David A. Greenwald

Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011.

● The beneficial role of GI endoscopy for the prevention, diagnosis, and treatment of many digestive diseases and cancer is well established. Like many sophisticated medical devices, the endoscope is a complex, reusable instrument that requires reprocessing before being used on subsequent patients. The most commonly used methods for reprocessing endoscopes result in high-level disinfection. To date, all published occurrences of pathogen transmission related to GI endoscopy have been associated with failure to follow established cleaning and disinfection/ sterilization guidelines or use of defective equipment. Despite the strong published data regarding the safety of endoscope reprocessing, concern over the potential for pathogen transmission during endoscopy has raised questions about the best methods for disinfection or sterilization of these devices between patient uses. To this end, in 2003, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Healthcare Epidemiology of America collaborated with multiple physician and nursing organizations, infection prevention and control organizations, federal and state agencies, and industry leaders to develop evidence-based guidelines for reprocessing GI endoscopes.1,2 Since that ime, high-level disinfectants, automated reprocessing mahines, endoscopes and endoscopic accessories have all volved.3-6 However, the efficacy of decontamination and high-level disinfection is unchanged and the principles guiding both remain valid.7 Additional outbreaks of infection related to suboptimal infection prevention practices during endoscopy or lapses in endoscope reprocessing have been well publicized. A cluster of hepatitis C cases was attributed to grossly inappropriate intravenous medication and sedation practices.8 In numerous other instances, risk of infection transission has been linked to less willful, but incorrect, eprocessing as a result of unfamiliarity with endoscope hannels, accessories, and the specific steps required for eprocessing of attachments.9 Recent on-site ambulatory urgery center surveys confirm widespread gaps in infecion prevention practices.10 Given the ongoing occurrences of endoscopy-associated infections attributed to

Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update.

1,2 The beneficial role of GI endoscopy for the prevention, diagnosis, and treatment of many digestive diseases and cancer iswell established. Likemany sophisticatedmedical devices, the endoscope is a complex, reusable instrument that requires meticulous cleaning and reprocessing in strict accordance with manufacturer and professional organization guidance before being used on subsequent patients. To date, published episodes of pathogen transmission related to GI endoscopy using standard end-viewing instruments have been associated with failure to follow established cleaning and disinfection/sterilization guidelines or use of defective equipment. Recent reports pertaining to transmission among patients undergoing specialized procedures using side-viewing duodenoscopes with distal tip elevators have raised questions about the best methods for the cleaning and disinfection or sterilization of these devices between patient uses. In 2003 the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Healthcare Epidemiology of America collaborated with multiple physician and nursing organizations, infection prevention and control organizations, federal and state agencies, and industry leaders to develop evidence-based guidelines1,2 The beneficial role of GI endoscopy for the prevention, diagnosis, and treatment of many digestive diseases and cancer iswell established. Likemany sophisticatedmedical devices, the endoscope is a complex, reusable instrument that requires meticulous cleaning and reprocessing in strict accordance with manufacturer and professional organization guidance before being used on subsequent patients. To date, published episodes of pathogen transmission related to GI endoscopy using standard end-viewing instruments have been associated with failure to follow established cleaning and disinfection/sterilization guidelines or use of defective equipment. Recent reports pertaining to transmission among patients undergoing specialized procedures using side-viewing duodenoscopes with distal tip elevators have raised questions about the best methods for the cleaning and disinfection or sterilization of these devices between patient uses. In 2003 the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Healthcare Epidemiology of America collaborated with multiple physician and nursing organizations, infection prevention and control organizations, federal and state agencies, and industry leaders to develop evidence-based guidelines

Clostridium difficile-associated diarrhea in the elderly.

Objective:It is widely believed that Clostridium difficile (C. difficile)-associated diarrhea is a more severe disease in the elderly than in the young, associated with increased morbidity and mortality. These beliefs are largely anecdotal, and there are few data supporting them.Methods:We conducted an evaluation in an urban, tertiary care hospital of 89 inpatients in whom C. difficile–associated diarrhea was identified. These patients were evaluated prospectively, and the group was divided by age into those <60 yr of age (younger) and those ≥60 yr (elderly).Results:There was no difference in mortality or morbidity in elderly individuals with C. difficile-associated diarrhea when compared with younger persons similarly infected. The response to standard treatment was similar in both groups. Older patients were more likely to have an elevated white blood cell count in association with C. difficile-associated diarrhea (60%vs 26%, p < 0.05), and were more likely to have acquired their infection in the hospital (89%vs 50%, p < 0.0001).Conclusions:In the elderly, C. difficile-associated diarrhea is almost always acquired in institutions, and may not be obvious among patients’ other problems. The elderly do not seem to have an increase in C. difficile diarrhea–associated morbidity or mortality. There is no evidence that C. difficile-associated diarrhea is more severe in the elderly than it is in the young.

Preoperative Gastrointestinal Assessment Before Bariatric Surgery

Obesity is a major health problem throughout the world. Bariatric surgery is frequently considered among the treatment options for the severely overweight, and surgically induced weight loss has become the best treatment for many morbidly obese people. A preoperative assessment to evaluate the suitability of a patient for a given operation and to clarify factors that may affect the outcome of a planned procedure should be carried out before the surgery. Preoperative evaluation of the gastrointestinal tract by a gastroenterologist before bariatric surgery yields important information that can lead to changes in planned treatments. This article discusses the factors that a gastroenterologist should assess before the surgery.

Non-pulmonary allergic diseases and inflammatory bowel disease: a qualitative review.

While the etiological underpinnings of inflammatory bowel disease (IBD) are highly complex, it has been noted that both clinical and pathophysiological similarities exist between IBD and both asthma and non-pulmonary allergic phenomena. In this review, several key points on common biomarkers, pathophysiology, clinical manifestations and nutritional and probiotic interventions for both IBD and non-pulmonary allergic diseases are discussed. Histamine and mast cell activity show common behaviors in both IBD and in certain allergic disorders. IgE also represents a key immunoglobulin involved in both IBD and in certain allergic pathologies, though these links require further study. Probiotics remain a critically important intervention for both IBD subtypes as well as multiple allergic phenomena. Linked clinical phenomena, especially sinonasal disease and IBD, are discussed. In addition, nutritional interventions remain an underutilized and promising therapy for modification of both allergic disorders and IBD. Recommending new mothers breastfeed their infants, and increasing the duration of breastfeeding may also help prevent both IBD and allergic diseases, but requires more investigation. While much remains to be discovered, it is clear that non-pulmonary allergic phenomena are connected to IBD in a myriad number of ways and that the discovery of common immunological pathways may usher in an era of vastly improved treatments for patients.

Cost and characteristics of intravenous proton pump inhibitor use and misuse in a tertiary care hospital

Cost and characteristics of intravenous proton pump inhibitor use and misuse in a tertiary care hospital

Segmental increases in force application during colonoscope insertion: quantitative analysis using force monitoring technology

BACKGROUND Colonoscopy is a frequently performed procedure that requires extensive training and a high skill level. OBJECTIVE Quantification of forces applied to the external portion of the colonoscope insertion tube during the insertion phase of colonoscopy. DESIGN Observational cohort study of 7 expert and 9 trainee endoscopists for analysis of colonic segment force application in 49 patients. Forces were measured by using the colonoscopy force monitor, which is a wireless, handheld device that attaches to the insertion tube of the colonoscope. SETTING Academic gastroenterology training programs. PATIENTS Patients undergoing routine screening or diagnostic colonoscopy with complete segment force recordings. MAIN OUTCOME MEASUREMENTS Axial and radial force and examination time. RESULTS Both axial and radial force increased significantly as the colonoscope was advanced from the rectum to the cecum. Analysis of variance demonstrated highly significant operator-independent differences between segments of the colon (zones) in all axial and radial forces except average torque. Expert and trainee endoscopists differed only in the magnitude of counterclockwise force, average push/pull force rate used, and examination time. LIMITATIONS Small study, observational design, effect of prototype device on insertion tube manipulation. CONCLUSION Axial and radial forces used to advance the colonoscope increase through the segments of the colon and are operator independent.

The American College of Gastroenterology and the 80% by 2018 Colorectal Cancer Initiative: A Multifaceted Approach to Maximize Screening Rates

The American College of Gastroenterology and the 80% by 2018 Colorectal Cancer Initiative: A Multifaceted Approach to Maximize Screening Rates

Reducing infection risk in colonoscopy.

Colonoscopy is a well recognized diagnostic and therapeutic tool. Endoscope reprocessing must be done correctly every time; a breach of protocol leading to transmission of infection has the potential to bring endoscopy to a halt. Standards exist that guide the practitioner in all health care settings to minimize the chance of transmission of infection. Safe injection practices and reprocessing of endoscopes using high-level disinfection and sterilization methods may help avert the risk of contracting possible infections during colonoscopy procedures.

Medical device evaluation by the Food and Drug Administration (FDA).

VOLUME 53, NO. 7, 200