Clinical Endoscopy

Use of abdominal compression device in colonoscopy: a systematic review and meta-analysis: Yousaf Zafar, Ahmed Mustafa Rashid, Syed Sarmad Javaid, Ahmed Kamal Siddiqi, Adnan Zafar, Arsalan Zafar Iqbal, Jagpal Singh Klair, Rajesh Krishnamoorthi; Clin Endosc 2023;56(4):446-452. Published online May 26, 2023; DOI: https://doi.org/10.5946/ce.2022.304

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Colonoscopy for screening is associated with unpleasant experiences for patients, and abdominal compression devices have been developed to minimize these problems. However, there is a paucity of data supporting the therapeutic benefits of this strategy. This study examined the effects of using an abdominal compression device during colonoscopy on the cecal intubation time (CIT), abdominal compression, patient comfort, and postural changes.
Methods
We searched PubMed and Scopus (from inception to November 2021) for randomized controlled trials that assessed the effects of an abdominal compression device during colonoscopy on CIT, abdominal compression, patient comfort, and postural change. A random-effects meta-analysis was performed. Weighted mean differences (WMDs) and Mantel-Haenszel odds ratios (ORs) were calculated.
Results
Our pooled analysis of seven randomized controlled trials revealed that abdominal compression devices significantly reduced CIT (WMD, –0.76 [–1.49 to –0.03] minutes; p=0.04), abdominal compression (OR, 0.52; 95% confidence interval [CI], 0.28–0.94; p=0.03), and postural changes (OR, 0.46; 95% CI, 0.27–0.78; p=0.004) during colonoscopy. However, our results did not show a significant change in patient comfort (WMD, –0.48; 95% CI, –1.05 to 0.08; p=0.09) when using an abdominal compression device.
Conclusions
Our findings demonstrate that employing an abdominal compression device may reduce CIT, abdominal compression, and postural change but have no impact on patient comfort.

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Safe implementation of transoral incisionless fundoplication as a new technique in a tertiary care center: Shivanand Bomman, Sofya Malashanka, Adil Ghafoor, David J. Sanders, Shayan Irani, Richard A. Kozarek, Andrew Ross, Michal Hubka, Rajesh Krishnamoorthi; Clin Endosc 2022;55(5):630-636. Published online August 17, 2022; DOI: https://doi.org/10.5946/ce.2022.003

Background
/Aims: Transoral incisionless fundoplication (TIF) is an accepted anatomic treatment for gastroesophageal reflux disease in selected patients. In this report, we analyze our institution’s programmatic allocation of resources during the safe implementation of TIF as a new procedure.
Methods
A retrospective analysis of all patients who underwent TIF from January 2020 to February 2021 at our institution was performed. The process of initially allocating the operating room (OR) with overnight admission and postoperative esophagram for added safety, and subsequently transitioning TIF to the endoscopy suite (ES) as an outpatient procedure was described. Patient safety and outcomes were evaluated during transition.
Results
Thirty patients who underwent TIF were identified. The mean age was 51.2±16.0 years. TIF was performed in an OR in nine patients (30%) and 21 (70%) in the ES. All the OR patients were admitted overnight and had routine EG. In contrast, four (19%) from the ES group required clinically-indicated admission and three (14.2%) required esophagram. The mean procedure duration was significantly lower in the ES group (65.7 min vs. 84 min, p=0.02).
Conclusions
A stepwise, resource-efficient process was described that allowed safe initiation of TIF as a new technique and its effective transition to a fully outpatient procedure.

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Gastroesophageal reflux disease in children: What’s new right now?
Palittiya Sintusek, Mohamed Mutalib, Nikhil Thapar
World Journal of Gastrointestinal Endoscopy.2023; 15(3): 84. CrossRef
Assessing implementation strategy and learning curve for transoral incisionless fundoplication as a new technique
Muhammad Haseeb, Christopher C. Thompson
Clinical Endoscopy.2022; 55(6): 751. CrossRef

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Contamination Rates in Duodenoscopes Reprocessed Using Enhanced Surveillance and Reprocessing Techniques: A Systematic Review and Meta-Analysis: Shivanand Bomman, Munish Ashat, Navroop Nagra, Mahendran Jayaraj, Shruti Chandra, Richard A Kozarek, Andrew Ross, Rajesh Krishnamoorthi; Clin Endosc 2022;55(1):33-40. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.212

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Multiple outbreaks of multidrug-resistant organisms have been reported worldwide due to contaminated duodenoscopes. In 2015, the United States Food and Drug Administration recommended the following supplemental enhanced surveillance and reprocessing techniques (ESRT) to improve duodenoscope disinfection: (1) microbiological culture, (2) ethylene oxide sterilization, (3) liquid chemical sterilant processing system, and (4) double high-level disinfection. A systematic review and meta-analysis was performed to assess the impact of ESRT on the contamination rates.
Methods
A thorough and systematic search was performed across several databases and conference proceedings from inception until January 2021, and all studies reporting the effectiveness of various ESRTs were identified. The pooled contamination rates of post-ESRT duodenoscopes were estimated using the random effects model.
Results
A total of seven studies using various ESRTs were incorporated in the analysis, which included a total of 9,084 post-ESRT duodenoscope cultures. The pooled contamination rate of the post-ESRT duodenoscope was 5% (95% confidence interval [CI]: 2.3%–10.8%, inconsistency index [I²]=97.97%). Pooled contamination rates for high-risk organisms were 0.8% (95% CI: 0.2%–2.7%, I²=94.96).
Conclusions
While ESRT may improve the disinfection process, a post-ESRT contamination rate of 5% is not negligible. Ongoing efforts to mitigate the rate of contamination by improving disinfection techniques and innovations in duodenoscope design to improve safety are warranted.

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Recommendations and guidelines for endoscope reprocessing: Current position statement of digestive endoscopic society of Taiwan
Wei-Kuo Chang, Chen-Ling Peng, Yen-Wei Chen, Cheuk-Kay Sun, Chieh-Chang Chen, Tao-Chieh Liu, Yin-Yi Chu, I-Fang Tsai, Chen-Shuan Chung, Hsiao-Fen Lin, Fang-Yu Hsu, Wei-Chen Tai, Hsi-Chang Lee, Hsu-Heng Yen, E-Ming Wang, Shu-Hui Chen, Cheng-Hsin Chu, Ming-
Journal of Microbiology, Immunology and Infection.2024; 57(2): 211. CrossRef
Duodenoscopes With Disposable Elevator Caps—An Incremental Reduction in Infection Risk for Patients
Melinda Wang, Graham M. Snyder
JAMA Internal Medicine.2023; 183(3): 200. CrossRef
Transmission of oral microbiota to the biliary tract during endoscopic retrograde cholangiography
Maria Effenberger, Ramona Al-Zoairy, Ronald Gstir, Ivo Graziadei, Hubert Schwaighofer, Herbert Tilg, Heinz Zoller
BMC Gastroenterology.2023;[Epub] CrossRef
Role of peroral cholangioscopy and pancreatoscopy in the diagnosis and treatment of biliary and pancreatic disease: past, present, and future
Harishankar Gopakumar, Neil R. Sharma
Frontiers in Gastroenterology.2023;[Epub] CrossRef
Performance of single-use duodenoscopes for ERCP: a systematic review and meta-analysis
Harishankar Gopakumar, Ishaan Vohra, Neil R. Sharma, Srinivas R. Puli
iGIE.2022; 1(1): 77. CrossRef

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