Endoscopy Unit Research Articles

Production and possible reduction of greenhouse gases produced during GI endoscopy activity: a systematic review of available literature

Background and aimsGreenhouse gases (GHGs) that trap heat in the atmosphere are composed of carbon dioxide (CO2), methane, nitrous oxide and fluorinated gases (synthetic hydrofluorocarbons, perfluorocarbons and nitrogen trifluoride). In...

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Pre-Endoscopy real-time PCR testing for SARS-CoV2 does not reduce health care workers infection and is associated with a higher reduction of endoscopic activity in an outpatient setting.

The role of pre-procedure SARS-CoV2 testing in digestive endoscopy is still debated. AGA guidelines recommend against pre-procedure testing considering low prevalence of SARS- CoV2 infection in the general population and low incidence of infection among endoscopy units Health Care Workers (HCWs). However, no studies have compared pre-procedure testing associated to symptom screening vs. symptom screening alone in reducing the risk of infection for HCWs. Main aim of the present study is to compare the risk of infection for HCWs in different Endoscopy Units adopting different pre-endoscopy screening and operating in two nearby hospital of the same region in Northern Italy in pre-vaccination period. For outpatients in the Endoscopy Unit of Trento (Unit 1) only pre-procedure symptom screening was performed, while in the Endoscopy Unit of Bolzano (Unit 2) pre-procedure symptom screening and negative pre-procedure real-time PCR were requested. Secondary aims were to assess the impact of pre-procedure real-time PCR testing on endoscopic activity and diagnostic delay. Retrospective data collection on a prospectively maintained database was performed, including outpatient endoscopy procedures performed between June 1st 2020 and February 28th 2021 in Unit 1 and Unit 2. No differences in terms of infection rate in HCWs have been identified in Unit 1 and Unit 2 (9.0 vs. 19.3% P=0.2) over a nine-month period. Moreover, in the unit performing pre- procedure real-time PCR before endoscopy a significantly higher reduction in endoscopic activity has been recorded (61.9% vs. 53.4%; P<0.01). In patients with positive real-time PCR, endoscopy was performed with a mean delay of 61.7 days (range 9-294) and 22.5% of them were lost at follow-up and did not undergo any endoscopic procedure in the following 12 months. This study supports the AGA recommendation suggesting that pre-endoscopy real-time PCR is an expensive and time-consuming procedure without proven benefits in an outpatient setting.

Bacterial contamination of propofol vials: The second report from Turkey

Objective: In this study, we look at the case report of an outbreak of sepsis in patients who underwent upper gastrointestinal endoscopy or colonoscopy during three consecutive days. Twelve patients had diagnostic procedures in the endoscopy unit between 05 May 2018 and 07 May 2018. Of the 12 patients, three had upper gastrointestinal endoscopy, six had a colonoscopy, and three had a combination of two procedures. Within two days of discharge, five patients diagnosed with SIRS and referred with fever as the major sign were hospitalized to the infectious diseases clinic. In our Endoscopy Unit, media, drug, and material cultures were taken for microbiological analysis, and microbial agents were searched. Growth was detected only in the propofol drawn into the syringe that was used on the patient. This study highlights the importance of strict compliance with aseptic injection guidance and constant analysis of microbiological data

The Hidden Burden of Equipment Failure in Endoscopy: Uncovered and Improved With Digital Technology.

Objective A growing and ageing population combined with severe disruptions across endoscopy services throughout the United Kingdom (UK) during the recent pandemic has accelerated the backlog of patients awaiting endoscopic procedures. This places increased pressure to improve service efficiencies in an attempt to reduce this growing burden. Moreover, beyond repair costs, the full impact of faulty endoscopes on services is not well documented. This study aimed to outline tasks performed to traditionally report a broken endoscope; measure the impact on staff time, efficiency costs and staff morale; and report outcomes of staff experience and productivity when replacing traditional reporting with a digital reporting tool. Methods This study was conducted over six months at three endoscopy units. Cognitive-task analysis (CTA) and a time-motion study (TMS) were performed to process map all traditional tasks when an endoscope breaks, and again after a digital reporting tool was implemented. Two staff surveys were conducted. Data was aggregated to determine the overall impact and model efficiency costs. Results With traditional processes, on average one faulty endoscope generated 54 tasks, consuming 8 hours 53 minutes of staff time or £325 in efficiency costs, with 60% of staff reporting a negative effect on morale. In comparison, digital reporting generated 41 tasks, consuming 4 hours 31 minutes of time or £147 in efficiency costs, resulting in £45,468 saved annually. Furthermore, 95% of staff said their morale improved, and environmentally all paper-based processes were removed. Conclusion This study demonstrated the immense hidden burden of faulty endoscopes. Given the current challenges to endoscopy recovery,digital reporting tools may present an attractive means to minimise disruption to endoscopy services driven through improved equipment maintenance.

Micronutrient deficiency among patients with ulcerative colitis

Background and aimMalnutrition is a common problem among patients with inflammatory bowel disease and up to 18–62% of ulcerative colitis (UC) patients were reported to be malnourished. This study aimed to assess micronutrient status among naïve UC patients and its correlation with disease severity.MethodsA prospective case-control study carried out on 46 patients who visited our endoscopy unit between April 2019 and April 2021. The patients were classified into 3 groups of mild, moderate, and severe UC based on colonoscopy findings, and histopathological examination. Serum was collected and assayed for levels of iron, magnesium, zinc, selenium, and copper.ResultsForty-six (17 male, 29 female) patients divided into 2 groups (23 naïve UC patients and 23 healthy individuals) with the mean age of 32 years were included in the study. The serum levels of magnesium, zinc, and selenium were significantly lower in the UC group (p < 0.001, 0.018 and < 0.001, respectively). However, iron and copper levels were not significantly different between the 2 groups. In discriminating severe from mild-moderate UC cases, there was a statistically significant result of magnesium at cutoff 1.8 or less in discriminating severe from mild to moderate UC cases with an AUC of 0.950 and p value of < 0.001.ConclusionMicronutrients should be assessed in patients in UC patients to alert to the fact that correction of these deficiencies could facilitate achievement of remission. Further research is needed to confirm if magnesium levels could serve as a predictor of the disease severity.

Factors Influenced the Endoscopic Services Volume during the COVID-19 Pandemic at National Tertiary Referral Hospital in Indonesia: Dr. Cipto Mangunkusumo Hospital.

The impact of the COVID-19 pandemic caused a decrease in healthcare services, the intervention of non-surgical procedures, and endoscopy. This study examined the volume of endoscopy at Dr. Cipto Mangukusumo Hospital, the highest referral hospital in Indonesia. A cross-sectional mixed method was used to assess the relationship between endoscopy volume, age, gender, number of COVID-19 cases, type of patient's case, the origin of treatment, and the kind of endoscopic procedure before and during the pandemic. The secondary data were collected through the hospital's Electronic Health Record (EHR) System and "Kawal COVID-19" Websites, while the primary data were collected through observation, document reviews, and in-depth online interviews with doctors at endoscopic units. This study period was divided into six intervals of three months, respectively, from January 2020 to September 2021, and 5030 endoscopic procedures were collected. The data were analyzed both quantitatively through the SPSS statistics and qualitatively. The quantitative data presented as descriptive and bivariate results in an Independent T-Test and a Chi-Square test. The results showed there was a significant difference (p = 0.004) in the volume of endoscopes before (the highest volume) and during the pandemic (the lowest volume during April-June 2020 period). The mean age of the patients was higher before the pandemic. There was a significant difference between patient admissions from outpatient and emergency procedures before and during the pandemic. There are changes in the flow of outpatient to do endoscopies which were different from the flow of emergency patients during the pandemic, which focused on the long waiting list for inward entry queues, the mandatory COVID-19 PCR swab, and the criteria of emergency cases for fast-track procedures, the reduced bed capacity, and the expired date of laboratory examinations. The decreased volume was also caused by the limitation of patient intervention by the doctors. However, the duration of the action procedure was accelerated without reducing its quality. Furthermore, there was a high wave of Delta Variant cases from May to July 2021. In addition, the factors of age, type of patient's case, origin, and treatment showed significant differences before and during the COVID-19 pandemic. Finally, changes in the flow of services also influenced various impacts on endoscopy and service costs. Therefore, further study is required to calculate the unit costs.

Endoscopic esophageal stenting for advanced esophageal cancer in Lubaga Hospital, Kampala, Uganda

ObjectiveEsophageal cancer is a common malignancy globally. Most patients in sub-Saharan Africa present at advanced stage not amenable to curative therapy. Stenting provides palliation for these patients. In Uganda, many endoscopy units can perform diagnostic endoscopy but only a handful routinely perform endoscopic interventions like stenting. We describe esophageal cancer patients who underwent esophageal stenting intending to highlight its importance in a resource-limited setting.Endoscopy reports were reviewed for patients who underwent evaluation for esophageal cancer at Lubaga Hospital from December 2014 to March 2022.Results315 records of patients with esophageal cancer were reviewed. Male to female ratio was 2:1. 188(60%) patients were 60 years and above. 268 (85%) esophageal lesions were described as fungating, friable or polypoid. 249 (79%) tumors were in mid or distal esophagus. 66% esophageal lesions caused severe luminal obstruction not traversable by the scope. 164 (52%) patients did not opt for stenting due to personal and other reasons. Stenting wasn’t successful in 7 out of the 148 patients who underwent either primary or tandem stenting. Despite 207 (66%) of patients with advanced esophageal cancer presenting with endoscopically non-traversable tumors, endoscopic stenting was still possible with a technical success rate of 95.3%.

Investigation of the New Advantages of Colonoscope Insertion with an Endoscopic Position Detection Unit.

The use of an endoscopic position detection unit (UPD) enables better and more objective understanding of the shape and position of the colonoscope. Here, we investigated the reproducibility of the insertion of a colonoscope with UPD. Study participants were 122 patients who received a colonoscopy with UPD twice for the purpose of large bowel screening and surveillance. The mean age of participants was 69.7 ± 10.4 years, and the male-to-female ratio was 9.2:1. The colonoscope insertion technique was primarily based on the shaft-holding, shortening insertion method. The cecal intubation time was recorded; the method used for passing through the sigmoid/descending colon junction (SDJ) and the hepatic flexure. The mean cecal intubation time was 990 ± 511 s. The cecal intubation time and the patterns for passing through the SDJ and hepatic flexure were significantly correlated between the first and second colonoscopies. Use of a UPD revealed good reproducibility of colonoscope insertion. This is the first time we have proved that both time and pattern are inserted in much the same way for the first and second times. In patients' conducted UPD combination TCS after the second time, it was suggested that individual tailor-made insertions are possible based on the information from the first time.

Comparison of Sequential, Hybrid, and Quadruple Therapy Protocols in Helicobacter pylori Eradication: A Single-Center Study.

Many treatment protocols are used in Helicobacter pylori eradication treatment within the framework of factors such as antibiotic resistance, drug side effects, patient compliance, and regional differences. H. pylori was diagnosed with upper gastrointestinal system endoscopic biopsy in the Internal Diseases Gastroenterology Endoscopy Unit of Atatürk University Medical Faculty Hospital; a total of 229 patients over the age of 18 were evaluated prospectively by dividing them into 3 groups and applying 3 different H. pylori eradication treatment protocols. A total of 229 patients who completed the treatment were included in the study. H. pylori eradication was achieved in 186 patients and not achieved in 43 patients. The H. pylori eradication success of our study was found to be 81.2%. Among the 84 patients in group 1, while H. pylori eradication was achieved in 67 of them, it was not achieved in 17 patients. The eradication success of quadruple treatment with bismuth was 79.8%. Also, among the 68 patients in group 2, while H. pylori eradication was achieved in 55 patients, it was not achieved in 13. The eradication success of the 14-day hybrid treatment was 80.9%. Among the 77 patients in group 3, while H. pylori eradication was achieved in 64 patients, it was not achieved in 13. The eradication success of the 10-day sequential treatment was 83.1%. It is necessary to conduct studies to find the most successful eradication regimen in primary care treatment of H. pylori in our country, to determine the regional antibiotic resistance rates, to individualize the proton pump inhibitor treatment due to metabolism and resistance differences, to examine the factors that stop from achieving the desired eradication success, and especially to avoid unnecessary antibiotic use.

Baseline Cannabinoid Use Is Associated with Increased Sedation Requirements for Outpatient Endoscopy.

Background and Aims: Given the underlying properties of cannabinoids, we aimed to assess associations between cannabinoid use and sedation requirements for esophagogastroduodenoscopy (EGD) and colonoscopy. Methods: A prospective cohort study was conducted at three endoscopy units. Adult outpatients undergoing EGD or colonoscopy with endoscopist-directed conscious sedation (EDCS) were given questionnaires on cannabinoid use and relevant parameters. Outcomes included intraprocedural midazolam, fentanyl, and diphenhydramine use, procedural tolerability, and adverse events. Multivariable logistic regression was performed to yield adjusted odds ratios (AORs) of outcomes. Results: A total of 419 patients were included. Baseline cannabinoid use was associated with high midazolam use, defined as ≥5 mg, during EGD (AOR 2.89, 95% confidence interval, CI: 1.19-7.50), but not during colonoscopy (AOR 0.89, 95% CI 0.41-1.91). Baseline cannabinoid use was associated with the administration of any diphenhydramine during EGD (AOR 3.04, 95% CI: 1.29-7.30) with a similar nonsignificant trend for colonoscopy (AOR 2.36, 95% CI: 0.81-7.04). Baseline cannabinoid use was associated with increased odds of requiring high total sedation, defined as any of midazolam ≥5 mg, fentanyl ≥100 mcg, or any diphenhydramine during EGD (AOR 3.72, 95% CI: 1.35-11.68). Cannabinoid use was not independently associated with fentanyl use, intraprocedural awareness, discomfort, or adverse events. Conclusions: Baseline cannabinoid use was associated with higher sedation use during endoscopy with EDCS, particularly with midazolam and diphenhydramine. Given increasingly widespread cannabinoid use, endoscopists should be equipped with optimal sedation strategies for this population. As part of the informed consent process, cannabis users should be counseled that they may require higher sedation doses to achieve the same effect.

Microbiological surveillance post-reprocessing of flexible endoscopes used in digestive endoscopy: a national study

Microbiological surveillance of endoscopes is a safety measure for verifying the quality of reprocessing procedures and identifying contaminated devices, but duodenoscope-related outbreaks are still reported. To assess the effectiveness of duodenoscope reprocessing procedures in Italy. Between December 2019 and April 2020, data obtained from microbiological surveillance post-reprocessing in 15 Italian endoscopy units were collected. Sampling was carried out after reprocessing or during storage in a cabinet. In keeping with international guidelines and the Italian position paper, the micro-organisms were classified as high-concern organisms (HCOs) and low-concern organisms (LCOs). In total, 144 samples were collected from 51 duodenoscopes. Of these, 36.81% were contaminated: 22.92% were contaminated with HCOs and 13.89% were contaminated with LCOs [2.08% with an LCO load of 11-100colony-forming units (CFU)/device and 0.69% with an LCO load of >100CFU/device]. The contamination rate was 27.5% in samples collected after reprocessing, 40% in samples collected during storage in a cabinet that was compliant with EN 16442:2015 (C-I), and 100% in samples collected during storage in a cabinet that was not compliant with EN 16442:2015 (NC-I). The respective HCO rates were 15.00%, 27.27% and 66.67%. Correlation between LCO contamination and storage time was demonstrated (Spearman's rho=0.3701; P=0.0026). The Olympus duodenoscope TJFQ180V demonstrated the lowest rate of contamination (29.82%), although the contamination rate was 100% for duodenoscopes stored in an NC-I cabinet. Microbiological surveillance, along with strict adherence to reprocessing protocols, may help to detect endoscope contamination at an early stage, and reduce the risk of duodenoscope-associated infections.

New endoscopic tools in inflammatory bowel disease.

Endoscopic remission is now considered the ultimate long-term goal for treating inflammatory bowel disease (IBD). Recent advances in endoscopic techniques have progressively added new tools to the armamentarium of endoscopists for a deeper assessment and characterisation of the intestinal mucosa. Virtual Electronic chromoendoscopy is widely available in the endoscopic units, leading to a more accurate evaluation of the vascular and mucosal architecture of the colon, reducing the gap with histology, which is considered a favourable long-term measure. In addition, advanced, sophisticated techniques such as endocytoscope and confocal laser endomicroscopy provide insights into individualised and personalised IBD therapy. Finally, high expectations are placed on the advent of Artificial Intelligence (AI) with promising applications that have the potential to revolutionise IBD diagnosis and management. Here, we discuss state-of-the-art of endoscopic techniques and their applicability to accurate assess endoscopic and histological remission, predict response to therapy and detect, characterise and guide treatment of colonic dysplastic lesions. We are seeing the dawn of a new era wherein the applications of these new endoscopic tools, hand in hand with AI, offer the most incredible opportunity to deliver precision medicine to patients with IBD.

Risks of infection associated with aerosol generation during medical procedures in an endoscopy unit

Several medical procedures for treatment or diagnosis of diseases have been identified as potentially aerosol generators. The aim of this study is to investigate the potential exposure of the health professionals to aerosols generation during different medical procedures in a hospital endoscopy unit, and to characterize the emitted aerosols in terms of airborne concentration and size. Aerosols number concentrations and sizes, were measured and indoor activity was collected and correlated with the emitting sources. Endoscopy, bronchoscopy, colonoscopy, and bidirectional endoscopy procedures were identified as the most important aerosol sources. During these procedures, the increases in mean aerosols concentration (< 5 µm) in relation to the reference concentration for colonoscopy, upper endoscopy, bronchoscopy and bidirectional endoscopy procedures were 12, 72, 39, and 141%, respectively. These results showed that, depending on the type of activity performed inside the room, the concentration of aerosols varied considerably in relation to the reference concentration. The results also demonstrated that aerosols generation events during medical procedures in an endoscopy unit are divided into two categories: the events that create and disperse aerosols mechanically and events that induce the patient to produce aerosols.In the SARS-CoV-2 context, the virus stability characteristics and modes of transmission make all sources analyzed as high risk for COVID-19 transmission.

Optimising the reprocessing of endoscopes for patient safety

Background: Annually, millions of endoscopies are performed around the globe. Endoscopes are reused countless times, and it is essential to reprocess them. Appropriate reprocessing maximises safety for patients undergoing endoscopy. Aim: This study aimed to assess practices before and after implementation of an evidence-based protocol in the endoscopy unit of a tertiary hospital in India. Methods: The protocol was communicated to healthcare professionals (HCPs) in a blended learning format. A validated reliable checklist was used by one group of HCPs to assess factors, practice and microbial growth before and after implementation of the protocol. Results: Most HCPs were male (71.42%) and nurses (57.14%). With no formal training, the practice scores were in an unacceptable range before the protocol and reached acceptable levels after. While the outer tip of endoscope showed no microbial growth, high concern organisms such as Escherichia coli were detected in suction channels. The protocol was effective in improving practice (t=-23.86; p&lt;0.00) and reducing microbial growth (11.07; p&lt;0.003), respectively. Conclusion: Facilities need to standardise guidelines of practice to ensure training, provide oversight and assess competency.

S1085 Impact of Location on Radiation Exposure During ERCP: A Multi-Institutional Analysis at Tertiary Academic Centers

S1085 Impact of Location on Radiation Exposure During ERCP: A Multi-Institutional Analysis at Tertiary Academic Centers

S629 Clinical Setting and Outcomes in Patients Undergoing Endoscopic Disimpaction of Esophageal Food Bolus

Introduction: Esophageal food impaction (EFI) resulting in obstruction is a common gastrointestinal emergency most often treated with disimpaction by emergent upper endoscopy. EFI’s may occur secondary to the underlying esophageal stricture, eosinophilic esophagitis, mass, or underlying dysmotility. We sought to understand the association between the clinical setting, including the emergency department (ED), operating room (OR), or endoscopy unit (EU), in which endoscopic disimpaction was performed with clinical outcomes among patients presenting with EFI. Methods: We conducted a retrospective review of 409 adult patients that presented to the ED with suspected EFI at any of the three Lifespan academic or community hospital sites from 2015 to 2021. We compared 30-day readmission and length of stay (LOS), among individuals who were treated with an upper endoscopy. Chi-square, Fisher exact test, and Student’s t-tests were performed for descriptive analysis to report demographics and other health-related measurements. The multivariable regression models were adjusted for age, race, ethnicity, Charlson Comorbidity Index score (CCI), and if the procedure was done during the weekend. The multivariable logistic regression model was adjusted for age, CCI, and if the procedure was done during the weekend, or after 5 pm. Analysis was performed in SAS version 9.4. Results: The majority of the procedures were done in the EU (62.2%), followed by ED (29.5%) and OR (8.3%). Eighty-five percent of the individuals were white, 6.4% were hispanic or latino, and average age at presentation was 57.0. Individuals undergoing upper endoscopy in the ER were sicker, with a mean CCI of 2.8, compared with 1.8 at EU, p-value=0.0126. The average LOS was higher (3.5 days) among patients that had the procedure in the ED, compared with the EU (2.4 days), adjusted p-value=0.0173, but higher (10.8 days) among patients that had the procedure in the OR, compared with the ER, adjusted p-value=0.0249. Individuals having upper endoscopy in the ED were observed having over 2-fold greater likelihood for 30-day readmission compared with the EU, OR 95%CI 2.3 [1.03-5.13]. Conclusion: Endoscopic food disimpaction can be safely completed in a controlled setting such as the ED, EU, or OR. We observed a 30-day readmission and lower LOS is seen when the procedure is done on the EU compared with ED.

S1481 Impact of Time-Motion Patient Flow Analysis on the Productivity of an Endoscopy Unit in a Large Safety-Net Health Center

Introduction: The COVID-19 pandemic disrupted health care delivery, particularly for high-volume procedural areas. To improve productivity in the Los Angeles County + University of Southern California Medical Center (LAC + USC) Endoscopy Unit, we initiated an iterative rapid cycle quality improvement process to identify inefficiencies and implement changes to our workflow. Methods: A time-motion analysis of patient flow through the LAC + USC Endoscopy Unit was used to construct a time-tracked flow sheet to track individual patients as they moved through the Unit. Data were collected weekly over 3 9-10 week phases, and intervening plan-do-study-act (PDSA) cycles were conducted to direct interventions for subsequent phases. Following phase 1 (9/1/21 to 11/9/21) we implemented targeted interventions at the start of phase 2 (12/1/21 to 2/1/22) and phase 3 (3/15/22 to 5/31/22). Phase 2 was focused on our anesthesia supported endoscopy room which requires greater resource coordination. Metrics were compared to published benchmarks. Linear regression was used to compare outcome parameters for the lean process flow improvement project. Results: Our phase 1 analysis showed operational delays in room turnover time for all procedures and pre-operative assessment and first-case on time start percentage for procedures supported by anesthesia, when compared to published benchmarks (Table 1). In phase 2 we implemented an intervention of combining pre-anesthesia visits with endoscopy teaching visits for patients designated to have anesthesia support. This significantly improved both turnover time and throughput for the anesthesia room (Table 1). In phase 3 we initiated a policy of preparing the first patient of the day in the procedure room which dramatically increased first-case on time start percentage. We further streamlined inter-procedure processes by simultaneously consenting, placing monitoring equipment and documenting in the time between procedures, leading to a greater than 20% increase in total procedure volume (Table 1). Procedure throughput for the anesthesia supported procedure room increased from 4.5 to 7 to 9 procedures per room per day for phases 1, 2, and 3 respectively (Table 1). Endoscopy Unit staffing remained unchanged throughout the study period. Conclusion: Time-motion analysis of patient flow may be used to perform targeted interventions with significant improvements in Endoscopy Unit efficiency. This may be achieved without costly interventions such as hiring additional support staff or faculty. Table 1. - Core Productivity and Efficiency Parameters of LAC+USC Endoscopy Unit Phase 1 FIRST INTERVENTION 12/1/2021: pre-anesthesia visit Phase 2 SECOND INTERVENTION 3/15/2022:First patient prepared in-room and streamlined inter-procedure processes Phase 3 Sep-2021 Oct-2021 Nov-2021 Dec-2021 Jan-2022 Feb-2022 Mar-2022 Apr-2022 May-2022 Total Procedures 539 556 450 511 467 501 504 647 612 Moderate Sedation 515 539 426 488 432 468 465 608 573 Anesthesia Supported 24 17 24 23 35 33 39 39 39 Mean Room Turnover Time (minutes - for anesthesia room) 45 (±40) 31 (±40) 30 (±24) First-Case On Time Start % (moderate sedation) 75.7% 78.3% 87.5% First-Case On Time Start % (anesthesia supported) 0% 0% 92.5% Anesthesia Room Throughput (mean # of procedures per day) 4.5 7.0 9.0

S1071 Assessment of Pathogenic Enteric Flora Contaminating Novel Duodenoscopes With Disposable Tips

Introduction: The FDA has advised that endoscopy units use duodenoscopes with disposable components to minimize the risk of duodenoscope-associated infections. Data are emerging on the effectiveness of disposable tips in preventing contamination of the duodenoscope with high-risk organisms. We hypothesize that disposable tips will not eliminate high-risk bacterial contamination. Methods: We conducted a prospective observational study from October 2021 to March 2022 to speciate and quantify the bacterial contamination rate of 46 Pentax Medical ED34-i10T2 duodenoscopes with disposable tips. After disposal of the tip, the duodenoscope was cultured after one manual wash (MW) and one cycle of high-level disinfection (HLD) in an automated endoscope re-processor, and then again after two MW and an additional cycle of HLD. Each duodenoscope was sampled in 4 locations after the first MW-HLD cycle and the second: 1) elevator tab, 2) instrument channel distal opening, 3) composite duodenoscope tip, 4) instrument channel (Figure). Bacterial pathogenicity was classified by the FDA 1 as high-concern (any CFU) and low/moderate-concern organisms ( >100 CFU). Clostridium difficile and Enterococcus faecalis were classified as high-concern organisms. We compared contamination rates to historical data from the FDA surveillance study of Pentax reusable duodenoscopes that demonstrated contamination rates of 6.0% high-concern organisms and 8.2% low/moderate-concern organisms. Results: 46 Duodenoscopes were sampled resulting in 368 sample events. After one MW-HLD cycle, 8 of 46 duodenoscopes remained contaminated with any organism. After the full HLD, 5 of 46 duodenoscopes remained contaminated with any organism. Low/moderate concern organisms were isolated in 2.7% of samples (95% CI 0.9%, 6.2%). High concern organisms were isolated in 0% of samples (95% CI 0%, 2.0%). (Table) Conclusion: Compared to historical FDA data from reusable Pentax duodenoscopes, the rate of low/moderate-concern organism contamination of duodenoscopes with disposable tips was lower, and the confidence interval excluded the historical rate. The rate and confidence interval limits for high-concern organism contamination in our study were also lower than FDA data1. Our results suggest that disposable tips decrease but do not eliminate duodenoscope bacterial contamination. 1 522 postmarket surveillance studies database: pilot phase (phase 1) of the Sampling and Culturing Study for Pentax. accessdata.fda.gov. 2020.Figure 1.: Each duodenoscope was sampled in 4 locations: 1) elevator tab, 2) instrument channel distal opening, 3) composite duodenoscope tip, 4) instrument channel. Samples 1-3 were collected with flocked swabs. Swabs were plated on routine medias for relevant enteric pathogens. The 4th was collected by flushing 25mL of neutralizing buffer through the elevator channel, then scrubbing the channel with a brush, followed by another 25mL flush. The 50mL eluent was vacuum filtered through a 0.22-micron filter and plated on TSA. Antibiotic resistance was assessed via PCR. CFU and proportion of contaminated scopes were compared between MW-HLD cycles. Table 1. - Descriptive Table comparing sample rates to historical FDA reported rates of contamination Outcome Historical Rate Summarized Rate across all Sites (95% CI) Raw sample total low-concern organism >100 CFU presence 8.2% 2.7% (0.9%, 6.2%) Raw sample total high-concern organism (Enterococcus and C difficile) >1 CFU presence 6.0% 0% (0%, 2.0%)

S1923 Abutting Percutaneous Drains Can Jeopardize Healing of Post-Cholecystectomy Bile Leaks

S1923 Abutting Percutaneous Drains Can Jeopardize Healing of Post-Cholecystectomy Bile Leaks