Endoscopic Channel Research Articles

ATP+AMP量を指標とした上部消化管内視鏡チャンネル内の汚染と洗浄消毒の評価

ATP+AMP量を指標とした上部消化管内視鏡チャンネル内の汚染と洗浄消毒の評価

A New Progression Towards a Safer Anterior Percutaneous Endoscopic Cervical Discectomy: A Technical Report

Percutaneous Endoscopic Cervical Discectomy (PECD) has evolved as an efficient and minimally invasive procedure for both contained and non-contained cervical disc herniations in the recent years. With the advent of new working channel endoscopes and instruments design, the PECD is gaining popularity among spine surgeons and is becoming an alternative to the fusion surgery. The insertion of the working channel is the key to PECD which has to be placed very meticulously without injuring the vital structure in the neck anteriorly. We wish to present a technical report and brief discussion about the new instruments design and procedure that will enhance the safety measures in PECD.

Propagation characteristics of atmospheric-pressure He+O2 plasmas inside a simulated endoscope channel

Cold atmospheric-pressure plasmas have potential to be used for endoscope sterilization. In this study, a long quartz tube was used as the simulated endoscope channel, and an array of electrodes was warped one by one along the tube. Plasmas were generated in the inner channel of the tube, and their propagation characteristics in He+O2 feedstock gases were studied as a function of the oxygen concentration. It is found that each of the plasmas originates at the edge of an instantaneous cathode, and then it propagates bidirectionally. Interestingly, a plasma head with bright spots is formed in the hollow instantaneous cathode and moves towards its center part, and a plasma tail expands through the electrode gap and then forms a swallow tail in the instantaneous anode. The plasmas are in good axisymmetry when [O2] ≤ 0.3%, but not for [O2] ≥ 1%, and even behave in a stochastic manner when [O2] = 3%. The antibacterial agents are charged species and reactive oxygen species, so their wall fluxes represent the “plasma dosage” for the sterilization. Such fluxes mainly act on the inner wall in the hollow electrode rather than that in the electrode gap, and they get to the maximum efficiency when the oxygen concentration is around 0.3%. It is estimated that one can reduce the electrode gap and enlarge the electrode width to achieve more homogenous and efficient antibacterial effect, which have benefits for sterilization applications.

Usefulness of Adenosinetriphosphate Bioluminescence Assay (ATPmetry) for Monitoring the Reprocessing of Endoscopes.

To assess the diagnostic value of an adenosinetriphosphate bioluminescence assay (ATPmetry) to monitor the effectiveness of the reprocessing of endoscopes compared with microbiologic sampling. Diagnostic study. A 2,200-bed teaching hospital performing 5,000 to 6,000 endoscopic procedures annually. All samples from bronchial or gastrointestinal endoscopes whatever the context. Samples for microbiologic analysis and ATPmetry measurements were taken when each endoscope was inspected following reprocessing. Sampling was performed by flushing each endoscope with 300 mL Neutralizing Pharmacopeia Diluent thiosulfate rinsing solution divided equally between the endoscope channels. For each endoscope a series of 3 ATPmetry measurements were made on a vial containing the first jet from each channel and a second series on the whole sample. Of 165 samples from endoscopes, 11 exceeded the acceptability threshold of 25 colony-forming units/endoscope. In the first jet collected, the median (interquartile range) level of ATPmetry was 30.5 (15.3-37.7) relative light units (RLU) for samples with 25 or fewer colony-forming units compared with 37.0 (34.7-39.3) RLU for samples with more than 25 colony-forming units (P=.008). For the whole sample, the median (interquartile range) level of ATPmetry was 24.8 (14.3-36.3) RLU and 36.3 (36.0-38.3) RLU (P=.006), respectively. After adjusting on the batch of cleansing solution used, no difference in ATPmetry values was found between microbiologically acceptable and unacceptable samples. ATPmetry cannot be used as an alternative or complementary approach to microbiologic tests for monitoring the reprocessing of endoscopes in France.

Modified transforaminal lumbar interbody fusion for acute and chronic lumbar intervertebral disc injury via minimally invasive expandable access system

Objective To evaluate outcomes of modified transforaminal lumbar interbody fusion (TLIF) assisted by the minimally invasive expandable access system and spinal channel endoscope for acute and chronic lumbar intervertebral disc injury. Methods From March 2013 to November 2014, 45 patients with lumbar intervertebral disc injury were managed with minimally invasive (Group A) or open TLIF (Group B). Location for disc injury was at L3/4 in 5 patients, L4/5 in 28 patients and L5-S1 in 12 patients. Group A composing 12 males and 10 females showed age of (53.70±3.59) years (range, 43 to 67 years). Group B composing 14 males and 9 females showed age of (54.80±4.37)years (range, 42 to 68 years). Between-group comparison was conducted with respect to operation time, blood loss, postoperative drainage loss, ambulation time and postoperative complications. Clinical outcomes were evaluated using the visual analogue scale (VAS), Oswestry dysfunction index (ODI), and bone fusion rate. Results Except for the comparable operation time, group A was associated with better results in the blood loss [(152.1±15.5)ml vs (409.9±28.3)ml], drainage volume[(106.1±14.3)ml vs (223.0±19.4)ml], ambulation time[(4.5±1.1)d vs (8.9±1.4)d] and 1-week postoperative VAS [(3.0±0.7) points vs (4.7±0.4) points](P 0.05). Bone fusion rate in Group A was 95% (21/22) versus 96% (22/23) in Group B 6-month postoperatively (P>0.05). No nerve root injury, intervertebral space infection or other complications occurred. Conclusion Modified TLIF assisted by the minimally invasive expandable access system offers the benefits of less trauma, less bleeding and a quicker recovery for acute and chronic lumbar intervertebral disc injury and has similar long-term clinical outcomes with open TLIF. Key words: Intervertebral disc; Lumbar vertebrae; Endoscopes; Transforaminal lumbar interbody fusion

Endoscopic Application of Transnasal Tube, Clipping Over-The-Scope Clip, and Stenting for an Esophago-Mediastinal Fistula and Anastomotic Leakage

Introduction: The fistula and anastomotic leakage following surgery of the upper GI tract are major causes of morbidity and mortality. The effects on the patient are wide ranging-pain, complex wound care, reduced quality of life, prolonged hospital stay and psychological effects. Complications such as malnutrition, abscesses and sepsis may occur. We report several endoscopic techniques appear to be an effective, technically feasible, and minimally invasive treatment option, and can shorten the time of closure. Methods: Twelve patients are applied following endoscopic methods. 1. Thoracic drainage inserted through trans-nasal route. Trans-nasal drainage tube through a guide wire is inserted at the site of intrathoracic esophagogastric anastomotic leak under the endoscopic observation. 2. Endoscopic management of anastomotic leakage using clipping. - The metallic clip fixing device with a loaded clip can be passed through the forceps channel of a standard endoscope. - Pulling on the handle of the fixing device leads to opening of the prongs. - Through manipulation of the tip of the endoscope the clip can be brought into position to grasp the tissue flanks of the leakage after suction to reduce the size of the fistula. 3. Endoscopic over-the-scope (OTS) clip placement. - 1. Endoscopic deployment for fistula closure by approximating the margins of the fistula opening with a single clip device. 2. Place the fistula opening at the center of the endoscopic cap, apply firm suction through the endoscopic channel allowing the surrounding tissues to be suctioned into the endoscopic cap attachment. 3. Deploy the clipping device by turning the firing wheel attached to the endoscope handle. 4. Endoscopic stenting. - 1. At first we confirm the location of the fistula or leakage by endoscopy and X-ray contrast. - 2. The removable covered stent in the setting of anastomotic leak or fistel is used in sealing the leak or fistel. Results: 1. We succeeded to close the fistula and anastomotic leakage of all cases by endoscopic procedures. 2. In a case the stent was migrated but the fistula was closed. Conclusion: There is encouraging progress in shortening the time to closure of the leakage and reducing the risk of severe systemic complications such as sepsis or malnutrition and an apparent reduction of global costs, with a broad range of conservative and endoscopic therapeutic methods.

Effectiveness of current disinfection procedures against biofilm on contaminated GI endoscopes

Attention to patient safety has increased recently due to outbreaks of nosocomial infections associated with GI endoscopy. The aim of this study was to evaluate current cleaning and disinfection procedures of endoscope channels with high bioburden and biofilm analysis, including the use of resistant mycobacteria associated with postsurgical infections in Brazil. Twenty-seven original endoscope channels were contaminated with organic soil containing 10(8) colony-forming units/mL of Pseudomonas aeruginosa, Staphylococcus aureus, or Mycobacterium abscessus subsp bolletii. Biofilms with the same microorganisms were developed on the inner surface of channels with the initial inoculum of 10(5) colony-forming units/mL. Channels were reprocessed following current protocol, and samples from cleaning and disinfection steps were analyzed by bioluminescence for adenosine triphosphate, cultures for viable microorganisms, and confocal microscopy. After contamination, adenosine triphosphate levels increased dramatically, and high bacterial growth was observed in all cultures. After cleaning, adenosine triphosphate levels decreased to values comparable to precontamination levels, and bacterial growth was demonstrated in 5 of 27 catheters, 2 with P aeruginosa and 3 with M abscessus. With regard to induced biofilm, a remarkable reduction occurred after cleaning, but significant microbial growth inhibition occurred only after disinfection. Nevertheless, viable microorganisms within the biofilm were still detected by confocal microscopy, more so with glutaraldehyde than with peracetic acid or O-phataladehyde. After the complete disinfection procedure, viable microorganisms could still be detected within the biofilm on endoscope channels. Prevention of biofilm development within endoscope channels should be a priority in disinfection procedures, particularly for ERCP and EUS.

Endoscopic slipknot clip suturing method: an ex vivo feasibility study (with video)

We developed a suturing method with slipknot string and clips for the single-channel endoscope. The aim of this study was to analyze the efficacy of the slipknot clip suturing method. Twelve 30-mm mucosal defects were created by endoscopic submucosal dissection in an ex vivo bovine model. A slipknot is a type of knot that can "slip" along the string. The loop can be tightened when tension is applied to the free end of the string. The clip and string can be passed through the instrument channel of the single-channel endoscope. The slipknot loop is anchored on the mucosal defect's proximal margin with the clip. An additional clip anchored at the slipknot loop is placed on a different side of the margin. The slipknot loop is tightened by pulling the string. Additional clips are placed to achieve complete closure. All 12 defects were completely closed by the slipknot clip suturing method. The procedure time decreased significantly from the first 6 procedures to the last 6 procedures (865 ± 213 vs 556 ± 103 seconds, P = .009). The slipknot clip suturing method makes it easy to close a large mucosal defect completely by using a single-channel endoscope.

A Confocal Endoscope for Cellular Imaging

ABSTRACT Since its inception, endoscopy has aimed to establish an immediate diagnosis that is virtually consistent with a histologic diagnosis. In the past decade, confocal laser scanning microscopy has been brought into endoscopy, thus enabling in vivo microscopic tissue visualization with a magnification and resolution comparable to that obtained with the ex vivo microscopy of histological specimens. The major challenge in the development of instrumentation lies in the miniaturization of a fiber-optic probe for microscopic imaging with micron-scale resolution. Here, we present the design and construction of a confocal endoscope based on a fiber bundle with 1.4-μm lateral resolution and 8-frames per second (fps) imaging speed. The fiber-optic probe has a diameter of 2.6 mm that is compatible with the biopsy channel of a conventional endoscope. The prototype of a confocal endoscope has been used to observe epithelial cells of the gastrointestinal tracts of mice and will be further demonstrated in clinical trials. In addition, the confocal endoscope can be used for translational studies of epithelial function in order to monitor how molecules work and how cells interact in their natural environment.

Persistent contamination on colonoscopes and gastroscopes detected by biologic cultures and rapid indicators despite reprocessing performed in accordance with guidelines

Pathogens have been transmitted via flexible endoscopes that were reportedly reprocessed in accordance with guidelines. Researchers observed reprocessing activities to ensure guideline compliance in a large gastrointestinal endoscopy unit. Contamination was assessed immediately after bedside cleaning, manual cleaning, high-level disinfection, and overnight storage via visual inspection, aerobic cultures, and tests for adenosine triphosphate (ATP), protein, carbohydrate, and hemoglobin. All colonoscopes and gastroscopes were reprocessed in accordance with guidelines during the study. Researchers collected and tested samples during 60 encounters with 15 endoscopes. Viable microbes were recovered from bedside-cleaned (92%), manually cleaned (46%), high-level disinfected (64%), and stored (9%) endoscopes. Rapid indicator tests detected contamination (protein, carbohydrate, hemoglobin, or ATP) above benchmarks on bedside-cleaned (100%), manually cleaned (92%), high-level disinfected (73%), and stored (82%) endoscopes. Visible residue was never observed on endoscopes, but it was often seen on materials used to sample endoscopes. Seven endoscopes underwent additional reprocessing in response to positive rapid indicators. Control endoscope channels were free of biologic residue and viable microbes. Despite reprocessing in accordance with US guidelines, viable microbes and biologic debris persisted on clinically used gastrointestinal endoscopes, suggesting current reprocessing guidelines are not sufficient to ensure successful decontamination.

OC-045 Faecal microbiota transplantation: implementing a new treatment for recurrent/refractory clostridium difficile infection using banked stool in a tertiary uk centre

Introduction Faecal microbiota transplantation is an effective treatment for recurrent/refractory Clostridium difficile infection (CDI). A randomised controlled trial reported sustained response in greater than 90% of patients, with an excellent safety profile. NICE approved the treatment as of March 2014. We introduced this new service in January 2015, setting up a stool bank to treat patients with recurrent CDI. We describe the process of initiating this service. Method Stool donors are recruited from non-clinical members of hospital staff or patient selected donors. Donors must be healthy with a BMI >50 g of fresh donated stool is diluted with 250 mls 0.9% normal saline and 12.5% glycerol, filtered to remove large particles and immediately frozen at –80 0 C. Frozen stool can be stored for up to 6 months, offers the benefit of being available on demand, and is as effective as freshly used stool. Recipients are informed of the risks of colonoscopy and the risk of acquiring an unrecognised transmissible disease. Standard bowel preparation is given and the transplant is delivered through the endoscope channel with 75% of the donor stool placed in the caecum, and the remainder in the right colon. Alternatively, infusion can be performed via a nasoduodenal tube. Results This pathway has been successfully implemented. Procedures are performed at the end of a list to allow subsequent deep cleaning of the endoscopy room, and donor stool is available in an ice box 30 min prior to procedure. Individuals are discharged home the day after the procedure, and contacted a week later to ascertain improvement in symptoms, and at 3-months for a second assessment including laboratory testing for C. difficile . Preliminary experience is promising with 100% of patients achieving clinical remission within a week of a single procedure. Conclusion Introduction of a faecal transplant service for CDI is feasible. As with all new treatments safety is paramount. Thorough screening of donors, traceability of transplants and long term follow up is essential. Disclosure of interest None Declared.

The role of hemospray in the endoscopic treatment of non variceal upper gastrointestinal bleeding; initial experiences in a tertiary centre gastroenterological unit

Introduction: Early endoscopic diagnosis and endoscopic haemostasis are essential tasks in cases with acute upper gastrointestinal bleeding (UGIB). Hemospray is a novel modality in endoscopic treatment of UGIB. The aim of our retrospective analyses was to evaluate the role and efficacy of Hemospray treatment in acute upper non variceal bleeders referred to our tertiary centre gastroenterological and endoscopy unit. Method: Hemospray as an endoscopic haemostatic modality is available in our unit since June 2013. Hemospray powder was sprayed via a 7 or 10 French catheter inserted through the endoscope channel targeting the actively bleeding points. Hemospray was used either as a rescue therapy after failed primary endotherapies or as a first choice intervention. Results: In 20 months period a total of 271 acute UGIB patients were admitted to our department with a mean age of 66.9 ± 13.7. At the emergency endoscopy in 66 patients gastrooesohageal varices or portal gastropathies were detected as bleeding sources. Gastroduodenal ulcers were found in 115 patients and in 90 cases the bleeding originated from other sources like Mallory-Weiss tear, erosive oesophagitis, angiodysplasia. Endoscopic therapy was performed in 56.6% out of the non variceal upper gastrointestinal bleeders (116/205). Combined endotherapies were done in 62 cases while endoscopic monotherapies were performed in 54 cases. In 10 severly bleeding patients Hemospray was used in a total of 11 settings. Hemospray therapy was necessary in 5 cases because of failed primary hemostatic efforts and in other 5 cases Hemospray was used as a first line therapy. In 10 cases out of all non variceal UGIB patients was necessary to act with of Hemospray (4.9%). Out of all endoscopic therapies Hemospray was used as rescue activity in 9.5% of patients (11/116). Primary haemostasis was achieved 9 out of the 10 Hemospray cases. Conclusions: Hemospray endotherapy may support the chance of primary hemostasis in severe acute upper GI bleeders in about one out of every twenty patients. Hemospray rescue therapy proved to be useful in nearly 10% of all endoscopic haemostatic efforts in our practice.

Endoscopic intracranial surgery enhanced by electromagnetic-guided neuronavigation in children.

Navigated intracranial endoscopy with conventional technique usually requires sharp head fixation. In children, especially in those younger than 1 year of age and in older children with thin skulls due to chronic hydrocephalus, sharp head fixation is not possible. Here, we studied the feasibility, safety, and accuracy of electromagnetic (EM)-navigated endoscopy in a series of children, obviating the need of sharp head fixation. Seventeen children (ten boys, seven girls) between 12 days and 16.8 years (mean age 4.3 years; median 14 months) underwent EM-navigated intracranial endoscopic surgery based on 3D MR imaging of the head. Inclusion criteria for the study were intraventricular cysts, arachnoid cysts, aqueduct stenosis for endoscopic third ventriculostomy (ETV) with distorted ventricular anatomy, the need of biopsy in intraventricular tumors, and multiloculated hydrocephalus. A total of 22 endoscopic procedures were performed. Patients were registered for navigation by surface rendering in the supine position. After confirming accuracy, they were repositioned for endoscopic surgery with the head fixed slightly on a horseshoe headholder. EM navigation was performed using a flexible stylet introduced into the working channel of a rigid endoscope. Neuronavigation accuracy was checked for deviations measured in millimeters on screenshots after the referencing procedure and during surgery in the coronal (z = vertical), axial (x = mediolateral), and sagittal (y = anteroposterior) planes. EM-navigated endoscopy was feasible and safe. In all 17 patients, the aim of endoscopic surgery was achieved, except in one case in which a hemorrhage occurred, blurring visibility, and we proceeded with open surgery without complications for the patient. Navigation accuracy for extracranial markers such as the tragus, bregma, and nasion ranged between 1 and 2.5 mm. Accuracy for fixed anatomical structures like the optic nerve or the carotid artery varied between 2 and 4 mm, while there was a broader variance of accuracy at the target point of the cyst itself ranging between 2 and 9 mm. EM-navigated endoscopy in children is a safe and useful technique enhancing endoscopic intracranial surgery and obviating the need of sharp head fixation. It is a good alternative to the common opto-electric navigation system in this age group.

Tu1592 Multi-Center Experience With the Cryoballoon Focal Ablation System (CAS) for Esophageal Dysplasia

Tu1592 Multi-Center Experience With the Cryoballoon Focal Ablation System (CAS) for Esophageal Dysplasia Kenneth K. Wang*, Ann M. Chen, Shai Friedland, Blair A. Jobe Gastroenterology, Stanford University, Palo Alto, CA; Gastroenterology, VA Palo Alto HCS, Palo Alto, CA; Gastroenterology, Mayo Clinic, Rochester, MN; Surgery, West Penn Allegheny Health System (WPAHS), Canonsburg, PA; Gastroenterology, Santa Clara Valley Medical Center, San Jose, CA Mucosal ablation using RFA with or without EMR is the current treatment of choice for Barrett’s esophagus with high-grade dysplasia. Although effective, RFA has drawbacks such as the need for precise sizing, mucosal cleaning, and need for multiple treatments over the same segment. Cryotherapy is currently being used for refractory dysplasia or squamous disease. However, currently-available devices have been limited by the need for large units and high volume suction. The CAS is a novel device that can perform cryotherapy without the need for suction in a self-contained handheld system. Methods: This is a retrospective cohort study of the initial experience with the CAS system performed in tertiary referral centers. The CAS is a battery-powered, handheld device that uses cryogen contained in disposable nitrous oxide cartridges. The disposable catheter (3.5mm in diameter) is delivered through the biopsy channel of a therapeutic endoscope and positioned alongside a segment of Barrett’s mucosa. A balloon is inflated on the distal catheter using nitrous oxide (Figure 1). The mucosa can be viewed through the transparent balloon. The mucosa to be treated is selected by using a short burst of nitrous oxide. After the short burst, a treatment session of 10 seconds can be delivered to the tissue. Results: The initial experience has been with 7 patients (6 males) treated with the CAS at three institutions. Median age is 65 years (IQR 42-73). Five (5/7, 70%) patients had Barretts Esophagus with high-grade dysplasia; one patient also has intramucousal carcinoma. Two patients (2/7, 30%) were being treated for squamous cell esophageal carcinoma. Six of seven (85%) had prior treatment. One patient had 4 areas treated with the CAS, while 2 patients each had cryoablation in 3 areas and 4 each had cryoablation in one area. Ablations were ten (10) seconds in duration. Complete ablation was achieved in 6 of the 7 patients: in one patient tumor in the upper esophageal sphincter was not treated completely because stable placement of the CryoBalloon could not be achieved.Reasons for physician choice of the CAS include failure of previous treatment, device ease-of-use and the conformable balloon. One of the patients with squamous cell carcinoma had two interventions with the CAS, both ablations considered effective. Follow-up histopathology for this patient showed fragments of benign squamous mucosa, negative for dysplasia or neoplasia.At followup endoscopy areas of treatment were all epithelialized with squamous mucosa. No strictures were noted at any treatment sites. Conclusions: CAS is a novel handheld cryotherapy device that can effectively treat areas of Barrett’s esophagus without need for suction with minimal side effects in this preliminary experience.

Risk of lens cloudiness during colorectal endoscopic submucosal dissection and ability of a novel lens cleaner to maintain and restore endoscopic view.

Generally, colorectal endoscopic submucosal dissection (ESD) cannot be carried out with severe lens cloudiness. We examined the occurrence of lens cloudiness during ESD as well as the efficacy of a novel cleaner for it. This study was a prospective study compared to historical control. First, we analyzed 103 ESD cases using standard cleaner at the Kyoto Prefectural University of Medicine in 2012. Relationship between lens cloudiness and clinical characteristics of lesions was analyzed. Lens cloudiness was recorded as grade 0 (clear) to grade 2 (very unclear). Then, we recruited 92 consecutive patients who underwent colorectal ESD using the novel cleaner from August 2013 to July 2014. The cleaner was applied on top of the lens before procedure and ability to prevent lens cloudiness was tested. Additionally, the novel cleaner was injected from endoscopic channel into a space created by endoscopic hood and colonic wall in seven cases with grade 1 or 2 of lens cloudiness and the ability to clean lens cloudiness inside the colon was tested. Rate of severe lens cloudiness was 8.7%. Multivariate analysis showed that severe lens cloudiness was related with severe submucosal fatty tissue (P < 0.001). The novel cleaner had significantly less cloudiness cases compared to the standard cleaner (14.1% vs 33.0%, P = 0.002). Additionally, the novel cleaner enabled us to clean lens cloudiness in all seven cases. Lens cloudiness during ESD was associated with submucosal fatty tissue. Effective lens cleaner should be used to prevent and clean lens cloudiness.

The "two-sword fencing" technique in endoscopic submucosal dissection.

Endoscopic submucosal dissection (ESD) is a minimally invasive treatment and enables en bloc resection of large lesions. However, ESD is a technically demanding and time-consuming procedure.1 Here, we report a two-sword technique with an injection needle and an ESD knife. A 74-year-old man presented with a laterally spreading tumor (LST), 7 cm in diameter, on the right wall of the rectum, and occupying half of the colonic lumen on colonoscopy. The tumor extended distally to the dentate line. Histological examination of biopsy specimens indicated tubular adenoma. ESD of the rectal LST was carried out using a double-channel endoscope with a multibending system (GIF-2TQ260M; Olympus, Tokyo, Japan). Glycerol (Glyceol; Chugai Pharmaceutical Co., Tokyo, Japan) mixed with a small volume of epinephrine and indigo carmine dye was injected into the submucosal layer with the injection needle (IFH-SG; Top Corp., Tokyo, Japan). ESD was performed with a dual knife (KD-650Q; Olympus). Dual refers to the two extension lengths of the cutting knife; it has no capacity for injection. The electrosurgical unit (VAIO300D; ERBE, Tubingen, Germany) was set as follows: drycut (effect 2, 30 W) for circumferential incision; and swift-coag (effect 4, 30 W) for dissection. For the two-sword technique, an injection needle and an ESD knife were inserted through either channel of a double channel endoscope (Fig. 1). Using ESD, en bloc resection of the tumor was performed in 140 minutes. Histological examination of the resected tissue revealed well-differentiated mucosal adenocarcinoma. Both the vertical and horizontal margins were negative. Fig. 1 The two-sword technique in endoscopic submucosal dissection. (A) Two-sword fencing style. (B) Insertion of injection needle. (C) Injection of solution. (D) Immediate cutting. Although flush knives (Fujifilm Medical, Tokyo, Japan) have a water-jet system that allows rapid needle-free infusion of solution into the submucosa, other knives such as the dual knife, flex knife, or hook knife lack this function.2 Takeuchi et al.3 compared the efficacy of flush knives with water-jet functionality to that of flex knives (electrosurgical endo-knife without a water-jet function). A total of 49 patients with superficial colorectal neoplasms were randomly assigned to undergo ESD using a flush knife or a flex knife. The median number of endoscopic device changes was 22 (range, 8 to 44) in the flex knife group and 9 (range, 1 to 35) in the flush knife group (p<0.0001). The mean operation time was 87.3 minutes (95% confidence interval [CI], 71.3 to 103.4) in the flex knife group and 61.0 minutes (95% CI, 49.3 to 72.7) in the flush knife group (p=0.02). The endoscopists using flush knives did not need to switch their devices as often. This helped reduce the total operation time, and enabled the endoscopists to perform their procedures without interruption. The two-sword technique also saves time in changing endoscopic devices. The two-sword technique allows dissection of the submucosal layer just after injection, before the collapse of the submucosal cushion. When the injected solution leaks from the submucosa, the two-sword technique may be useful for speedy submucosal dissection.

MEMS scanning micromirror for optical coherence tomography.

This paper describes an endoscopic-inspired imaging system employing a micro-electromechanical system (MEMS) micromirror scanner to achieve beam scanning for optical coherence tomography (OCT) imaging. Miniaturization of a scanning mirror using MEMS technology can allow a fully functional imaging probe to be contained in a package sufficiently small for utilization in a working channel of a standard gastroesophageal endoscope. This work employs advanced image processing techniques to enhance the images acquired using the MEMS scanner to correct non-idealities in mirror performance. The experimental results demonstrate the effectiveness of the proposed technique.

Endoscope storage time: assessment of microbial colonization up to 21 days after reprocessing

Insufficient data exist for how long endoscopes can be stored after reprocessing. Concern about possible microbial colonization has led to various recommendations for reprocessing intervals among institutions, with many as short as 5 days. A significant cost savings could be realized if it can be demonstrated that endoscopes may be stored for as long as 21 days without risk of clinically significant contamination. To demonstrate whether flexible endoscopes may be stored for as long as 21 days after reprocessing without colonization by pathogenic microbes. Prospective, observational study. Tertiary care center. Four duodenoscopes, 4 colonoscopes, and 2 gastroscopes. Microbial testing of endoscope channels. Culture results at days 0, 7, 14, and 21. There were 33 positive cultures from 28 of the 96 sites tested (29.2% overall contamination rate). Twenty-nine of 33 isolates were typical skin or environmental contaminants, thus clinically insignificant. Four potential pathogens were cultured, including Enterococcus, Candida parapsilosis, α-hemolytic Streptococcus, and Aureobasidium pullulans; all were likely clinically insignificant as each was only recovered at 1 time point at 1 site, and all grew in low concentrations. There were no definite pathogenic isolates. Single center. Endoscopes can be stored for as long as 21 days after standard reprocessing with a low risk of pathogenic microbial colonization. Extension of reprocessing protocols to 21 days could effect significant cost savings.

Correlation between the growth of bacterial biofilm in flexible endoscopes and endoscope reprocessing methods

The purpose of this article was to investigate bacterial biofilm formed on endoscopes and to explore the possible correlation between endoscope reprocessing procedures and bacterial biofilm growth on endoscope channels. Sixty-six endoscope suction and biopsy channels and 13 water and air channels were collected from 66 hospitals throughout China. Scanning electron microscopy was used to observe biofilm growth on the internal surface of these channels. Questionnaires were mailed to 66 endoscopy centers to investigate reprocessing procedures for endoscopes. Obvious biofilm growth was detected on 36 suction and biopsy channels (36/66, 54.6%) and 10 water and air channels (10/13, 76.9%). The percentage of manual cleaning in group B (n = 36, without detection of biofilms) was 92.3% (33/36), whereas it was 50.0% (15/30) in group A (n = 30, with detection of biofilms). Follow-up of group A (n = 30) showed that no biofilm was detected, whereas biofilm was detected in group B. The difference was statistically significant (P = .001). The proportion of detergent reuse in group B was 92.3% (33/36), and it was 61.5% in group A (18/30) (P = .005). The proportion of alcohol-air drying in group B was 38.9% (14/36), and it was 76.7% (23/30) in group A (P = .002). The formation of endoscopic biofilm during clinical practice may be related to reuse of detergent, manual cleaning, and incomplete drying.

Hyperspectroscopic imager for baby fibers.

Hyperspectral imaging system for diagnosing digestive diseases was newly developed in order to obtain information on pathology beyond morphology of lesions. In order to guide light reflected from a lesion, a baby fiber, which can be inserted in a forceps channel of the electronic endoscope, was also developed. The performance of the system was evaluated by animal experiment. Obtained hyperspectral data were found to have sufficient quality endurable to practical use. Harmful phenomena to a living body were not observed within the experiment. It was considered from the animal experiment that the present system could be practically used for humans.