Reprocessing of flexible gastrointestinal endoscopes. American Society for Gastrointestinal Endoscopy.
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Flexible gastrointestinal endoscopy is a valuable diagnostic and therapeutic tool for the care of patients with gastrointestinal and pancreaticobiliary disorders. Compliance with accepted guidelines for the reprocessing of gastrointestinal endoscopes between patients is critical to the safety and success of their use. When these guidelines are followed, pathogen transmission can be effectively prevented. Increased efforts and resources should be directed to improve compliance with these guidelines. Further research in the area of gastrointestinal endoscope reprocessing should be encouraged. The organizations that endorsed this guideline are committed to assisting the FDA and manufacturers in addressing critical infection control issues in gastrointestinal device reprocessing.
The use of relaxation music as an adjunct to sedation has not been well studied. We tried to determine whether the use of relaxation music can improve patient tolerance of gastrointestinal endoscopic procedures. Fifty-nine patients undergoing gastrointestinal endoscopic procedures were randomly assigned to receive either relaxation music (n = 28) or no music (n = 31) using headphones and a portable compact disc player. Patient anxiety before the procedure, tolerance of the procedure, and willingness to undergo a repeated procedure were self-assessed using a visual analog scale. Patient tolerance was also assessed by the assisting nurse. There was no significant difference in the overall tolerance score between the two groups. However, a significantly higher proportion of patients described the experience of a gastrointestinal endoscopic procedure as being at least moderately unpleasant in the no-music group. Patient acceptance of the relaxation music was high: 82% in the group stated they would have music again if they required another procedure. We conclude that, even in patients who have sedation, relaxation music can reduce the number who find the experience of gastrointestinal endoscopic procedures unpleasant. Therefore we believe it has a role as an adjunct to sedation in gastrointestinal endoscopic procedures.
Endoscopes are used for visualization and biopsy of gastrointestinal lesions, as well as therapeutic procedures, such as foreign body retrieval. In the past, they were primarily used in large institutional settings where specialized personnel could focus on their maintenance. Today, they are becoming increasingly common in general practice. The maintenance of gastrointestinal endoscopes in the veterinary setting involves many challenges, including safe handling, reprocessing, and storage. Meeting these challenges requires well-trained personnel and strict protocols. Reprocessing, which includes cleaning and disinfection, offers the greatest challenge. The complex structure of flexible endoscopes, particularly the long, narrow channels, makes them difficult to clean. Gastrointestinal endoscopes operate in a contaminated environment, exposing them to high levels of organic matter and bacteria. High-level disinfection is necessary for infection control, but liquid germicides available for endoscope disinfection can be toxic to medical personnel and patients.
A working knowledge of normal endoscopic anatomy and the effects of positioning must be mastered to take advantage of endoscopic procedures involving the gastrointestinal system. Endoscopic procedures involving the gastrointestinal system offer advantages over conventional surgery in that they are less invasive and provide direct visualization. Laparoscopy can be used to evaluate horses with abdominal pain before and after surgery. It can be used to evaluate and biopsy abdominal masses and parenchymal organs such as the spleen, liver, and kidney. Endoscopic gastrointestinal surgical procedures such as colopexy and adhesionolysis are limited at this time but should continue to be developed as instrumentation and technology evolve.
BACKGROUND: Upper gastrointestinal tract involvement in HIV/AIDS is common. No data exist on the pattern of upper gastrointestinal endoscopic findings in HIV/AIDS patients in Nigeria. OBJECTIVE: To describe the pattern of upper gastrointestinal endoscopic findings in HIV/AIDS patients. DESIGN: A hospital based retrospective case-control study involving 52 HIV/AIDS patients and 52 age and sex matched controls. SETTING: Medicine Department of the Jos University Teaching Hospital, Nigeria. METHODS: Medical records of patients with HIV/AIDS and an age and gender matched control who underwent upper gastrointestinal endoscopy over an eight-year period were reviewed. RESULTS: Oesophageal candidiasis was the commonest finding in 18 (34.6%) of subjects with HIV/AIDS followed by normal upper gastrointestinal tract in 17 (32.1%). Normal upper gastrointestinal tract was found in 57.6% of HIV seronegative subjects while oesophageal candidiasis occurred in one (1.9%) of these patients. Duodenal ulcer and gastritis occurred with equal frequencies in HIV/AIDS patients (7.5%) and controls. CONCLUSION: Oesophageal candidiasis was the commonest upper gastrointestinal endoscopic finding in patients with HIV/AIDS.
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Every available means to insure the safety of patients during endoscopic procedures is mandatory. This begins with a fully trained and knowledgeable endoscopist, thorough preparation of the unit to handle endoscopic procedures and potential adverse outcomes, appropriate patient preparation, skilled assistants, and monitoring of the patient's well-being before, during and after the procedure. The relative risks involved can be estimated from patient and procedural factors and should be determined for each procedure. The level and type of monitoring during endoscopic procedures is dependent upon a thorough understanding and assessment of the risk to the patient. Monitoring of patients undergoing endoscopic procedures is mandatory and prudent. The ultimate responsibility for protecting patients lies with the endoscopist and cannot be assigned to an assistant or electronic monitoring device. However, both may greatly improve the ability to detect patient distress at a time when intervention will prevent an otherwise adverse outcome.
From January 1992 to August 1993, 150 endoscopies (114 fiber gastroscopies, 29 fiber colonoscopies and 7 CPRE) were carried out in a total of 142 anti HIV positive patients. The most frequent clinical manifestations leading to the exploration were dysphagia, epigastric pain, diarrhea and upper or lower gastrointestinal bleeding. Endoscopic alterations were observed in most of the exploration although specific diagnosis was only achieved in approximately one third of the patients with the most frequent being esophagitis by Candida and CMV (21% and 5%, respectively in the fiber gastroscopies performed). Digestive manifestations were varied in the patients in whom esophagitis by Candida was diagnosed while dysphagia and diarrhea were the symptoms commonly observed in the patients with esophagitis or colitis by CMV. The diagnostic profitability of endoscopy was high in patients presenting dysphagia, diarrhea, gastrointestinal bleeding or in those in whom endoscopy was performed for tumoral staging or to evaluate the possible existence of manifestations secondary to the presence of portal hypertension.
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In this paper, the minimal standards for the disinfection of endoscopes and endoscopic accessories, as defined by the OMED's Minimal Standards for Disinfection, are described. Given the difficulties of disinfecting reusable accessories, disposable accessories are desirable and marketed by many companies. However, they are less economical than the reusable accessories available. Presently, both disposable and reusable forceps are marketed and those that are to be reused must be disinfected according to the Minimal Standards for Disinfection. This paper will discuss the factors to consider in choosing single-use or reusable accessories, such as economy, reliability of disinfection and durability of function. The one-time biopsy cost of reusable and disposable accessories that can be satisfactorily disinfected will also be compared. This paper concludes that the accessories used for endoscopic retrograde cholangiopancreatography are less reliably disinfected, less expensive and less durable compared with biopsy forceps.
The key issues that determine the decision between reusable versus disposable accessories are cost and functionality. In most health-care systems the availability and dissemination of endoscopic services relates directly to the resources (i.e. budget) of that system. Given the limitations of health-care budgets, access to endoscopic services will depend upon the cost efficiency of endoscopic practice. The onus on endoscopists and health-care providers, therefore, is to meticulously evaluate the necessary steps for safe reutilization of accessories. This paper addresses the principles of reuse, quality assurance and particularly disinfection practices. Any change to a more costly disposable accessory policy must bear the responsibility of denied access to endoscopic services in a system with finite resources.
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