Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians

Gastrointestinal endoscopy plays an important diagnostic and therapeutic role in the field of gastrointestinal disease. As endoscopies have become more common due to the nationwide screening program for digestive cancer and an increasing interest in health among the general public, the risk of infection transmission between patients has emerged as a clinical challenge. Although endoscopes can become highly contaminated with secretions and blood during use, the thorough reprocessing of an endoscope before it is reused in subsequent patients can be difficult due to its complicated structure. Although the incidence of endoscopy-associated infections has been reported to be extremely low, compelling evidence suggests that the actual incidence is underestimated. It has been well established that endoscopes reprocessed appropriately, in accordance with standard guidelines, have no risk of infection transmission. Although revised guidelines for endoscope reprocessing were released in Korea in 2015, suboptimal infection prevention practices during endoscope reprocessing have been reported. Under these circumstances, the Korean Society of Digestive Endoscopy developed the ‘Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians’ based on the currently available evidence. These guidelines provide accurate and updated information on reprocessing techniques, and can help improve the quality of reprocessing and compliance by health care personnel. As a result, infection control during gastrointestinal endoscopies can be expected to be achieved in Korea.

Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians

Gastrointestinal endoscopy plays an important diagnostic and therapeutic role in the field of gastrointestinal disease. As endoscopies have become more common due to the nationwide screening program for digestive cancer and an increasing interest in health among the general public, the risk of infection transmission between patients has emerged as a clinical challenge. Although endoscopes can become highly contaminated with secretions and blood during use, the thorough reprocessing of an endoscope before it is reused in subsequent patients can be difficult due to its complicated structure. Although the incidence of endoscopy-associated infections has been reported to be extremely low, compelling evidence suggests that the actual incidence is underestimated. It has been well established that endoscopes reprocessed appropriately, in accordance with standard guidelines, have no risk of infection transmission. Although revised guidelines for endoscope reprocessing were released in Korea in 2015, suboptimal infection prevention practices during endoscope reprocessing have been reported. Under these circumstances, the Korean Society of Digestive Endoscopy developed the ‘Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians’ based on the currently available evidence. These guidelines provide accurate and updated information on reprocessing techniques, and can help improve the quality of reprocessing and compliance by health care personnel. As a result, infection control during gastrointestinal endoscopies can be expected to be achieved in Korea.

A Case of Mucin-Hypersecreting Intrahepatic Bile Duct Tumor Combined with Pancreatic Intraductal Papillary Mucinous Tomor (IPMT) / 대한소화기내시경학회지

Intraductal papillary mucinous tumor (IPMT) of the pancreas is a recently understood unique clinicopathologic disease entity comprising approximately 1% of all exocrine pancreatic tumors and 11% of cystic neoplasms of pancreas. It has been reported worldwide, mostly in Japan. It is generally characterized by recurrent pancreatitis, mucin oozing from the papilla of Vater, and dilated pancreatic duct with intraductal filling defects. Microscopically, the mucin-producing columnar epithelium forms papillary proliferation into the dilated pancreatic duct and this feature differentiates IPMT of the pancreas from the more common mucinous cystic neoplasms of the pancreas which usually do not communicate with the pancreatic duct. On the other hand, mucin-hypersecreting bile duct tumors have been rarely reported in the English literature. We herein present the first case of mucin-hypersecreting bile duct tumor combied with IPMT of the pancreas with a review of the related literature.

Gallbladder Cancer Associated with an Anomalous Union of the Pancreaticobiliary Duct and a Choledochal Cyst / 대한소화기내시경학회지

An anomalous pancreaticobiliary ductal union is a rare anomaly occurring in the biliary tract. This anomaly has been implicated as a cause of choledochal cysts, bile duct and gallbladder carcinoma, and recurrent pancreatitis. A case is herein reported of a 63 year-old woman who suffered from gallbladder cancer associated with a choledochal cyst and an anomalous pancreaticobiliary union.

A Case of an Anomalous Union of the Pancreatobiliary Duct Associated with Pancreas Divisum / 대한소화기내시경학회지

An anomalous union of the pancreatobiliary ductal system is defined as the junction between the common bile duct and the pancreatic duct outside the duodenal wall and beyond the influence of the sphincter of Oddi. This anomaly may relate to some pancreatobiliary lesions such as choledochal cysts, biliary tract carcinomas, or pancreatitis. Pancreas divisum is the most common congenital variant of the pancreatic ductal anatomy, and when it occurs, the ductal system of the dorsal and ventral pancreatic bud, fail to fuse during the second month of gestation. There have only been four cases of the coexistence of an anomalous union of the pancreatobiliary duct and pancreas divisum, reported until now. The case of a 29 year old man with epigastric pain and fever was recently experienced. An ERCP revealed an anomalous union of the pancreatobiliary duct, complete pancreas divisum and common bile duct stone. The case is herein reported.

A Case of Pancreas Divisum Associated with a Pancreatic Duct Stone and Stricture for which Extracorporeal Shock Wave Lithotripsy was Effective / 대한소화기내시경학회지

A 40-year-old man was presented with recurrent abdominal pain. An ERCP (Endoscopic RETROGRADE Cho-langiopancreatography) revealed complete pancreas divisum and pancreatic duct stricture with a stone. Initially, endoscopic stone removal through the minor papilla origice was unsuccessful due to an impacted pancreatic stone associated with a dominant stricture at the dorsal pancreatic duct. Extracorporeal shock wave lithotripsy (ESWL) was performed twice and the impacted pancreatic stone was fragmented. After ESWL, endoscopic stone removal became possible and pancreatic stenting was performed for the correction of the dorsal duct stricture. This case in herein reported in which ESWL was successful in treating an impacted dorsal pancreatic duct stone associated with pancreas divisum.

Treatment of Pancreatic Ascites with Endoscopic Pancreatic Duct Stenting and Octreotide Injection / 대한소화기내시경학회지

Pancreatic ascites is an exudative which is an amylase-rich accumulation of intraperitoneal fluid and occurs in association with rupture of a pseudocyst or disruption of the pancreatic duct. Characteristically the patient presents with increasing abdominal girth, weight loss, and varying degrees of abdominal pain. Conservative medical management, including withholding of oral feeding, total parenteral nutrition, and large volume paracentesis has led to successful resolution of pancreatic ascites in less than 50% of cases. Recently octreotide injection and endoscopic transpapillary pancreatic duct stenting have made a major impact on the conservative treatment of pancreatic ascites. We describe the case of a patient with chronic pancreatitis and pancreatic ascites who was treated by endoscopic pancreatic duct stenting and octreotide injection.

An Impacted Pancreatic Stone at the Orifice of the Minor Papilla Causing a Bout of Acute Pancreatitis in a Patient with Pancreas Divisum / 대한소화기내시경학회지

Pancreas divisum is the most common congenital anomaly of the pancreas. Whether pancreas divisum is the cause of chronic abdominal pain, acute pancreatitis, or chronic pancreatitis is a matter of controversy yet. We recently experienced a case of acute pancreatitis due to an impacted stone at the orifice of the minor papilla in a 58 year-old man with pancreas divisum who showed clear radiologic evidences of dorsal chronic pancreatitis. The bout of acute pancreatitis recovered rapidly after endoscopic treatment (minor papilla sphincterotomy, stone removal, and endoscopic nasopancreatic drainage). We herein report an unusual manifestation of pancreas divisum in which endoscopic treatment was effective.