Effects of endoscopic reprocessing on disinfection and its influential factors during coronavirus disease 2019 pandemic.

Objective To explore the effects of endoscopic reprocessing on disinfection and its influential factors under the coronavirus disease 2019 (COVID-19) pandemic. Methods A total of 450 endoscopes cleaned and disinfected according to Technical Specifications for Cleaning and Disinfection of Endoscopes from November 2019 to January 2020, and 450 endoscopes cleaned and disinfected according to The recommended procedure for cleaning and disinfection of gastrointestinal endoscopes during COVID-19 epidemic by Chinese Society of Digestive Endoscopology from February to April 2020 in the Second Affiliated Hospital of Chongqing Medical University were enrolled in the control group and observation group respectively by random number method. Both the control group and the observation group contained 200 gastroscopes, 200 enteroscopes and 50 ultrasound endoscopes. ATP fluorescence detection method and pour plate technique were used to evaluate the disinfection effect of endoscopes. Single factor analysis and multiple logistic regression were used to analyze the risk factors for unqualified sterilization after endoscopic reprocessing. Results The disinfection pass rates of gastroscopes, enteroscopes and ultrasound endoscopes in the observation group were not significantly different compared with those of the control group (P>0. 05). The sterilization pass rates and ATP test pass rates of gastroscopes, enteroscopes and ultrasound endoscopes in the observation group were significantly higher than those in the control group (all P<0. 05). Multivariate logistic regression analysis showed that non-strict implementation of endoscopic reprocessing (OR = 7. 96, 95%CI: 4. 55-22. 84, P<0. 001), non-standard operation (OR = 2. 26, 95%CI: 1. 24-5. 63, P<0. 001), insufficient concentration of disinfectant (OR = 5. 43, 95% CI: 2. 52-9. 02, P < 0. 001), insufficient concentration ratio of multi-enzyme solution (OR = 4. 38, 95% CI: 1. 95-8. 61, P < 0. 001), non-timely cleaning (OR= 2. 86, 95%CI: 1. 33-6. 42, P<0. 001), incomplete cleaning (OR = 3. 75, 95%CI: 1. 61-7. 49, P<0. 001) and improper endoscopic preservation (OR= 2. 12, 95%CI: 1. 36-4. 12, P<0. 001) were independent risk factors for unqualified sterilization after endoscopic reprocessing. Conclusion In COVID-19 pandemic, endoscope reprocessing can significantly improve the disinfection effect of endoscopes, worthy of further clinical promotion. The failure to strictly implement the reprocessing procedure is an important factor that may lead to unqualified sterilization.Copyright © 2021 The authors.

Inadvertent Treatment of a Vertical Banded Gastroplasty Stricture With a LAMS for Two Years

Introduction: Lumen-apposing metal stents (LAMS) are innovative endoscopic devices representing the next significant advancement in stent technology. LAMS have demonstrated success, most notably with improving drainage of pancreatic fluid collections. Other clinical indications for using LAMS include biliary drainage, gastroenterostomy, or the managment of luminal tract strictures. The stent has a larger lumen diameter than previously created stents as well as a unique "dumbbell" shape to limit migration. Studies have demonstrated advantages such as shorter procedure times and overall reduced repeat endoscopic procedures. As LAMS has gained notoriety, there have been increasing studies demonstrating potential complications of the device. Most common consequences of LAMS include bleeding, biliary stricture, and buried LAMS syndrome. As the anatomical design has decreased migration risk, prompt removal is recommended to prevent buried LAMS syndrome, where the stent is embedded in the wall of the gastric mucosa and can eventually not be visualized endoscopically. In this case, we will present a patient with an endoscopically placed LAMS, which was successfully removed with minimal complications after two years in place. Case Description/Methods: Our patient is a 68 year old female with a Vertical Banded Gastroplasty Stricture. She had required multiple repeat endoscopies for dilation therapy but the stricture was refractory to dilation, as a result, she underwent LAMS placement Due to the onset of the COVID pandemic, patient was lost to follow up. On a repeat EGD two years after placement, the stent remained in its original location. There were signs of mild gastric tissue overgrowth at the right lateral side of the LAMS. The stent was then removed easily with no signs of bleeding. After removal, the stricture remained dilated as the scope could be passed without difficulty. Over course of COVID she ate better than she had in years. (Figure) Discussion: LAMS have demonstrated significant success in a variety of endoscopic interventions. Their potential complications are well documented in various studies. This case is unique in regards to the length of time in which the LAMS remained in position. From a literature review, no study has demonstrated a LAMS in place as long as two years for stricture management. More remarkable is the lack of complications from the stent such as no bleeding with removal and no true buried LAMS syndrome as there was minimal tissue overgrowth. (Figure Presented).

Robotic Manipulation System Design and Control for Non-Contact Remote Diagnosis in Otolaryngology: Digital Twin Approach

The COVID-19 pandemic has emphasized the need for non-contact medical robots to alleviate the heavy workload and emotional stress experienced by healthcare professionals while preventing infection. In response, we propose a non-contact robotic diagnostic system for otolaryngology clinics, utilizing a digital twin model for initial design optimization. The system employs a master-slave robot architecture, with the slave robot comprising a flexible endoscope manipulation robot and a parallel robot arm for controlling additional medical instruments. The novel 4 degrees of freedom (DOF) control mechanism enables the single robotic arm to handle the endoscope, facilitating the process compared to the traditional two-handed approach. Phantom experiments were conducted to evaluate the effectiveness of the proposed flexible endoscope manipulation system in terms of diagnosis completion time, NASA task load index (NASA-TLX), and subjective risk score. The results demonstrate the system's usability and its potential to alternate conventional diagnosis. © 2013 IEEE.

Recent Advances in Endoscope Disinfection: Where Do We Stand in the COVID era?

Over 16 million cases worldwide, severe acute respiratory syndrome coronavirus 2 has profoundly affected healthcare as we know it. Given reports of gastrointestinal involvement and viral shedding in the stool, it is unsurprising there are concerns that endoscopic equipment may be a potential vector of viral transmission. Here, we provide an overview of existing practices for endoscope reprocessing, recent developments in the field, and challenges in the COVID-19 environment. Current multi-society guidelines do not advise any change to endoscope disinfection protocols but emphasize strict adherence to recommended practices. However, endoscopy reprocessing staff may benefit from supplemental personal protective equipment measures, especially in high risk situations. Because thorough endoscope reprocessing is highly operator dependent, adequate training of personnel is critical for proper manual cleaning and disinfection of endoscopes that have potential to harbor virus. Bacterial contamination of duodenoscopes has caused outbreaks of infection from multidrug-resistant organisms, highlighting vulnerable areas. The emphasis of current studies is on optimization of disinfection and drying, minimization of simethicone use, and on quality control of endoscope reprocessing with sampling and microbiological culturing. Recent advances include novel approaches to endoscope sterilization, infection barrier methods, and design of partially or fully disposable duodenoscopes. Overall, the available data indicate that, when correctly executed, current reprocessing practices are sufficient in preventing SARS-COV-2 transmission.

Impact of Covid-19 Pandemic on Otorhinolaryngology Practice in India

Background: Covid-19 has dramatically changed everyday life across the globe. Otorhinolaryngologists were at the forefront of being exposed to the virus. As the virus evolved so did the practice of otorhinolaryngology in the country. Some innovative tacks for protecting otorhinolaryngologists and improving patient care were put into our practice by many doctors. Assessment of these techniques will help us to overcome the difficulties if a similar situation arises in the future. Material(s) and Method(s): An online survey was conducted among Indian otorhinolaryngologists. The invitation to participate in the survey was circulated among otolaryngology consultants and postgraduates all over India through multiple modalities on social media. The survey consisted of 4 sections with a total of 24 questions, related to covid vaccination status, changes made in practice, OPD (outpatient department) consultations during the lockdown period, and modifications done in outpatient and operation theatre setups. Google forms were kept open for one month. Result(s): There were changes in outpatient and operation procedure management like screening of patients before treatment and surgery, patient health care declarations, vaccination status, improvisation done in the methods of sterilization of ENT instruments, endoscopes, case selection of elective OT (operation theatre) cases. This paper aims to give a brief overview of current knowledge about the impact of covid 19 on otolaryngology practice using the best available evidence. Conclusion(s): COVID-19 had made crucial changes in ENT practice forever which will help otorhinolaryngologists in the better care of patients if a similar situation arises in the future.Copyright © 2022, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 PREVALENCE IN SALIVA AND GASTRIC AND INTESTINAL FLUID IN PATIENTS UNDERGOING GASTROINTESTINAL ENDOSCOPY IN CORONAVIRUS DISEASE 2019 ENDEMIC AREAS: PROSPECTIVE CROSS-SECTIONAL STUDY IN JAPAN

Objectives: Gastrointestinal endoscopy (GIE) is useful for the early detection and treatment of many diseases;however, GIE is considered a high-risk procedure in the coronavirus disease 2019 (COVID-19) pandemic era. This study aimed to explore the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity in saliva and gastrointestinal fluids to which endoscopy medical staff are exposed. Method(s): The study was a single-center cross-sectional study. From June 1 to July 31, 2020, all patients who underwent GIE at Yokohama City University Hospital were registered. All patients provided 3 mL of saliva. For upper GIE, 10 mL of gastric fluid was collected through the endoscope. For lower GIE, 10 mL of intestinal fluid was collected through the endoscope. The primary outcome was the positive rate of SARS-CoV-2 in saliva and gastrointestinal fluids. We also analyzed serum-specific antibodies for SARS-CoV-2 and patients' background information. Result(s): A total of 783 samples (560 upper GIE and 223 lower GIE samples) were analyzed. Polymerase chain reaction (PCR) on saliva samples did not show any positive results in either upper or lower GIE samples. However, 2.0% (16/783) of gastrointestinal fluid samples tested positive for SARS-CoV-2. No significant differences in age, sex, purpose of endoscopy, medication, or rate of antibody test positivity were found between PCR positive and PCR negative cases. Conclusion(s): Asymptomatic patients, even those with no detectable virus in their saliva, had SARS-CoV-2 in their gastrointestinal tract. Endoscopy medical staff should be aware of infection when performing procedures. The study was registered as UMIN000040587. Text S1 Detection of SARS-Co-V-2 genomic RNA and serological tests for SARS-CoV-2 antibodies. Detection of SARS-CoV-2 genomic RNA was performed according to the Manual for the Detection of Pathogen 2019-nCoV Ver.2.61) provided by the National Institute of Infectious Diseases in Japan. RNA extraction was performed from a 140-microl sample using a QIAamp Viral RNA Mini Kit (Qiagen, Valencia, CA, USA) according to the manufacturer's protocol. The final elution was performed with 60 microl of elution buffer, and 5 microl of extracted RNA was subject to evaluation by real-time quantitative PCR (RT-qPCR). The RT-qPCR reaction mix was prepared using TaqMan Fast Virus 1-Step Master Mix (Thermo Fisher Scientific, Foster City, CA, USA) and primer/probe N2 (2019-nCoV) (TakaRa, Tokyo, Japan) according to the manufacturer's protocol. Primer sequences are shown in Supplementary Table 1. RT-PCR was conducted by StepOnePlusTM Real-Time PCR System (Applied Biosystems, Thermo Fisher Scientific, MA. USA) The denaturation and annealing/extension steps were repeated for 45 cycles. A well containing absolutely quantified artificial synthetic template RNA was evaluated as a positive control, and a well without template RNA was evaluated as a negative control. According to the Manual for the Detection of Pathogen 2019-nCoV Ver.2.6, the assay was considered valid when the following criteria were met: (a) 50 copies/well of template RNA successfully detected before 40 cycles and (b) nonspecific amplification not detected in the well lacking template RNA up to 45 cycles. Samples showing amplification of SARS-CoV-2 genomic RNA before 40 cycles were defined as positive for COVID-19. We previously reported a method for serological testing2),3). Briefly, an enzyme-linked immunosorbent assay was performed to detect and quantify anti-SARS-CoV-2 antibodies in plasma. We used an N-terminally-truncated nucleocapsid protein (NP) and the receptor-binding domain of the spike protein (SP) as antigens (100 ng/well). Following blocking with phosphate-buffered saline (PBS) containing 3 % skimmed milk for 2 h, 100 microl of diluted plasma (1:100) were added and incubated for 1 h. After three washes with PBS-T, wells were incubated with 100 microl of diluted horseradish peroxidase-conjugated goat anti-human immunoglobulin G antibody (1:20000) for 1 h. Afte five additional washes with PBS-T, 100 microl of Tetramethylbenzidine Substrate (Kirkegaard & Perry Laboratories, Maryland, USA) was added and incubated for 10 mins. The reaction was terminated by adding 50 microl of 2-M H2SO4, and optical density was measured at 450 nm using a plate reader. In the serological test, COVID-19 antibody positivity was defined as a value greater than 1.139 in the NP test and greater than 0.277 in the SP test. In this study, a positive result in either the NP test or the SP test was defined as a positive antibody test. Copyright © 2022 Japan Gastroenterological Endoscopy Society. All rights reserved.

Gas Pressure From the Endoscope: An Unexplored Contributor to Morbidity and Mortality?

Background It has been shown that the incidence of venous air embolism and venous carbon dioxide (CO2) embolism is high during endoscopic retrograde cholangiopancreatography (ERCP). We examined insufflating gas flow and maximum pressure produced by three types of commonly used endoscopes because we could not readily locate technical data for endoscope gas flow and maximum emitted pressure in the manufacturer's manuals. Methods We tested the Olympus GIF-Q180 used for esophagogastroduodenoscopy, the CF-Q180 used for colonoscopy, and the TJF-Q180 used for ERCP (Olympus America Inc., Center Valley, Pennsylvania). Under three different clinical gas insufflation scenarios, we measured in vitro maximum gas pressure transduced from a closed space created at the endoscope tip in a worst-case scenario analysis. Results We showed that it is readily possible to generate a pressure (>5-30 times normal central venous pressure) in the air space at the tip of all three endoscopes when insufflation is activated and the gas egress is limited. Conclusions These findings shed additional light on in vivo occurrences of gas embolism during gastrointestinal endoscopy. We postulate that in addition to using exclusively CO2 as the insufflating gas, the risk of gas embolism can be further diminished by regulating insufflating gas pressure at the tip of endoscopes.

Willingness to Pay and Preferences Among Patients Undergoing Cystoscopies: Results from a Large Survey-Based Study in Spain.

Purpose: Cystoscopy procedures can cause distress among patients. Patient perspectives on health services are essential inputs in decision-making. This study investigated the patient preferences in Spain regarding single-use cystoscopes (SUC) compared to reusable cystoscopes and their willingness to pay (WTP) for cystoscopy procedures. Patients and Methods: Between May and June 2021, an anonymous survey was distributed to Spanish patients who had previously undergone a cystoscopy. The survey included patient preference measures on reusable cystoscopes compared to SUCs and a discrete choice experiment. The survey was distributed through a human data science company (IQVIA), collected using an online survey tool (QuestionPro®), and analyzed using Stata/MP, StataCorp. Results: Of 300 respondents, 148 (49.33%) were female and 150 (50%) were male, and mainly between 18-49 years (247, 82.33%). Most (265, 88%) preferred to have their procedure performed with a SUC rather than a reusable cystoscope. Among these patients, 215 (80%) could imagine asking their doctor to use a SUC. A total of 231 (77%) respondents indicated an increased level of concern about the risk of exposure to contamination related to their cystoscopy following the COVID-19 pandemic. Patients would pay 62 EUR to have their initial consultation and cystoscopy procedure on the same day (p < 0.001), 59 EUR to reduce the environmental impact, and 57 EUR to reduce the risk of contamination (p < 0.001). Conclusion: Patients prefer to undergo cystoscopy using an SUC on the same day as their initial consultation. The increased contamination concerns due to the COVID-19 pandemic and WTP to reduce the risk of cystoscope contamination may explain patients' preferences for SUCs. The most important attributes related to their cystoscopy procedure are the ability to have their procedure performed on the same day as their initial consultation, the reduction of the environmental impact, and the reduction of the contamination risk.

FINGERNAIL CLIPPING AS A FOREIGN BODY CAUSING SEVERE EMPYEMA

SESSION TITLE: Chest Infections with Pleural Involvement Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Foreign body aspiration (FBA) is an uncommon cause of dyspnea and respiratory infection. 80% of cases occur in children under 15-years-old, with the highest mortality in children under 1 and adults over 75. We present an unusual case of a fingernail clipping causing severe empyema in a middle-aged male. CASE PRESENTATION: A 44-year-old male with diabetes mellitus presented with a 3-day history of dyspnea, productive cough, and anorexia, and a 1-day history of fevers and substernal chest pain. Exam was notable for fever, tachypnea, tachycardia, and hypoxemia requiring a non-rebreather mask. Labs were significant for a negative COVID-19 polymerase chain reaction (PCR) test, white blood cell (WBC) count 17,000 μL, and lactate 3.4 mmol/L. He was given albuterol-ipratropium nebulizer treatments and methylprednisolone 125 mg. Chest x-ray revealed a large right-sided air-fluid level, dense consolidation of the lung base, and complicated pleural effusion. Computed Tomography (CT) of the chest revealed a large right mid-lung abscess, right middle lobe (RML) and right lower lobe (RLL) consolidations, and loculated pleural effusion with hydropneumothorax. A surgical chest tube was placed that drained purulent fluid. The effusion grew Klebsiella pneumoniae, which was treated with ampicillin-sulbactam. Repeat CT chest revealed improved loculated effusion, but persistent RML and RLL consolidations with concern for endobronchial obstruction. Flexible bronchoscopy was performed, which identified and removed a human fingernail clipping obstructing the RML. Post-procedure, his oxygen requirements, cough, and dyspnea improved remarkably. He was discharged with a 4-week course of amoxicillin-clavulanate. On outpatient follow-up 6 weeks later, he was asymptomatic. DISCUSSION: In our patient, a fingernail clipping was lodged in the opening of the RML, resulting in a post-obstructive pneumonia complicated by empyema. Post-bronchoscopy, the patient admitted to anxiety-induced nail-biting. FBA most commonly occurs in the right bronchial tree (71.5%) as compared to the left bronchial tree (22.8%) and trachea (5.7%). Objects were most commonly lodged in the bronchus intermedius (27%) and right lower lobe (33%). Foreign bodies can be removed via rigid or flexible bronchoscopy, with a 90% success rate in the latter. Instruments such as forceps and baskets can be used to remove the foreign body, and Trendelenberg positioning can be useful in moving the object proximally. In up to 76% of cases, granulation tissue caused by a localized reaction to the foreign body may occur and can be minimized with systemic steroids for 24 hours. CONCLUSIONS: FBA in a middle-aged patient is an unusual cause of respiratory infection, but should be on the differential diagnosis for post-obstructive pneumonia. Reference #1: Hsu Wc, Sheen Ts, Lin Cd, Tan Ct, Yeh Th, Lee Sy. Clinical experiences of removing foreign bodies in the airway and esophagus with a rigid endoscope: a series of 3217 cases from 1970 to 1996. Otolaryngol Head Neck Surg. 2000 Mar;122(3):450-4. doi: 10.1067/mhn.2000.98321. PMID: 10699826. Reference #2: Blanco Ramos M, Botana-Rial M, García-Fontán E, Fernández-Villar A, Gallas Torreira M. Update in the extraction of airway foreign bodies in adults. J Thorac Dis. 2016;8(11):3452-3456. doi:10.21037/jtd.2016.11.32. Reference #3: Fang YF, Hsieh MH, Chung FT, Huang YK, Chen GY, Lin SM, Lin HC, Wang CH, Kuo HP. Flexible bronchoscopy with multiple modalities for foreign body removal in adults. PLoS One. 2015 Mar 13;10(3):e0118993. doi: 10.1371/journal.pone.0118993. PMID: 25768933;PMCID: PMC4358882. DISCLOSURES: No relevant relationships by Nuzhat Batool No relevant relationships by Lisa Glass No relevant relationships by Alice Mei No relevant relationships by Daisy Young

Structural Design and Analysis of a New Four-blade Biopsy Capsule Endoscope

Due to the rapid spread of COVID-19 around the world, people's diet environment has also changed, and gastrointestinal diseases have become a common disease around us so far, and the prevalence is on the rise. But because traditional treatments for gastrointestinal diseases are unfriendly to patients, they often require the administration of anesthetics, which can cause side effects. Wireless capsule endoscope is a kind of medical robot that can alleviate the pain of patients, and the research on wireless capsule endoscope has been gradually mature at home and abroad, this paper designed a new four-page propeller-driven biopsy capsule robot. The optimal number of propeller pages is obtained by comparing the velocity of three different numbers of propeller blades in the pipeline. The three axis Helmholtz coil driving system and biopsy module based on CAM structure are also introduced. At the same time, the anchoring module used for precise biopsy of the robot is introduced, so as to ensure that the biopsy capsule robot can reach the specified position quickly and accurately and complete the biopsy task. Finally, we use simulation software to simulate the velocity and pressure of different propeller blades in the same liquid. © 2022 IEEE.

ERYTHEMA MULTIFORME MAJOR (EMM) POST SECOND COVID-19 VACCINATION: A CASE REPORT

CASE: Our patient is a 52-year-old female with a history of gastroesophageal reflux and hypertension. 36 hours after receiving the second Pfizer COVID-19 vaccine, she developed lip and tongue swelling, mucosal ulcerations, and respiratory distress. There was no conjunctivitis or genital involvement. She denied taking any new medications, supplements, or food that might have led to the reactions. She initially presented to an outside hospital and required intubation prior to transfer to our facility. A bedside esophagogastroduodenoscopy (EGD) was performed noting extensive Grade D erosive esophagitis and gastric ulcerations with friability. When the endoscope was removed a 34cm section of necrotic esophageal tissue was removed from the airway. Despite intravenous steroid treatment, she continued to have esophageal scarring and was unable to tolerate food by mouth. Therefore, a gastrostomy tube was placed. Since that time, she has required several recurrent EGDs for esophageal dilation due to scarring. It has now been six months from her initial injury, and unfortunately, the patient is still unable to take PO and is dependent on tube feedings. IMPACT/DISCUSSION: The coronavirus pandemic began in December 2019. At the time of this report, SARS-CoV-2 infection has been the cause of 5.48 million deaths worldwide and 836,000 deaths in the United States alone. In addition, this global pandemic has had severe economic and social implications. There are currently three vaccines authorized by the United States Food and Drug Administration for emergency use. I report an extremely uncommon complication of the Pfizer COVID-19 vaccine: a case of Eryethema Multiforme Major that occurred after the second dose vaccine without exposure to any other drug. Eryethema Multiforme is divided into major and minor forms and is regarded as distinct from Stevens- Johnson syndrome and toxic epidermal necrolysis. It is related to infections, usually Herpes Simplex Virus, or less commonly, to medications. In Erythema Multiforme, mucous membrane involvement is absent or mild. Erythema Multiforme Major is an immune mediated skin reaction involving the oral cavity and mucosa that is serious and occasionally life threatening. There have been several reported cases of Erythema Multiforme following COVID-19 vaccination but only one other cases of Erythema Multiforme Major associated with the mRnA-1273 SARS-CoV-2 vaccine (Moderna.) CONCLUSION: This case highlights an extremely rare vaccine consequence. The benefits still greatly outweigh the risks of vaccination, and this case does not diminish the importance of COVID-19 vaccination to effectively control this pandemic.

Disorders of Taste and Olfaction by COVID- 19- Patients- A functional and morphological Study

Purpose We investigated the prevalence of smell and/or taste loss and the clinical characteristics and recovery in a cohort of consecutive patients treated by two COVID-19 reference hospitals and evaluated the late persistence of hyposmia. Material and Methods 53 consecutive RT-PCR diagnosed patients (23 males, 30 females, 42,54 ± 10, 95 years) who had been hospitalized between January- June 2021 in the COVID-19 care wards were contacted, excluding patients with cognitive disorders and severe deconditioning. These patients (Group A) have been examined twice, once direct after leaving the hospital, and once again 4-6 weeks later. The patients- nasal and oral mucosa (Fungiform Papillae on tongue-s tip-fPap) were examined with a contact endoscope. Their olfaction was also examined with Sniffin' Sticks. As control-group we have examined 53 healthy subjects (Group B). Results Significant alterations in form and vascularization of fPap have been detect, specially by the first examination. Patients EGM-Thresholds of both measurements are higher than those of healthy subjects, although those of the second one are clearly lower. The same results have been found using Schniffin- Sticks. Discussion Our findings suggest that COVID-19 can produce a mild to profound neuropathy of multiple cranial nerves, which are responsible for the regeneration of fPap and the transmission of the chemical stimuli.

DOES USE OF AN ENDOSCOPIC PATIENT FACEMASK REDUCE PARTICLE AEROSOLIZATION DURING UPPER ENDOSCOPIC PROCEDURES? A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Background: The COVID-19 pandemic has heightened awareness surrounding the danger of aerosolizing procedures which may lead to viral transmission. Most viruses are spread via droplets which are predominantly 5-10 microns (mm) in size and can remain suspended in the environment for extended periods of time. While personal protective equipment may reduce some risk, this prolonged suspension of infectious droplets may still lead to transmission. Furthermore, there is little data describing the risk of aerosolization during upper endoscopic procedures. We sought to characterize particle aerosolization between patients undergoing upper endoscopy with and without an endoscopic patient facemask. Methods: Adult patients scheduled for elective upper endoscopic procedures under monitored anesthesia care at a tertiary care center between August and October 2021 were prospectively enrolled. Patients were randomized to either receive an endoscopic facemask designed with fenestrated openings for endoscope insertion (Procedural Oxygen Mask, Simi Valley, CA) or undergo endoscopy with no mask using nasal cannula oxygen support. Exclusion criteria included requiring endotracheal intubation or medically needing an endoscopic facemask for oxygen delivery. Particle aerosols were measured using a commercially available particle detector (Met One GT-526S, Grants Pass, OR) which measured particles of six different sizes (<0.3mm, 0.3-0.5mm, 0.5-0.7mm, 0.7-1mm, 1-5mm and 5- 10mm). The device was placed at 1 foot from the subject's mouth and equidistant between the endoscopist and the anesthesia staff. Measurements were taken every 5 seconds for analysis. A linear mixed effects model was used to analyze the difference in particle aerosolization between groups. Results: Out of 57 patients who were randomized, 27 underwent endoscopy with a facemask and 30 underwent endoscopy with no mask. There were no significant differences in age, gender, body mass index, Mallampati score, patient positioning, or American Society of Anesthesiology (ASA) score between the 2 groups. Analysis of 27,724 measurements showed no difference in particle aerosolization of any size particle between the 2 study arms. The predictive model demonstrated a trend of decreasing particles during endoscopy which then increased by the end for all six particle sizes for both groups. Conclusions: Use of a widely available endoscopic patient facemask did not prevent particle aerosolization during upper endoscopic procedures. Interestingly, there was an initial decrease in particle counts during the procedures followed by a subsquent increase which may reflect heightened aerosolization with insertion and removal of the endoscope. Further study is warranted to determine if additional interventions may be useful for preventing particle aerosolization during endoscopy and improving safety for all health care staff. (Table Presented) (Figure Presented)

Sans Standardization: Effective Endoscope Reprocessing.

Bronchoscopy is a commonly performed procedure within thoracic and critical care medicine. Modern bronchoscopes are technologically advanced tools made of fragile electronic components. Their design is catered to allow maximum maneuverability within the semi-rigid tracheobronchial tree. Effective cleaning and reprocessing of these tools can be a challenge. Although highly functional, the design poses several challenges when it comes to reprocessing. It is a very important step, and lapses in the procedure have been tied to nosocomial infections. The process lacks universal standardization; several organizations have developed their own recommendations. Data have shown that key stakeholders are not fully versed in the essentials of endoscope reprocessing. A significant knowledge gap exists between those performing bronchoscopy and those who are stewards of effective endoscope reprocessing. To service as a resource for bronchoscopists, this study summarizes the steps of effective reprocessing, details the important elements within a health-care facility that houses this process, and reviews some of the current data regarding the use of disposable endoscopes.

PROSPECTIVE EVALUATION OF SMALL BOWEL INSERTION DEPTH ACHIEVED WITH PUSH ENTEROSCOPY BY USING CAPSULE ENDOSCOPY

DDW 2022 Author Disclosures: Ryosuke Kobayashi: NO financial relationship with a commercial interest ;Natalia C. Calo: NO financial relationship with a commercial interest ;Bong Sik Kim: NO financial relationship with a commercial interest ;Christopher Teshima: NO financial relationship with a commercial interest Aims: Push enteroscopy (PE) is commonly used in patients with obscure GI bleeding after a negative esophagogastroduodenoscopy and colonoscopy to investigate for a bleeding source within the proximal small bowel. However, there is almost no literature that has measured the anticipated proportion of the small intestine that can be evaluated by using the PE technique. The primary aim of this study was to quantify the percentage of small bowel examined by PE by using capsule endoscopy (CE). Methods: Prospective patients referred for small bowel investigation of obscure GI bleeding were offered single session PE followed by CE. PE was performed using a pediatric colonoscope fitted with a distal attachment cap that was advanced as far as possible into the small intestine using a water immersion method and aided by multiple reduction maneuvers. Two endoscopic clips were placed to denote the maximal insertion point reached by PE. Potential bleeding sources identified during PE were treated during careful endoscope withdrawal. CE was then performed with direct endoscopic placement of the capsule into the duodenum by use of a gastroscope fitted with a capsule delivery device. CE was then performed as per usual standard-of-care. The clips were identified during CE and the small bowel insertion depth of PE was quantified by the percentage of small bowel transit time (SBTT) and of small bowel progress (SBP) from the CE examination. The study was approved by our center’s IRB. Results: Fifty-six patients were enrolled between August 2019 and November 2021;mean age 62 years;59% male. Study recruitment was hindered by our institution’s pausing of clinical research recruitment in the first year of the Covid-19 pandemic. Five cases were excluded due to incomplete small bowel examination by CE and 1 case in which PE could not be performed;leaving 50 cases for the analysis. The median CE SBTT was 4h 55m. The median SBP and SBTT percentage as determined by the location of the endoscopic clips placed during PE were 14% (IQR 5-26) and 11% (IQR 4-21), respectively. Bleeding lesions were detected by PE in the stomach in 10 cases and in the duodenum/jejunum in 20 cases. CE identified potential bleeding lesions within the segments of small bowel examined by PE in 12 cases and distal to the clips in 22 cases. CE detected only 69% of angioectasias that had been treated by PE and did not visualize 2 cases of submucosal tumor that were discovered during PE. Conclusions: PE achieves an average examination of the proximal 14% of the small bowel. This should inform appropriate selection of PE vs. DBE when a bleeding lesion is detected by CE. However, notable lesions may be missed by both PE and CE examinations.

EVALUATION OF ENVIRONMENTAL BACTERIA BY NORMAL CLEANING AND HYPOCHLOROUS ACID SPRAY IN AN ENDOSCOPY UNIT

DDW 2022 Author Disclosures: KUMIKO UCHIDA: NO financial relationship with a commercial interest ;Takao Itoi: NO financial relationship with a commercial interest ;Masakatsu Fukuzawa: NO financial relationship with a commercial interest ;Akira Madarame: NO financial relationship with a commercial interest ;Takashi Kawai: NO financial relationship with a commercial interest Background: The outbreak of coronavirus infection (COVID-19) in 2020 has not yet ended in Japan and overseas, and droplet, contact, and aerosol infections have been suggested as routes of COVID-19 infection. As COVID-19 infection spreads, supply and demand for alcohol disinfectant solutions are temporarily tight, and hypochlorous acid water has attracted attention as a material available to the consumers.Purpose: The purpose of this study was to evaluate the environmental bacteria in an endoscopy unit sprayed with hypochlorous acid water from the viewpoint of space purification as an infection control for aerosols. Methods: An unmanned endoscopy unit was used after the end of a day's work. The viable counts of environmental bacteria in the cleaning group (before and after normal cleaning) and in the spraying group (before and after spraying with hypochlorous acid water) were compared and examined. Sampling of adherent bacteria (environmental bacteria) on beds, floors, illuminating apparatus for endoscope, PC desks, and washbasins, which are considered to be exposed to aerosols, was evaluated using SCD agar medium (product name: Petan Check, manufacturer: Eiken Chemical Co., Ltd.). For normal cleaning, disinfectant solutions of quaternary ammonium, isopropyl alcohol, and 80% ethanol were use after the work was completed. The hypochlorous acid water was sprayed with IONLESSTM hypochlorous acid water (product name: CLFine, manufacturer: Nipro Corporation) in accordance with the working environment evaluation standard of the Industrial Safety and Health Act, and the atmospheric effective chlorine concentration was kept at about 0.03 ppm, which is considered to be the optimum concentration, for 5 hours. The Mann-Whitney U test was used to compare the number of adherent bacteria. Results: There was no difference in the number of bacteria on the bed, illuminating apparatus for endoscope, computer desk, and washbasin between the cleaning and spraying groups. The median number of bacteria on the floor before cleaning was 26 CFU/10cm2, while that after cleaning was 23 CFU/ 10cm2. On the other hand, in the hypochlorous acid water group, the median value before spraying was 27 CFU/10cm2 and after spraying was 4 CFU/10cm2. Although there was no statistical difference (p=0.057), the hypochlorous acid water group tended to have fewer adherent bacteria. Conclusion: The hypochlorous acid spray tended to reduce the number of adherent bacteria (environmental bacteria) on the floor where aerosol exposure was possible, and the hypochlorous acid spray was considered to be useful in reducing environmental bacteria in endoscopy unit.

ANALYZING AND IMPROVING ENDOSCOPY UNIT EFFICIENCY IN AN ACADEMIC TERTIARY CARE UNIVERSITY HOSPITAL

DDW 2022 Author Disclosures: Armin Parsi: NO financial relationship with a commercial interest ;QiQi Zhou: NO financial relationship with a commercial interest ;G. Nicholas Verne: NO financial relationship with a commercial interest Background: The COVID-19 pandemic required postponement of many elective gastrointestinal (GI) endoscopic procedures. With the pandemic now in control, the number of patients requiring GI endoscopic procedures has steadily increased. This increasing demand combined with a shortage of qualified support staff in the aftermath of the pandemic has made efficiency-improvement in endoscopy centers an increasingly important topic for academic medical centers. Aim: To determine strategies to enhance efficiency in an academic tertiary-care endoscopy unit. The overall goal was to decrease physician down-time and maximize the use of support staff and nurses without adversely impacting the patient or provider experience. Methods: We introduced a new metric, inter-procedure time, defined as the elapsed time between endoscope removal from one patient and endoscope insertion into the next patient, as the metric of choice to measure and track improvements in efficiency. This metric not only accounts for the time spent for room turnover but also other factors that may delay initiation of the subsequent procedure while the patient is already in the endoscopy room. In an ongoing prospective quality-improvement project, we initiated a 3-pronged intervention strategy: 1) employed a “one- endoscopist-two-room” model, 2) improved nonphysician staff utilization by having a nurse rotating between two endoscopy rooms, and 3) instituted clear communication of when a procedure was close to completion in order to begin the room turnover process. Results: The inter-procedure times were prospectively measured for 100 consecutive patients presenting for elective outpatient endoscopy before the intervention and 66 consecutive patients after the intervention. Patient demographics, severity of comorbidities, and the type of endoscopic procedures did not differ between the two groups. Before the intervention, the average inter-procedure time was 36.7±21min while after the intervention the average inter- procedure time decreased to 17±9.7 min(p< 0.001). After the intervention, the number of endoscopic procedures performed per day increased by 32% without any change in the number of endoscopists or support staff. Conclusions: 1. Strategies such as one-endoscopist-two-room model, improving nonphysician staff utilization, and improved communication between providers can significantly enhance efficiency of endoscopy units without increasing costs. 2. Decreasing inter-procedure time is directly associated with increasing endoscopy unit output. Interprocedure time is therefore an appropriate metric for measuring and tracking efficiency in endoscopy units. 3. Further studies are needed to assess sustainability of these improvements in the long term. (No Image Selected)

CAPSULE ENDOSCOPY FINDINGS in PATIENTS with SEVERE SARS-CoV-2 INFECTION: PILOT STUDY

Background: Although SARS-CoV-2 has mainly respiratory manifestations, gastrointestinal symptoms are observed in 30% of cases. The ACE-2 receptor used by SARS-CoV-2 to infect cells is highly expressed in the brush border of enterocytes. However, studying the small intestine in live patients is a challenge in the field of clinical research. A minimally invasive alternative for studying the small intestine is the use of capsule endoscopy, which could be useful in the context of COVID-19. Here, we describe endoscopic changes in the mucosa of the small intestine secondary to severe SARS-CoV-2 infection in hospitalized patients. Methods: We performed a prospective observational study in hospitalized patients with a severe COVID-19 according to NIH guidelines. Participants with a positive COVID-19 PCR from nasopharyngeal swab, hemodynamically stable, able to swallow, and without additional respiratory co-infections, were enrolled between January 27th and May 17th, 2021 at the largest tertiary COVID-19 referral center in Mexico City. Demographic and clinical characteristics were collected for each participant from clinical files. A PillCam capsule from Medtronic® was used for Capsule Endoscopy (CE). Each capsule study was reviewed separately by two trained endoscopists. Detection of SARS-CoV-2 RNA in stool samples was performed according to CDC guidelines for all participants. Results: Twenty volunteers were enrolled in the study. Diarrhea was the most common gastrointestinal symptom (78%). CE study was normal in 6 participants, while the rest showed at least one intestinal finding. The most frequent finding was shortening or atrophy of villi and hyperemia (45%);followed by red spots (40%), and ulcers (15%). Two participants with shortening or atrophy of villi also presented denuded mucosa. CE findings were observed mainly in duodenum and jejunum. Participants showing changes in villi also presented positive SARS-CoV-2 RNA in stool. Conclusion: We observed that macroscopic changes in the small intestine mucosa, specifically in villi, occurred frequently in severe COVID-19 patients. These changes were accompanied by the presence of SARS-CoV-2 RNA in stool. We proposed the term COVID-19 Enteropathy to encompass these findings. Further studies are warranted to establish mechanisms of SARS-CoV-2-associated gastrointestinal disease.

A Wi-Fi-Based Mask-Type Laryngoscope for Telediagnosis During the COVID-19 Pandemic: Instrument Validation Study.

BACKGROUND: Owing to the COVID-19 pandemic, social distancing has become mandatory. Wireless endoscopy in contactless examinations promises to protect health care workers and reduce viral spread. OBJECTIVE: This study aimed to introduce a contactless endoscopic diagnosis system using a wireless endoscope resembling a mask. METHODS: The Wi-Fi-based contactless mask endoscopy system comprises a disposable endoscope and a controller. First, the effective force applied by the tip during insertion was evaluated in a simple transoral model consisting of a force sensor on a simulated oropharynx wall. Second, the delay in video streaming was evaluated by comparing the frame rate and delays between a movement and its image over direct and Wi-Fi connections. Third, the system was applied to a detailed laryngopharyngeal tract phantom. RESULTS: The smartphone-controlled wireless endoscopy system was successfully evaluated. The mean, maximum, and minimum collision forces against the wall of the transoral model were 296 mN (30 gf), 363 mN (37 gf), and 235 mN (24 gf), respectively. The delay resulting from the wireless connection was 0.72 seconds. Using the phantom, an inexperienced user took around 1 minute to orient the endoscope to a desired area via the app. CONCLUSIONS: Device articulation does not pose a significant risk of laryngopharyngeal wall penetration, and latency does not significantly impede its use. Contactless wireless video streaming was successful within the access point range regardless of the presence of walls. The mask endoscope can be controlled and articulated wirelessly, minimizing contact between patients and device operators. By minimizing contact, the device can protect health care workers from infectious viruses like the coronavirus.