Hospital Endoscopy Research Articles

S0566 Low-Risk COVID-19 Transmission During Endoscopy in a Single Center NYC Hospital

INTRODUCTION: Recent literature concerning the COVID-19 outbreak reported GI endoscopy as a potential source of infection for healthcare workers. However, not much is known about the risk for patients during endoscopy. The goal of this study is to assess the risk of COVID-19 transmission for patients undergoing endoscopic procedures during the pandemic. METHODS: We performed a retrospective chart review on all patients >18 years old who underwent an endoscopic procedure including EGD, colonoscopy, ERCP and EUS between March 2nd and May 27th at a single center in the Bronx, NY. We identified patients who had a COVID-19 test performed prior to the procedure. Patients who tested negative were contacted by phone. A questionnaire was used to identify patients who had developed fever, respiratory symptoms, or gastrointestinal symptoms. In addition, we also identified patients who were diagnosed as COVID-19 positive within 2 weeks after the procedures. RESULTS: Of the 412 patients that underwent endoscopic procedures only 191 (46%) had a COVID-19 test done prior; 41 (21.5%) tested positive, 150 (78.5%) tested negative. All 150 patients who had an endoscopic procedure performed, (70 EGDs, 38 colonoscopies, 34 ERCPs, and 21 EUS ) (Figure 1) received a 2-week follow-up phone call; the response rate was 112 (75%). None of these 112 patients developed symptoms, (fever, cough, dyspnea, sore throat, diarrhea, vomit, dysgeusia, anosmia). Three (2.7%) patients tested positive for COVID-9 after the procedures. None of them required hospitalization. CONCLUSION: Following a 2-week follow up, we identified only 3 out of 112 patients who become COVID-19 positive following an endoscopic procedure. Our results indicate a potentially low risk of COVID-19 transmission for patients undergoing GI endoscopy.Figure 1.: Endoscopic Procedures Performed on COVID-19 Negative Patients.

Raising the threshold for hospital admission and endoscopy in upper gastrointestinal bleeding during the COVID-19 pandemic

See also: Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) GuidelineEndoscopy 2015; 47(10): a1-a46DOI: 10.1055/s-0034-1393172

Prevalence of Helicobacter pylori infection in dyspeptic patients undergoing upper gastrointestinal endoscopy in a tertiary-care teaching hospital

Background: Helicobacter pylori infection is widely prevalent in the world especially in the developing countries. The common clinical presentation of this disease includes peptic and duodenal ulcer. A major post-infection complication of this disease is gastric carcinoma. The scope of this study was to determine the prevalence of active H. pylori infection in the local population by retrospective review of patient records, which can give a better picture of the current situation and estimate the at-risk population of gastric carcinoma. Objective of the study was to determine the prevalence of H. pylori infection in biopsy specimens obtained from upper gastrointestinal endoscopy performed in dyspeptic patients in a tertiary-care hospital.Methods: The study was performed as a retrospective review of biopsy reports of 262 dyspeptic patients with previously unknown H. pylori status who underwent upper gastrointestinal endoscopy during the months of January 2018 to May 2018. Biopsy obtained from stomach was evaluated for the presence of H. pylori infection by Rapid Urease Test (RUT) or histopathological examination.Results: The prevalence of H. pylori infection in dyspeptic patients obtained from the above study was 44.7% and was found to be more common in males compared to females.Conclusions: H. pylori is a risk factor for gastric carcinoma. Determining the prevalence with early identification of active infections results in better treatment and post infection monitoring for malignancy.

The incidence of anaerobic bacteria in adult patients with chronic sinusitis: A prospective, single-centre microbiological study.

IntroductionChronic sinusitis caused by anaerobes is a particular concern clinically, because many of the complications are associated with infections caused by these organisms. The aim of this study was to evaluate the incidence of anaerobic bacteria in chronic sinusitis in adults as a part of a prospective microbiological study.Materials and methodsOver a one-year period, aspirations of maxillary sinus secretions and/or ethmoid cavities were derived in n = 79 adult patients with chronic sinusitis by endoscopy in a tertiary-care teaching hospital in Hungary. The qualitative and quantitative compositions of the total cultivable aerobic and anaerobic bacterial and fungal flora cultured on the samples were compared. Correct anaerobic species level identifications were carried out according to standard methods.ResultsBacteria were recovered for all of the 79 aspirates and the numbers of the significant cultured isolates (with colony forming units ≥103) were between 1 and 10. A total of 206 isolates, 106 anaerobic and 100 aerobic or facultative-anaerobic strains were isolated. The most common aerobic bacteria were Streptococcus pneumoniae (n = 40), Haemophilus influenzae (n = 29), Moraxella catarrhalis (n = 6), Staphylococcus aureus (n = 7) and Streptococcus pyogenes (n = 6). The anaerobic bacteria included black-pigmented Prevotella spp. and Porphyromonas spp. (n = 27), Actinomyces spp. (n = 13), Gram-positive anaerobic cocci (n = 16), Fusobacterium spp. (n = 19) and Cutibacterium acnes (n = 8).ConclusionsThis study illustrates the microbial dynamics in which anaerobic and aerobic bacteria prevail and highlights the importance of obtaining cultures from patients with chronic sinusitis for guidance in selection of proper antimicrobial therapy.

Reflections on the coronavirus disease 2019 (COVID-19) epidemic: The first 30 days in one of New York’s largest academic departments of surgery

Reflections on the coronavirus disease 2019 (COVID-19) epidemic: The first 30 days in one of New York’s largest academic departments of surgery

Tu1978 WHERE DO WE GO FROM HERE? PROCESS AND IMPLEMENTATION OF A DETAILED QUANTITATIVE AND QUALITATIVE REPORT CARD FOR BOTH GASTROSCOPY AND COLONOSCOPY

Background: Quality in colonoscopy has been measured at two Queensland hospital endoscopy units in a structured key performance indicators (KPIs) report since July 2014. In this time, KPIs have increased from minimum accepted baselines to substantially higher levels, before plateauing. Initially, the provision of individual KPI data were enough to increase endoscopist engagement and improve KPIs, with additional anonymized comparison data provided to maintain motivation over time. Gastroscopy report quality had not previously been addressed. Methods: We undertook a comparative literature search to identify significant journal articles and international endoscopy society position papers that identified, collated, and stratified potential indicators of evidence of a quality procedure. Potential new indicators were identified for a feasibility review to delineate the relative weighting of each of the indicators for inclusion. On agreement, a comprehensive and detailed instruction manual was developed. A test run was completed to ensure that the communication of the new indicators was sufficient and that the database could accurately capture required information. Once confirmed, the indicators were endorsed and introduced. Results: Indicators were separated by procedure, report, and procedure quality (Fig. 1). Indicators with a strong body of evidence or required by government were considered “Level 1.” Indicators with a moderate body of evidence or that focused on morbidity were considered “Level 2.” The remainder were classified “Level 3” and should be considered in the wider context of an endoscopist's performance. Evidence from the first 10 months of implementation (5265 colonoscopies, 3397 gastroscopies) shows that procedure quality remains high across all levels of indicators and supports inclusion of additional measures that further help to stratify the high‐performing field. However, evidence regarding the level of report quality (Level 2), primarily the issue of photo documentation, had a slower rise from baseline. In this area, endoscopists are routinely photographing relevant landmarks but struggle to use the software to accurately label the landmark. Feedback and in‐procedure room support were offered to all endoscopists who were unable to meet these Level 2 indicator thresholds, with a noticeable improvement in the latter half of 2019 (Fig. 1). Conclusion: The development of additional indicators for endoscopy was welcomed by the endoscopists and supported by management. The implementation continues to show progressive improvement and has allowed for opportunities to motivate high‐performing endoscopists. Future plans will expand the indicators to include each endoscopist's contribution to wider unit‐based measures, such as time tracking of patients through each procedure stage, adherence to the new Australian Medicare billing guidelines, and overall patient satisfaction.

Current Knowledge and Research Priorities in the Digestive Manifestations of COVID-19

Current Knowledge and Research Priorities in the Digestive Manifestations of COVID-19

A113 COST SAVINGS OF SEROLOGIC VERSUS BIOPSY PROVEN DIAGNOSIS OF PEDIATRIC CELIAC DISEASE

Abstract Background Celiac disease (CD) affects approximately one percent of the population in Canada and the United States. At present, endoscopic diagnosis (ED) of CD remains the gold standard in North America, despite mounting evidence and validated European guidelines for serologic diagnosis (SD). Within publicly funded healthcare systems there is pressure to ensure optimal resource utilization and cost efficiency, including for endoscopic services. At Stollery Children’s Hospital, Edmonton, Canada, we have adopted serologic diagnosis as routine practice since 2016. Aims The aim of this study is to estimate cost savings, i.e. hard dollar savings and capacity improvements, to the health care system as well as impacts on families in regard to reduced work days lost and missing child school days for SD versus ED. Initial cost saving data is presented. Methods Micro-costing methods were used to determine health care resource use in patients undergoing ED or SD from 2017–2018. SD testing included anti-tissue glutaminase antibody (aTTG) ≥200IU/mL (on two occasions), human leukocyte antigen (HLA) DQA5/DQ2, blood sampling, transport and laboratory costs. ED diagnosis included gastroenterologist, anesthetist, OR equipment, staff, overhead and histopathology. Cost of each unit of resource was obtained from the schedule of medical benefits (Alberta) and reported average ambulatory cost for day hospital endoscopy for Stollery Children’s Hospital determined in 2016; reported in CAN$. Results Between March 2017-December 2018, 473 patients were referred for diagnosis of CD; 233 had ED and 127 SD. Estimated cost for ED was $1240 per patient; for SD was $85 per patient (6.8% of ED cost). Based on 127 patients not requiring endoscopy and a cost saving of $1155 per patient there was a total cost savings of $146,685 over 22 months. Conclusions A SD approach presents a significant cost savings to the public health care system. It also frees up valuable endoscopic resources, and limits exposure of children to the immediate and long-term risks associated with anesthesia and biopsy. SD also decreases time to diagnosis and the cost of the process to families (lost days of school/work, travel costs etc.). Our costing data can be used in combination with mounting evidence on the test performance of SD versus ED to determine cost-effectiveness of serological diagnosis for pediatric CD. Given the potential for cost saving and more efficient operating room utilization, SD for pediatric CD warrants further investigation in North America. Funding Agencies None

내시경적 아데노이드 등급과 소아 폐쇄성 수면무호흡증 중증도의 상관관계

Background and Objectives: Hypertrophy of adenoids was recognized as one of the main causes of snoring and obstructive sleep apnea (OSA) in pediatric patients. Recently, two endoscopic adenoid grading system was proposed, Parikh grade (P-G) and ACE grade (ACE-G). The aim of this study is to evaluate the correlation between obstructive sleep apnea severity and these two endoscopic adenoid grading systems. Materials and Methods: We retrospectively reviewed the medical records of 52 patients who underwent a polysomnography and endoscopic nasal endoscopy in the secondary referral hospital from 2008 to 2017. Adenoid exam was performed with nasal endoscopy after nasal packing soaked with lidocaine and xylometazoline in out-patient clinic. It was evaluated the correlation between each adenoid grading system and apnea-hypopnea index, adjusted by sex, age, tonsil grade, body mass index, and presence of allergic rhinitis. Results: Mean age was 7.6 year (range : 2-15, SD : 2.57) and 75% of the patient had obstructive sleep apnea (AHI≥1). P-G was statistically correlated with OSA severity. (OR=11.8, 95% CI : 1.5-92.2, p=0.02) Only subgrade E of ACE-G has meaningful correlation with OSA severity (OR=2.07, 95% CI : 0.91-4.81 p=0.03). Conclusion: P-G and subgrade E of ACE-G were statistically related to sleep apnea severity in pediatric patients. Endoscopic adenoid grading system can be useful tool to evaluate adenoid hypertrophy and upper airway in pediatric OSA patients. (J Clinical Otolaryngol 2019;30:204-208)

1639 Chronic Diarrhea Due to Pancolitis Caused by Trichuris trichiura

INTRODUCTION: Indonesia as one of the largest tropical countries in the world, shared the particularly high burden cases of parasitic colitis especially due to worm infections; Therefore patient with chronic diarrhea in tropical country should be evaluated for parasitic infections such as Trichiasis. CASE DESCRIPTION/METHODS: 22-year-old woman presented with prolonged diarrhea with mucus and no blood since one month ago. She had two to four times bowel movements once a day. She also complained for having recurrent diffuse periumbilical pain and nausea every day. She also reported for having weight loss of 3 kg. She had no remarkable past medical history. She admitted for having poor hygiene lifestyle and using non purified ground water as drinking water. She previously had visited nearest hospital for consultation, the blood test showed hemoglobin of 12.8 g/dl, white blood cell of 28,000/mL; stool analysis showed positive microscopic erythrocyte and leukocyte without worm eggs or other parasites. Other laboratory value was normal. She was admitted and treated with Levofloxacin, attaplugite, and probiotic. After five days of hospitalization, no improvement was seen, therefore she was referred to our hospital endoscopy unit for colonoscopy. Colonoscopy examination showed inflammation of the entire colon with erosion and ulceration, also multiple Trichuris trichiura were found. She was treated with mebendazole. She had clinical improvement and re-colonoscopy was done after two weeks. Re-colonoscopy examination showed no inflammation and no worms were found. DISCUSSION: Patients with Chronic diarrhea in tropical countries should always be evaluated for parasitic infections. Stool examination and colonoscopy may be helpful to establish the diagnosis. Trichuris trichiura infections may manifest as asymptomatic infection or chronic diarrhea or dysentery which may mimic inflammatory bowel disease.

1858 Corneal Injury After Routine Gastrointestinal (GI) Endoscopy With Moderate Sedation

INTRODUCTION: Corneal abrasion is the most common ocular adverse event from deep sedation and general anesthesia. Its occurrence during moderate sedation for gastrointestinal (GI) endoscopy has not been previously reported. We report 5 cases of corneal abrasion following standard GI endoscopy under moderate sedation. CASE DESCRIPTION/METHODS: Retrospective chart review of ocular adverse events during endoscopy collected prospectively from our endoscopy quality system. 5 cases were identified from May 2013 to January 2019. All patients (4 men, 1 woman; age 45-76) underwent routine endoscopy (2 upper endoscopies, 2 colonoscopies, 1 upper endoscopy and colonoscopy) and noted ocular discomfort during recovery from the procedure. All procedures were performed under moderate sedation with 4 patients receiving non-anesthesiologist administered propofol sedation in our hospital endoscopy lab and the 5th patient receiving monitored anesthesia care (MAC) propofol sedation in the medical ICU. Procedure times ranged from 15 minutes to 2 hours 18 minutes. Oxygenation methods included two by nasal cannula (4L/min and 6L/min), two by non-rebreather mask (12 L/min), and one by Bilevel positive airway pressure mask (BiPAP). Ophthalmological examination confirmed the presence of a corneal abrasion in all cases. No patients had prior ocular disease or injury. DISCUSSION: Moderate sedation for GI endoscopy is very safe, but there exists a risk for corneal injury which has not been previously reported. Endoscopists and unit staff should be made aware of this complication, which is likely underrecognized. Training to ensure patient’s eyelids are fully closed during procedure, supplemental oxygen delivery systems are properly fitted and that there is no direct contact between the dependent eye and underlying head support can prevent this complication.

Pathological characteristics of gastric polyps in 1995 patients undergoing upper gastrointestinal endoscopy in a tertiary hospital

Pathological characteristics of gastric polyps in 1995 patients undergoing upper gastrointestinal endoscopy in a tertiary hospital

Use of noninvasive positive pressure ventilation in patients with severe obesity undergoing esophagogastroduodenoscopy: a randomized controlled trial

BackgroundPatients with severe obesity being considered for bariatric surgery often undergo preoperative esophagogastroduodenoscopy (EGD). Severe obesity is a risk factor for oxygen desaturation events during EGD. The use of noninvasive positive pressure ventilation (NIPPV) to reduce desaturation events during EGD among patients with severe obesity has not been studied. ObjectiveTo evaluate the use of NIPPV among patients with severe obesity undergoing EGD. SettingCommunity hospital endoscopy suite. MethodsA randomized controlled trial evaluated the use of NIPPV in patients with severe obesity undergoing EGD. Patients were randomized into treatment (NIPPV) and control (nasal cannula, NIPPV for rescue) groups. Primary endpoints were oxygen desaturation events ≤94% and oxygen desaturation events <90% requiring intervention. A secondary endpoint was the use of NIPPV as a rescue maneuver. ResultsFifty-six patients with a body mass index of 40 to 60 were randomized (n = 28 treatment and n = 28 control). A statistically significant difference was noted between the groups for desaturation events ≤94% (14.3% of treatment and 57.1% of control groups, P = .002). There was also a statistically significant difference in the risk of a desaturation event <90% requiring intervention (3.5% of treatment and 28.6% of control groups, P = .025). All patients in the control group who developed desaturation events requiring intervention were rescued with NIPPV. ConclusionsThis study demonstrated the successful use of NIPPV as an adjunct to decrease the incidence of desaturation events in patients with severe obesity undergoing EGD.

Sa1040 PREDICTIVE CALCULATION FOR THE SESSILE SERRATED ADENOMA DETECTION RATE

Introduction: The potential inclusion of the sessile serrated adenoma detection rate (SSADR) in the key performance indicators of quality colonoscopy has been rapidly gaining understandable interest, given the associated pathway may contribute to 30% of colorectal cancers, particularly in the proximal colon. However, obtaining and calculating colonoscopy performance indicators is generally time‐consuming and laborious, as it involves manually reviewing and matching colonoscopy results with pathology results. It has been proposed that a formula based on polyp detection rate of the unit and the individual could perform as a proxy for adenoma detection rate (ADR) (Francis 2011), which was modified to account for high polyp detectors, but no such predictive proxy for SSADR exists. Although the SSADR is highly correlated with the ADR, the two rates are not directly predicative of one another. Aim: Our aim was to determine whether polyp detection rate (PDR) predicts SSADR. Methods: Colonoscopy records from July 2014 to September 2017 were retrospectively examined at two regional hospital endoscopy units in Australia. Patients with inflammatory bowel disease, polyposis syndromes, preoperative indications, failed examination due to inadequate bowel preparation, anastomosis, obstructing mass and failed intubation were excluded. In our previously proposed modification to the Francis calculation, the ADR target of 25% was replaced with the Proximal PDR (Prox‐PDR) and the adenoma to polyp detection rate quotient (APDRQ) then calculated from this (APDRQ = Prox‐PDR ÷ PDR). The group average weighted APDRQ was then calculated (0.6349) and the individual's PDR was multiplied by the weighted APDRQ. For the SSADR calculation, the SS‐APRDQ was determined by (PDR ÷ Prox‐PDR) + (group weighted average PDR ÷ group weight average Prox‐PDR), which was then multiplied by the individual PDR to determine the calculated SSADR. These calculations were then compared with the confirmed SSADR. Results: A total of 10 571 colonoscopies were included. The mean number of completed colonoscopies per endoscopist was 352. The average age of patients was 58 years and 45% were male. Including all endoscopists, the average PDR for all indications was 60.6% (SD, 14.1%), the average ADR was 39% (SD, 10.8%), and the average SSADR was 12.6% (SD, 7.4%). Table 1 presents the PDR, Prox‐PDR, actual SSADR, and calculated SSADR. The calculated SSADR had a strong positive calculation with the actual SSADR (r = 0.8646, P < 0.00001) and only differed from the actual SSADR by a mean of −0.003%. This correlation increased as the required minimum scope number was increased to at least 50 in the study period (n = 10 414, r = 0.8873, P < 0.00001). Conclusion: It is possible to accurately estimate SSADR for an individual endoscopist by using a proposed calculation incorporating the Prox‐PDR. In this study, this result is highly correlated to their actual SSADR. This may be invaluable in estimating SSADR before obtaining histology confirmation or for estimating SSADR for large centers.

Impact of public-private partnership on a regional colonoscopy service.

A public-private partnership for endoscopy was introduced in Geelong where there was no capacity for public hospital endoscopy lists to expand. This paper presents the impact of this partnership on colonoscopy services. Data were collated from prospectively maintained databases. Wait-times to outpatient appointments, colonoscopy and follow-up were analysed between July 2015 and June 2017 allowing for a 12-month period of analysis before and after the initiation of the contract. Data are presented as medians (interquartile range). A total of 1300 colonoscopies were done between July 2015 and June 2016 compared to 2114 colonoscopies (P < 0.01) after the initiation of the public-private contract; 1073 (51%) colonoscopies were done on private contract. Prior to public-private contract, 41% patients waited more than 120 days from first presentation to healthcare services to diagnostic colonoscopy, this decreased to 19% after. Improvements were seen in both the waiting time for outpatient consultation (reduced from 92 days (39-136) prior to July 2016 to 73 days (32-122); P < 0.01) after) and the time taken from consultation to colonoscopy (from 125 days (70-207) to 36 days (21-159); P < 0.01) for category 1 patients. Wait-times for both specialist outpatient assessment and colonoscopy have been significantly reduced through the introduction of a unique public-private partnership in the Greater Geelong area, resulting in more timely access for public patients and improved compliance with new guidelines.

High prevalence of asymptomatic peptic ulcers diagnosed during screening endoscopy in patients with cirrhosis.

Background:Peptic ulcer disease (PUD) is more prevalent in cirrhotics and this may aggravate prognosis. We investigated the prevalence of PUD in cirrhotics and its potential association with Helicobacter pylori (H. pylori) infection, the underlying etiology and severity of liver disease, and other manifestations of portal hypertension (PH).Methods:We enrolled consecutive asymptomatic cirrhotic patients who underwent screening endoscopy in a tertiary hospital during a 12-month period. We recorded the presence of PUD and the endoscopic findings associated with PH. H. pylori infection was documented through either histology or CLO-test. The diagnosis of cirrhosis was based on elastography, liver biopsy or a combination of clinical, biochemical and imaging data.Results:One hundred patients (M/F: 54/46, mean age: 61±14 years) were included in the analysis. Viral hepatitis (37%) and alcohol (22%) were the most common causes of cirrhosis. Child-Pugh stage was A/B/C: 60/35/5. PUD was found in 19 patients (14 gastric, 5 duodenal). H. pylori infection was diagnosed in 54%. Varices were detected in 59% (39% needed treatment). PH gastropathy was present in 81% (severe in 33%). The presence of PUD was unrelated to the etiology and the severity of liver disease or to other endoscopic manifestations of PH. No correlation was found between PUD and H. pylori infection.Conclusions:A high prevalence of PUD was observed in our cirrhotic patients, although they were asymptomatic and had no known risk factors of ulcerogenicity. The value of screening endoscopy for the early diagnosis and treatment of PUD in cirrhotics deserves further investigation.

Disparity in oesophageal cancer management in South Africa: a comparison between two tertiary centres with special focus on the palliation of dysphagia

For most patients with oesophageal cancer worldwide, palliation of dysphagia is the goal which is most commonly achieved with self-expanding metal stents (SEMS). The aim of this study was to assess the profile and management of oesophageal cancer patients at Frere Hospital in the Eastern Cape, and compare this to a similar cohort from Groote Schuur Hospital (GSH) in the Western Cape Province. This study is a retrospective comparative cohort which reviewed all patients diagnosed with oesophageal cancer by the Frere Hospital and GSH endoscopy units from January to December 2015. Independent prospective electronic databases for the two hospitals were merged for comparative analysis. During the study period, 346 and 108 patients were diagnosed with oesophageal cancer at Frere Hospital and GSH respectively. The rate of curative intended intervention was similarly low, with 3% of cases at Frere Hospital undergoing oesophagectomy or definitive radiotherapy as compared to 5% at GSH (p=0.48). In terms of palliation, significantly more patients received palliative oncological therapy at GSH as compared to Frere Hospital (21% vs 8%, p < 0.001). At Frere Hospital, 281 patients (81%) were treated primarily with serial dilatations. At GSH, 9 patients received a single dilatation, all as a bridge to radiotherapy or stenting. At Frere Hospital, 28 patients (8%) were stented, as compared to GHS where 69 patients (64%) were managed with a stent (p < 0.001). This study shows significant differences in the oncological and endoscopic palliation of patients between the two institutions, highlighting a gross disparity in healthcare provision between them. The reasons for these disparities should be investigated and equipoise addressed by national health policy makers.

The current situation of digestive endoscopy units in the Valencian Community.

in view of the advances made over the past few years, digestive endoscopy units must adapt to an increased demand and the development of novel techniques. However, the actual status of these units is virtually unknown and is limited to few surveys from over a decade ago. Thus, a new survey was performed of the current situation of endoscopy units in the Valencian Community. a specific survey was designed to assess the status of endoscopy units within public hospitals and privately managed public hospitals in the Valencian Community. The survey included the following items: hospital data, unit architectural structure, equipment, human resources, functional structure, sedation, procedures performed, advanced therapies and ongoing care. twenty-four of the 25 public hospitals or privately funded public hospitals in the Valencian Community responded to the survey, corresponding to a 96% participation. The number of physicians in gastroenterology services or sections ranged from 2 to 21. Endoscopist-controlled propofol sedation was used in 13 hospitals (54.2%). Most centers performed 1,000 to 3,000 gastroscopies per year. Fourteen units (58.3%) performed 2,000 to 3,000 colonoscopies and endoscopic retrograde cholangiopancreatography (ERCP) was performed in 22 hospitals (91.7%). the results of the survey revealed large differences in infrastructure and organization among public hospital endoscopy units in the Valencian Community. Organization is highly heterogeneous and independent of hospital size.

Agreement of triage decisions between gastroenterologists and nurses in a hospital endoscopy unit.

IntroductionEfficient and accurate triage of endoscopy referrals is essential. Many of the decisions made are based on national and local triage criteria. Standardizing this approach for nurse use could maintain quality, address clinical risk and significantly improve resource utilization.AimsThis study aimed to compare gastroenterologist and nurse triage of unselected gastroenterology referrals in order to evaluate the proportion of referrals felt able to be triaged to endoscopy and the inter-rater agreement between a triage gastroenterologist and endoscopy nurses for clinical triage decisions regarding the urgency of gastroscopy and colonoscopy.MethodsThe proportion of referrals triaged to endoscopy by a consultant gastroenterologist performing triage as a part of normal practice and two endoscopy nurses using a decision algorithm was measured. The inter-rater agreement for the triage category decision (urgency of referral) between the three triage clinicians was assessed. An adjudication panel provided a consensus decision triage category decision in cases where there was not complete agreement between the three triage clinicians.ResultsEach clinician assessed 105 referrals. Nurse A was able to triage 54 (51%) referrals to a triage category and Nurse B 44 (42%) referrals. Cohen’s κ was run to determine if there was agreement between clinicians for the triage categories allocated. The agreement between the two nurses was substantial (k=0.645, P<0.0005). Between the gastroenterologist and each nurse, moderate agreement was seen (Nurse A, k=0.589, P<0.0005; Nurse B, k=0.437, P<0.0005). Moderate agreement was seen between the nurses and an adjudication panel (Nurse A, k=0.423, P<0.0005; Nurse B, k=0.464, P<0.0005). However, there was only slight agreement between the adjudication panel and the gastroenterologist (k=0.099, P=0.010).ConclusionNurse triage using a decision algorithm is feasible, and inter-rater agreement is substantial between nurses and moderate to substantial between the nurses and a gastroenterologist. An adjudication panel demonstrated moderate agreement with the nurses but only slight agreement with the triage gastroenterologist. This suggests that nurse triage using a decision algorithm can approximate decision making by an experienced gastroenterologist.

The validity of adenosine triphosphate measurement in detecting endoscope contamination

Endoscopic procedures are vital to gastrointestinal disease diagnosis and management, but risk infection transmission. In Australia, endoscopes undergo monthly-to-quarterly microbiological testing, to prevent patient infection. Endoscopes are used more frequently, meaning contamination may not be detected by this surveillance before infection transmission occurs. To evaluate the use of adenosine triphosphate (ATP) measurement, alongside standard microbiological cultures, in detecting endoscope contamination before high-level disinfection. Using these results, we also aimed to confirm the efficacy of manual cleaning in reducing levels of ATP and cfu/mL. Seventeen in-clinical-use gastroscopes and 24 in-clinical-use colonoscopes from the Liverpool Hospital Endoscopy unit were sampled across three separate cleaning stages before high-level disinfection. Colony counts and ATP measurements were then performed on these samples. The correlation between the cfu/mL and RLU of samples collected from colonoscopes was 0.497 (95% confidence interval: 0.28-0.66; P<0.0001). The correlation between cfu/mL and RLU for samples collected from gastroscopes was 0.377 (0.08-0.61; P=0.0138). RLU and cfu/mL values were shown to fall significantly (P<0.005) following precleaning and manual cleaning. There was a significant correlation between ATP and cfu/mL measured from samples collected before high-level disinfection. Precleaning and manual cleaning were shown to reduce ATP and microbiological load significantly. ATP measurement can be performed within minutes with little training and produces results that are easy to interpret. These findings warrant further research on the utility of ATP measurement as a screening tool for detecting endoscope contamination after high-level disinfection.