideal approach for preventing transmission of infection related to endoscopy. We discuss multiple approaches to enhance and optimize reprocessing, drying, and storage of standard duodenoscopes. The optimal enhanced duodenoscope reprocessing modality remains to be determined. Acknowledging the challenges and limitations in effectively reprocessing duodenoscopes, the FDA issued a safety communiqué recommending transitioning to either single use disposable duodenoscopes or duodenoscopes with innovative designs that allow more effective reprocessing.
Topics: Algorithms; Cross Infection; Disease Transmission, Infectious; Disinfection; Duodenoscopes; Endoscopes; Equipment Contamination; Equipment Design; Humans; Infection Control; Infectious Disease Transmission, Professional-to-Patient
PubMed: 32891225
DOI: 10.1016/j.giec.2020.06.003 -
Current Opinion in Infectious Diseases Aug 2016Recent outbreaks of carbapenem-resistant enterobacteriaceae related to duodenoscopes in the United States and Europe have gained international attention and resulted in... (Review)
Review
PURPOSE OF REVIEW
Recent outbreaks of carbapenem-resistant enterobacteriaceae related to duodenoscopes in the United States and Europe have gained international attention and resulted in new regulations, especially in the United States, affecting healthcare facilities. In this review, we summarize findings from recent duodenoscope-related outbreaks, highlight what is known about the risk of transmission from these devices and discuss controversies about current recommendations to prevent transmission.
RECENT FINDINGS
Between 2013 and 2015, several US and European healthcare facilities reported outbreaks of carbapenem-resistant enterobacteriaceae associated with endoscopic retrograde cholangiopancreatography procedures. Unlike prior outbreaks (attributed to lapses in cleaning and reprocessing), the recent outbreaks occurred in spite of adherence to current reprocessing guidelines. Factors associated with infection transmission include a low margin of safety for gastrointestinal endoscopic procedures and complex design features of duodenoscopes. Outbreaks were halted with enhanced cleaning and surveillance measures or by adopting gas sterilization methods. New guidance from manufacturers and federal agencies has been issued as a result of these recent outbreaks; however, concerns remain that the new measures may not eliminate risks to patients.
SUMMARY
Recent duodenoscope-related outbreaks have highlighted the need for a reassessment of current guidelines for endoscope reprocessing and for new design of duodenoscope components. Although we summarize the US experience, this review has global implications for the safe cleaning and disinfection of these instruments.
Topics: Carbapenem-Resistant Enterobacteriaceae; Cross Infection; Disease Outbreaks; Disinfection; Duodenoscopes; Enterobacteriaceae Infections; Equipment Contamination; Europe; Humans; Practice Guidelines as Topic; Sterilization; United States
PubMed: 27310408
DOI: 10.1097/QCO.0000000000000290 -
Gastroenterology Nursing : the Official... 2017Transmission of carbapenem-resistant Enterobacteriaceae (CRE) via duodenoscopes, specialized endoscopes used during endoscopic retrograde cholangiopancreatography (ERCP)... (Review)
Review
Transmission of carbapenem-resistant Enterobacteriaceae (CRE) via duodenoscopes, specialized endoscopes used during endoscopic retrograde cholangiopancreatography (ERCP) procedures, has attracted media attention since early 2015. This attention has placed increasing focus on the reprocessing of duodenoscopes. Current reprocessing recommendations for these endoscopes require either high-level disinfection or ethylene oxide sterilization. While reprocessing duodenoscopes, staff at endoscopy locations within the Mercy health system perform a single high-level disinfection cycle that is preceded by two cycles of manual cleaning. The Mercy system has 37 locations for gastrointestinal endoscopic procedures and nine that can accommodate patients requiring ERCP. In early 2016, the Mercy Oklahoma City location performed an ERCP on a patient known prior to the case to be a carrier of CRE. After the case, multiple departments located in both the Oklahoma City and St. Louis facilities partnered to culture and sterilize the duodenoscope used in that case to ensure its safety for use on subsequent patients. This case study presents the situation and discusses culturing of endoscopes. In light of the evidence presented, the importance of enhanced communication and cooperation to achieve patient safety should be paramount to all other factors.
Topics: Carbapenems; Cholangiopancreatography, Endoscopic Retrograde; Cross Infection; Drug Resistance, Bacterial; Duodenoscopes; Duodenoscopy; Enterobacteriaceae; Enterobacteriaceae Infections; Equipment Contamination; Female; Humans; Incidence; Male; Needs Assessment; Risk Assessment
PubMed: 28134720
DOI: 10.1097/SGA.0000000000000268 -
Clinical Gastroenterology and... Aug 2020
Topics: Cholangiopancreatography, Endoscopic Retrograde; Cross Infection; Duodenoscopes; Humans; Infection Control
PubMed: 32302708
DOI: 10.1016/j.cgh.2020.04.026 -
Gastrointestinal Endoscopy Dec 2021
Topics: Cross Infection; Duodenoscopes; Equipment Contamination; Humans
PubMed: 34607702
DOI: 10.1016/j.gie.2021.08.010 -
Current Treatment Options in... Jun 2016A number of case studies have described the usefulness of peroral cholangioscopy for diagnosis and therapy, performed by visualizing the inner cavity of the bile duct.... (Review)
Review
A number of case studies have described the usefulness of peroral cholangioscopy for diagnosis and therapy, performed by visualizing the inner cavity of the bile duct. Currently available types of peroral cholangioscopy include peroral videocholangioscopy (POCS) using a mother-baby scope system (MBSS), direct peroral videocholangioscopy (D-POCS), and SpyGlass™ Direct Visualization System (SGDVS). POCS started with cholangioscopy using MBSS, requiring two skilled endoscopists using two endoscopic systems. On the other hand, D-POCS and SGDVS were developed as single-operator techniques. In MBSS, the videocholangioscope is inserted into the bile duct through the accessory channel of a conventional therapeutic duodenoscope. MBSS enables comparatively easy scope insertion into the bile duct and stable scope positioning. POCS using MBSS provides excellent images and can be coupled with an image-enhanced function system. However, it has a smaller accessory channel, limiting the devices that can be used. Additionally, scope fragility is serious problem. D-POCS using an ultraslim upper endoscope has been introduced to overcome the drawback of POCS using MBSS. D-POCS has a larger working channel and requires only one endoscopist. D-POCS allows a greater variety of procedures under excellent imaging even with an image-enhanced function system; however, scope insertion is still challenging. SGDVS is designed for single-operator use and is dedicated to procedural purposes. It comprises a reusable optical probe and disposable delivery catheter, which has four-way deflected steering and dedicated irrigation channels. These features lead to good maneuverability, although image quality is poor due to its optical probe system. All systems' features should be recognized and the appropriate system used depending on the need. Cholangioscopy has shown dramatic progress from diagnosis to therapy with high future growth potential.
PubMed: 27053226
DOI: 10.1007/s11938-016-0090-2 -
World Journal of Gastroenterology Jul 2020Patient-ready duodenoscopes were designed with an assumed contamination rate of less than 0.4%; however, it has been reported that 5.4% of clinically used duodenoscopes... (Review)
Review
BACKGROUND
Patient-ready duodenoscopes were designed with an assumed contamination rate of less than 0.4%; however, it has been reported that 5.4% of clinically used duodenoscopes remain contaminated with viable high-concern organisms despite following the manufacturer's instructions. Visual inspection of working channels has been proposed as a quality control measure for endoscope reprocessing. There are few studies related to this issue.
AIM
To investigate the types, severity rate, and locations of abnormal visual inspection findings inside patient-ready duodenoscopes and their microbiological significance.
METHODS
Visual inspections of channels were performed in 19 patient-ready duodenoscopes using the SpyGlass visualization system in two endoscopy units of tertiary care teaching hospitals (Tri-Service General Hospital and National Taiwan University Hospital) in Taiwan. Inspections were recorded and reviewed to evaluate the presence of channel scratches, buckling, stains, debris, and fluids. These findings were used to analyze the relevance of microbiological surveillance.
RESULTS
Seventy-two abnormal visual inspection findings in the 19 duodenoscopes were found, including scratches ( = 10, 52.6%), buckling ( = 15, 78.9%), stains ( = 14, 73.7%), debris ( = 14, 73.7%), and fluids ( = 6, 31.6%). Duodenoscopes > 12 mo old had a significantly higher number of abnormal visual inspection findings than those ≤ 12 mo old (46 findings 26 findings, < 0.001). Multivariable regression analyses demonstrated that the bending section had a significantly higher risk of being scratched, buckled, and stained, and accumulating debris than the insertion tube. Debris and fluids showed a significant positive correlation with microbiological contamination ( < 0.05). There was no significant positive Spearman's correlation coefficient between negative bacterial cultures and debris, between that and fluids, and the concomitance of debris and fluids. This result demonstrated that the presence of fluid and debris was associated with positive cultures, but not negative cultures. Further multivariate analysis demonstrated that fluids, but not debris, is an independent factor for bacterial culture positivity.
CONCLUSION
In patient-ready duodenoscopes, scratches, buckling, stains, debris, and fluids inside the working channel are common, which increase the microbiological contamination susceptibility. The SpyGlass visualization system may be recommended to identify suboptimal reprocessing.
Topics: Disinfection; Duodenoscopes; Endoscopes; Equipment Contamination; Humans; Taiwan
PubMed: 32774056
DOI: 10.3748/wjg.v26.i26.3767 -
Annals of Gastroenterology 2022Despite the standardization and optimization of disinfection protocols, duodenoscope-related infections (DRIs) remain an emerging threat for patients undergoing...
BACKGROUND
Despite the standardization and optimization of disinfection protocols, duodenoscope-related infections (DRIs) remain an emerging threat for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Single-use duodenoscopes could represent a potential alternative avenue to circumvent the problem of reprocessing and thus risk of exogenous patient-to-patient transmission. The aim of our study was to test the feasibility and technical success rate of a recently made available single-use duodenoscope.
METHODS
We carried out a thorough and standardized evaluation of the usability, performance and safety of a recently developed single-use duodenoscope in 52 consecutive patients scheduled for ERCP in a single center. Outcomes included performance ratings of the single-use duodenoscopes, adverse events (assessed at 3 days and 1 week), and crossover rate to a reusable duodenoscope.
RESULTS
The ERCP completion rate with a single-use duodenoscope was 90.4%, rising to 94.2% after crossover to reusable duodenoscope. The mean American Society for Gastrointestinal Endoscopy (ASGE) grade was 2.7, with 27 procedures (51.9%) considered as advanced level complexity (ASGE grade 3 & 4). Performance rating found that 94% of the therapeutic treatments were comparable to those using a traditional reusable duodenoscope. Overall satisfaction amounted to 80%. No major adverse events were attributable to the single-use endoscope.
CONCLUSIONS
Single-use duodenoscopes can provide an alternative to avoid the intensive and often inconsistent results of cleaning and disinfection procedures. We confirmed the feasibility, adequate performance characteristics and safety of a recently developed first-generation single-use duodenoscope over a broad range of ERCP procedures, in terms of both indication and complexity.
PubMed: 35784631
DOI: 10.20524/aog.2022.0723