Safety of cleaning and disinfection of duodenoscope for endoscopic retrograde cholangiopancreatography / 中华消化内镜杂志

Objective To investigate the safety of cleaning and disinfection of duodenoscope used in endoscopic retrograde cholangiopancreatography (ERCP).Methods The duodenoscopes,which were used in Endoscopy Center of Digestive Disease Hospital,Heilongjiang Provincial Hospital from May 4 to May 31 2016,were cleaned manually and disinfected with sterilization powder.The samples from elevator and elevator channel were collected for bacterial culture to evaluate the safety of clinical application of duodenoscope.Results Among 60 high level disinfections,one was excluded because disinfectant concentration wasn't effective.Among 59 elevator samples no positive cultures were detected,while among 59 channel samples,4(6.8％) cultures were positive and all from the same duodenoscope,including 3 cases of Klebsiella pneumonia and 1 case of Pseudomonas aeruginosa.Conclusion Sterilization powder is effective for disinfection of duodenoscope used for ERCP.Residual organic material can't be excluded from elevator sample even if it is negative for culture.Duodenoscope with high level disinfection still has the risk of transmitted infection,and should be monitored regularly by culture and reprocessed in time.

Clinical value of small bowel CT scan combined with single-balloon enteroscopy for Peutz-Jeghers syndrome / 中华消化内镜杂志

Objective To assess the value of small bowel computed tomography ( CT ) scan combined with single balloon enteroscopy ( SBE) for the diagnosis and treatment of Peutz-Jeghers syndrome ( PJS) . Methods CT scan was performed in cases that were clinically suspected or proved PJS for the number, size, location and relative acute complications of polyps in the small intestine. Single balloon enteroscopy was used to resect small intestinal polyps according to CT findings. The number of observed polyps in diagnosis, numbers of resected polyps, procedure duration and complications in endoscopic therapy were analysed. Results Polyps were found in the small intestine in all patients. There were 68 polyps whose diameter was 1-4 cm. Nine SBE procedures were completed in these patients. The mean procedure time was 120 min. A total of 65 polyps were detected by SBE with 95. 59％ concordance to CT results. A total of 52 polyps were resected under endoscopy, the largest diameter of which was 4 cm. No complications were observed after SBE. Conclusion Combination of small bowel CT scan and SBE is safe and effective for diagnosis and treatment of PJS patients, which is worth recommendation.

Clinical application of laparoscopy combined with choledochoscopy and duodenoscopy in treatment of gallstones complicated by intra- and extrahepatic bile duct stones / 临床肝胆病杂志

ObjectiveTo summarize the experience in laparoscopy combined with choledochoscopy and duodenoscopy in the treatment of gallstones complicated by intra- and extrahepatic bile duct stones, and to investigate its therapeutic effect. MethodsA total of 413 patients with gallstones complicated by intra- and extrahepatic bile duct stones who visited Meizhou People′s Hospital from March 2010 to March 2015 were enrolled, and according to the patients′ individual conditions, they were given laparoscopy combined with choledochoscopy and/or duodenoscopy. ResultsA total of 31 patients underwent laparoscopic cholecystectomy (LC)+laparoscopic transcystic common bile duct exploration (LTCBDE), and the success rate was 29.0% (9/31); 101 patients underwent LC+LTCBDE+T tube drainage, and the success rate was 93.1% (94/101); 96 patients underwent LC+laparoscopic common bile duct exploration (LCBDE)+choledochoscopic cholecystolithotomy+primary suture, and the success rate was 97.9% (94/96); 61 patients underwent LC+LCBDE+partial hepatectomy, and the success rate was 91.8% (56/61); 155 patients underwent endoscopic sphincterotomy (EST)+LC or LC+EST, and the success rate was 93.5% (145/155); 10 patients underwent laparoscopy+duodenoscopy+choledochoscopy (at the same time), and the success rate was 90%(9/10). Nineteen patients were converted to open surgery, and the overall success rate was 95.4％（394/413）. All the patients were cured, and there were no serious complications or deaths. ConclusionLaparoscopy combined with duodenoscopy and choledochoscopy is feasible, safe, and reliable in the treatment of gallstones complicated by intra- and extrahepatic bile duct stones.

Prevalence of Helicobacter Pylori Infection among Patients Attending Gastroenterology Endoscopy Unit at Serdang Hospital

To study the prevalence of Helicobacter Pylori (H. pylori) infection, according to ethnicity, gender and endoscopic findings among the patients underwent the oesophago-gastro-duodenoscopes (OGDS) at gastroenterology endoscopy unit, Hospital Serdang, Selangor, Malaysia. The database of all whom underwent OGDS at the gastroenterology endoscopy unit, Hospital Serdang from 1st August 2010 to 31st July 2012 was collected and assessed, retrospectively. A total of 924 patients who underwent OGDS were analyzed for the H. pylori infection by using Campylobacter-like organism (CLO) test. 130 (14.07%) tested positive, and their data were further studied according to gender, ethnicity, age group, initial indication for OGDS and endoscopic finding. The prevalence rate among males was 15.15% (70/462), while it was 12.99% (60/462) among females. In terms of ethnics, H. pylori infection was commonly found among Indian and Chinese with prevalence rate of 25.13% (50/199) and 17.41% (51/293) respectively. These figures are significantly higher than the 6.01% (25/416) for Malays. The age group (31-50 years old) had the highest prevalence rate of H. Pylori infection, which is of 18.55% (41/221). No significant difference was observed among initial indications for OGDS. Erosions were the commonest finding in H. pylori positive group with rate of 51.54% (67/130). However, erosions were not uncommon in H. pylori negative group as well with the rate of 48.61% (386/794). H. pylori infection rate among Malaysians was generally low, with the highest rate in Indians, followed by Chinese and relatively low in Malays. No significant difference between the prevalence rate of H. pylori infection in male and that in female was found. Erosions were equally common in either H. pylori positive or H. pylori negative group. .

Current Issues in Duodenoscope-Associated Infections: Now Is the Time to Take Action

A duodenoscope has a very complex structure that contains many small parts which make reprocessing more challenging. The difficulty in cleaning duodenoscopes contributes to a higher risk of infection than that of conventional gastrointestinal endoscopes. However, a duodenoscope shares similar disinfection process with other gastrointestinal endoscopes. Recent outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) infections associated with duodenoscopes used for endoscopic retrograde cholangiopancreatography procedures have raised many concerns worldwide. Duodenoscope-associated infections involving CRE or other multidrug-resistant bacteria pose a great threat to patients undergoing procedures using duodenoscopes and should be dealt with a great concern. Updated guidelines regarding cleaning and disinfection of duodenoscope needs to be developed urgently to prevent transmission of infection and ensure patient safety. Meanwhile, healthcare staff should pay special attention to thorough cleaning and disinfection of duodenoscopes.

Effect analysis on combination of laparoscopy and duodenoscopy treatment for calculus of extrahepatic bile duct / 国际外科学杂志

Objetive To study the medical value of the combined treatment of laparoscopy and duodenoscopy treatment for calculus of extrahepatic bile duct.Methods Retrospectivly analyzed the clinical data of 72 cases with combination of laparoscopy and duodenoscopy treatment for calculus of extrahepatic bile duct between March 2006 and October 2011.There were 11 cases of choledocholithiasis and 61 cases of choledocholithiasis and cholecystolithiasis.Results Three cases of severe abdominal adhesion converted to laparotomy and other 69 cases were cured.The cure rate was 95.83％.There were no complications such as infection,bile duct injury,bile leakage,intraabdominal hemorrhage,bile reflux cholangitis,pancreatitis and cicatrical stenosis of papilary.The examination after operation showed that there weren't any residual bile duct stones.Conclusions The combination of laparoscopy and duodenoscopy treatment for calculus of extrabepatic bile duct has less traumatic,few intercurrent disease,and was safe and reliable with well postoperative recovery.It can be regarded as the preference treatment for calculus of extrahepatic bile duct.

Sequential ERCP and laparoscopy for acute biliary pancreatitis / 中华消化内镜杂志

Objective To investigate the efficacy of sequential ERCP and laparoscopy for acute biliary pancreatitis (ABP).Methods A total of 80 patients with ABP were randomly divided into 2 groups to receive sequential ERCP and laparoscopy (observation group,n=40) or traditional surgery (control group,n=40).Clinical data including abdominal pain relief time,recovery time of white blood cell,blood amylase and liver function,hospital stay,complication rate and mortality were analyzed.Results ERCP failed in 1 patient in observation group,and the remaining 39 patients (97.5％) were recruited into the study.There were significant differences between 2 groups in regarding of abdominal pain relief time (7.7±2.7 d vs.11.4±3.7 d),recovery time of white blood cell ( 9.7±2.6 d vs.13.3±3.9 d ),blood amylase ( 8.2±2.1 d vs.12.5±3.3 d ),liver function ( 12.5±5.1 d vs.21.3±6.5 d ),hospital stay ( 16.1±5.1 d vs.23.3±7.6 d ) and rate of complication ( 12.8％ vs.30.0％ ).There was no significant difference in morbidity between 2 groups (5.1％ vs.7.5％).Conclusion Sequential ERCP and laparoscopy is effective for ABP.