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PubMed1978

[Endoscopy and radiological investigations of the stomach and duodenum. Alternative or complementary procedures? (author's transl)].

The results of radiological and endoscopic examination in 1,030 patients were compared. In one third of cases there was some discrepancy relating to a significant diagnostic finding (malignant process, peptic ulcer, polyp, stenosis or deformity, abnormal folds, diverticula or normal findings). In analysing false negative and false positive radiological diagnoses, the patients were divided into two groups (with or without a double contrast technique). Conventional radiography proved ten to 38% less reliable than the double contrast technique for a variety of reasons. In view of the high diagnostic accuracy of modern radiological investigations of the stomach and duodenum, endoscopy and biopsy are recommended as complementary procedures. In addition to the high degree of accuracy of radiological methods for various pathological processes, endoscopy places considerable demands during investigation of the upper intestinal tract. At present radiology is used 19 times as frequently as endoscopy, suggesting that there might have to be a tenfold increase in the capacity of pathological departments if endoscopy is used more frequently.

Duodenal Diseases↗
PubMed2000

[How safe is premedication in ambulatory endoscopy in Germany? A prospective study in gastroenterology specialty practices].

BACKGROUND: To date there is no prospective large-scale study of the risk of premedication on the complication rate of outpatient gastrointestinal endoscopy in Germany. PATIENTS AND METHODS: In 67 gastroenterological practises in Germany the number of esophagogastroduodenoscopies (EGD) and colonoscopies was recorded from april 1998 until march 1999. All serious complications had to be recorded in a structured protocol. RESULTS: The overall complication rate for EGD (n = 110,469) was low (0.009%) and about two third of the adverse effects were due to premedication (0.006%). The overall complication rate for diagnostic colonoscopy (n = 82,416) was 0.02% and the complication rate associated to premedication was 0.01%. An individual dosage of premedication for EGD and colonoscopy was given by all gastroenterologists. Most of the gastroenterologists applied premedication in 10 to 50 percent of the patients for EGD and in 70 to 100 percent of the patients for colonoscopy. Most of the cardiorespiratory adverse effects in colonoscopy occurred if sedation was performed by combination of benzodiazepines and opioids and in upper gastrointestinal endoscopy with high dosages of diazepam. In 6 of 45 practises disoprivan (propofol) was used for premedication in 2-50 percent of the colonoscopies. Two of four perforations in diagnostic colonoscopy occurred under sedation with disoprivan. CONCLUSIONS: Outpatient gastrointestinal endoscopy performed by German gastroenterologists in a safe. The complication rate is low compared to the international literature and could be further decreased by avoiding a combination of benzodiazepines and opioids for sedation in colonoscopy and high dosages of diazepam in upper gastrointestinal endoscopy.

Procedural Sedation↗
PubMed2001

Cleaning and disinfection practices in digestive endoscopy in spain: results of a national survey.

BACKGROUND AND STUDY AIMS: Disinfection and surveillance of it are important for ensuring safety in gastrointestinal endoscopy. The aim of this survey was to assess the current status of disinfection in gastrointestinal endoscopy units in Spain. MATERIALS AND METHODS: An anonymous questionnaire on cleaning and disinfection methods was sent to gastrointestinal endoscopy units at 244 public hospitals in Spain. A minimum standard of disinfection (MSD) was defined to evaluate the appropriateness of disinfection practices. RESULTS: A total of 144 centers responded (58 %). All units perform manual washing of endoscopes before disinfection. Automatic washers are available in only 23 % of the centers. Selective cleaning of internal channels is systematically performed in 85 % of the centers. Glutaraldehyde-based disinfectants are the most commonly employed (84 % of units). The time of exposure to the disinfectant is at least 10 min in 97 % of units, but 20 min or more in only 36 % of them. Endoscopic accessories are sterilized in 57 % of centers. The MSD was complied with by 79 % of the units evaluated. Compliance with the MSD was significantly lower in small units (P = 0.0005) performing small numbers of examinations per month. Quality control tests on the efficacy of disinfection methods are conducted at 66 % of the centers. Specialized personnel record disinfection procedures in 85 % of the centers and supervise them in 55 % of the centers. Half of the units have inadequate equipment and facilities. CONCLUSIONS: This survey suggests that cleaning and disinfection practices in gastrointestinal endoscopy units in Spain have improved in recent years, and that there is a good compliance with standard guidelines. Most units should improve their equipment and facilities in order to provide better comfort and safety for patients and staff.

Disinfectants↗
PubMed2002

Antibiotic prophylaxis of infective endocarditis during digestive endoscopy: over- and underuse in Switzerland despite professed adherence to guidelines.

BACKGROUND AND STUDY AIMS: Guidelines for antibiotic prophylaxis of infective endocarditis associated with gastrointestinal endoscopy are not uniform. Though based on weak scientific evidence, they do represent an attempt to unify the management of antibiotic prophylaxis. We investigated whether physicians who profess to adhere to these guidelines actually do apply them correctly. MATERIALS AND METHODS: A questionnaire was sent to all 195 Swiss gastroenterologists asking whether they adhered to antibiotic prophylaxis guidelines and under what conditions did they apply antibiotic prophylaxis in gastrointestinal endoscopy. We analysed whether the Swiss gastroenterologists who claim to adhere to these guidelines actually do so in practice. RESULTS: The response rate to our questionnaire was 95%. Of the Swiss gastroenterologists, 60% correctly employ antibiotic prophylaxis guidelines in gastroscopy, as do 47% in colonoscopy. In therapeutic endoscopy, the percentage of correct antibiotic prophylaxis use depends upon the type of intervention and varies between 21 and 58%. Overuse of antibiotic prophylaxis is at least twice as frequent in colonoscopy and therapeutic endoscopy than in gastroscopy. CONCLUSIONS: Guidelines for antibiotic prophylaxis are not well applied and do not lead to uniform management despite a high degree of professed adherence to them. This phenomenon can be explained by "cognitive dissonance" and "reactance." We conclude that guidelines based on unconvincing data may even prove harmful.

Antibiotic Prophylaxis↗
PubMed2002

Uvular necrosis after upper endoscopy: a case report and review of the literature.

Uvular necrosis after endotracheal intubation or upper endoscopy is rare. We report here on a case of uvular necrosis and ulceration after endoscopy. The combination of ulceration and necrosis suggests uvular ischemia during endoscopy. The uvula may have been sandwiched between the shaft of the endoscope and the gum or hard palate, or may have been pressed against the posterior pharynx, leading to prolonged ischemia and resultant ulceration and necrosis. Uvular trauma can also be caused by oral pharyngeal suction. We recommend that post-endoscopy uvular necrosis should be managed conservatively based on the patient's symptoms. In all reported cases, and in the present case as well, the uvula healed and the symptoms resolved within 2 weeks (5 - 14 days) after the procedure. The uvula regained its normal appearance. Overall, these patients should have a good clinical outcome.

Endoscopy, Gastrointestinal↗
PubMed2002

Overlooked lesions at emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding.

BACKGROUND AND STUDY AIMS: Excessive blood covering the examination field is a frequent cause of diagnostic failure in emergency endoscopy for acute upper gastrointestinal bleeding. The implications and outcome in these patients have not been well described. PATIENTS AND METHODS: The records for 1459 consecutive patients who presented at our medical center with acute nonvariceal upper gastrointestinal bleeding during a 15-month period were reviewed. All of the patients underwent emergency endoscopy within 24 h of initial presentation. Patients in whom an identifiable bleeding source was not found in spite of an overtly bloody lumen were designated as having a failure of diagnosis, and these cases were analyzed further. RESULTS: Diagnosis failed in 25 patients (1.7 %), 16 of whom underwent repeat endoscopy or surgical intervention. Bleeding vessels were identified in 13 of these patients. Gastric and duodenal ulcers were the most commonly overlooked lesions, with locations in the cardia (n = 3), fundus (n = 2), posterior wall of the antrum (n = 1), duodenal bulb (n = 3), second part of the duodenum (n = 2), and in the stoma of a Billroth II gastrectomy (n = 2). The rates for endoscopic complications, recurrent bleeding, surgery, and mortality were significantly higher in the group with diagnostic failure than in patients with acute upper gastrointestinal bleeding in whom diagnosis did not fail (8 % vs. 0.4 %; 20 % vs. 3.1 %; 16 % vs. 2.9 %; and 20 % vs. 3.6 %, respectively). CONCLUSIONS: In acute nonvariceal upper gastrointestinal bleeding, diagnostic failure is associated with higher morbidity and mortality. The data from this study emphasize the importance of good preparation before the procedure and adequate removal of blood during emergency endoscopy procedures.

Aged↗
PubMed2003

Even young patients with no alarm symptoms should undergo endoscopy for earlier diagnosis of gastric cancer.

BACKGROUND AND STUDY AIMS: There has been a tendency in recent years to omit endoscopy in dyspeptic patients younger than 45 years with no so-called "alarm symptoms." This study was conducted to test whether this policy might lead to an increased rate of delayed diagnosis of gastric cancer, especially in a population with a high prevalence of the disease. PATIENTS AND METHODS: The study included 860 patients (465 women, 395 men; median age 44) referred for the first time for upper gastrointestinal endoscopy because of suspected upper gastrointestinal pathology, to a secondary referral center between 1983 and 1993. Symptoms were assessed using a special questionnaire prior to endoscopy. The endoscopic diagnosis was always confirmed by histology. RESULTS: Gastric cancer was found in 83 patients (12 early cancers, 71 advanced). Patients with cancer were predominantly male (68 %, compared with 44 % in the no-cancer group; P < 0.001), and significantly older (median age 56, 44 and 42 years for advanced, early cancer, and no cancer, respectively; P < 0.001). As many as 24 % of patients with cancer were aged under 45 years. Symptoms occurring more frequently in the gastric cancer group compared with the no-cancer group were weight loss (11 % vs. 0.1 %; P < 0.001), gastrointestinal bleeding (18 % vs. 8 %; P < 0.001), anorexia (43 % vs. 25 %; P < 0.001), and fatigue (53 % vs. 30 %; P < 0.001). In 27 % of cancer patients none of the above symptoms was observed. No statistical difference was seen for pain, nausea, vomiting, and other symptoms. The mean symptom score (1 point for one symptom) was higher in patients with cancer compared with those without (3.1 vs. 2.4; P < 0.001). The duration score (1 to 4 points for durations of less than 6, less than 12, less than 24, and more than 24 months) was lower (1.3 vs. 1.8; P < 0.001) in cancer patients. In three-quarters of cancer patients the duration of symptoms was shorter than 6 months. CONCLUSIONS: Symptoms suggesting gastric cancer are gastrointestinal bleeding, weight loss, and to a lesser degree anorexia and fatigue. Gastric cancer patients show a greater intensity but shorter duration of symptoms than patients with no cancer. Age and alarm symptoms cannot determine the need for upper gastrointestinal endoscopy, at least in areas of high prevalence of gastric cancer.

Adult↗
PubMed2003

Capsule endoscopy for the evaluation of patients with chronic abdominal pain.

BACKGROUND AND STUDY AIMS: Chronic abdominal pain is a common complaint and in many patients even an extensive work-up does not reveal the cause for the pain. Given Imaging wireless capsule endoscopy is a new method for visualization of the entire small bowel. The aim of our study was to determine the role of capsule endoscopy in the evaluation of patients with unexplained chronic abdominal pain. PATIENTS AND METHODS: 20 patients with chronic abdominal pain of 6 - 96 months' duration were enrolled in the study. They had had an extensive diagnostic work-up which was negative. Capsule endoscopy was performed in all patients. RESULTS: Imaging of the small intestine was excellent and the colon was reached in 16 patients. In 14 patients the study was completely normal; in six patients the procedure revealed findings which were considered to be clinically insignificant. All patients tolerated the capsule well and had no adverse effects. CONCLUSION: Capsule endoscopy did not seem to have any significant clinical value in the evaluation of our patients with obscure chronic abdominal pain.

Abdominal Pain↗
PubMed2004

Wireless capsule endoscopy for evaluation of phenotypic expression of small-bowel polyps in patients with Peutz-Jeghers syndrome and in symptomatic first-degree relatives.

BACKGROUND AND STUDY AIMS: Peutz-Jeghers syndrome (PJS) is an inherited gastrointestinal hamartomatous polyposis disorder. Small-bowel intussusception and bleeding are the most common complications, and malignancy may also occur. Survey of the gastrointestinal tract, particularly of the small bowel, is difficult and current recommendations for management syndrome are ambiguous. We evaluated the feasibility of capsule endoscopy for identifying phenotypic expression of small-bowel polyps in patients with full-blown PJS and a previous diagnosis of gastrointestinal polyposis, and in symptomatic kindred of PJS patients with no previous diagnosis of gastrointestinal polyposis. PATIENTS AND METHODS: Two groups were studied: group A consisted of 14 patients with gastrointestinal polyposis, eight of whom had undergone previous small-intestine surgery; group B consisted of six symptomatic first-degree relatives of PJS patients; these patients had previous negative gastrointestinal endoscopic examinations. RESULTS: Numerous polyps were detected in all patients in group A. Most polyps were sessile, but the larger polyps tended to be pedunculated. Polyp density was highest in the jejunum (greater than in the ileum and duodenum). Seven patients had at least one large polyp (> 11 mm) and five of these patients subsequently underwent enteroscopy, which revealed that capsule endoscopy had correctly identified all the patients with large polyps, but had missed 20 % of the total number of large polyps in these patients. No polyps were detected by capsule endoscopy in group B patients, despite the excellent visualization of the small intestine. In all patients, the capsules were expelled within 24 hours, without complications, and the procedure was well tolerated. CONCLUSIONS: Capsule endoscopy is an effective and well-tolerated method for evaluating small-bowel pathology in patients with PJS.

Adolescent↗
PubMed2005

Changing patterns of sedation and monitoring practice during endoscopy: results of a nationwide survey in Switzerland.

BACKGROUND AND STUDY AIMS: Little is known about how practices in sedation and in monitoring during gastrointestinal endoscopy and the complication rates of sedation have changed over time. The aim of this nationwide survey was to assess the present practice among Swiss gastroenterologists, with a particular focus on the use of propofol, and to compare the results with similar data obtained in 1990. PATIENTS AND METHODS: At the end of 2003 a questionnaire (similar to the one used in 1990) was sent to all 249 Swiss gastroenterologists. The response rate was 72.3 %. Data from 179 953 endoscopies performed during the previous 12 months were analyzed for the study. RESULTS: In 2003 sedation was used in 78 % of esophagogastroduodenoscopies and colonoscopies (compared with 60 % in 1990), with midazolam being the most commonly used medication. The drugs were mostly administered by the endoscopy nurse, via an intravenous cannula. Oximetry monitoring was used in more than 95 % of examinations (compared with 2.5 % in 1990). The overall sedation-related morbidity was 0.18 % and the mortality rate was 0.0014 %. Of the 180 respondents, 77 (43 %) reported that they been using propofol regularly for a median time period of 23 months. The 62 respondents (34 %) who used propofol without the assistance of an anesthesiologist had performed a total of 82 620 procedures. The morbidity (defined as the need for bag-ventilation) in this group of patients was 0.19 % and no deaths were reported. CONCLUSIONS: The use of sedation in gastrointestinal endoscopy has markedly increased over the last 13 years and the use of electronic monitoring has become standard practice. A significant percentage of Swiss gastroenterologists report that they use propofol, mainly in a hospital setting.

Procedural Sedation↗
PubMed2004

[Diagnostic utility of capsule endoscopy in occult gastrointestinal bleeding].

BACKGROUND AND OBJECTIVE: The video-capsule endoscopy (CE) of the small intestine is a novel innovative procedure for outpatient use that can detect even small lesions of the mucosa of the small intestine. Aim of this retrospective clinical study was to evaluate the diagnostic value of CE in a clinical routine setting. PATIENTS AND METHODS: Between July 2001 and October 2002 we investigated 42 patients with suspected gastrointestinal bleeding by CE. In all patients, the previous upper and lower endoscopy work-up was normal. In some cases additional procedures such as bloodpool scintigraphy, angiography, small-bowel enteroclysis or push-enteroscopy were performed. RESULTS: CE detected relevant pathological findings in 23 out of 42 Patients (55 %). The majority of findings in the CE consisted of angiodysplasia (n = 16), ulcer and haemorrhagical erosions (n = 10), one Ulcus Dieulafoy and additional polyps of the small intestine (n = 2). In 4 cases an inflammatory small-bowel disease was detected. These findings could be confirmed by Re-endoscopy. The information provided was helpful to direct further diagnostic and treatment options. In 14 cases (33 %) CE-findings steered additional diagnostic and therapeutic steps. We conclude that CE is safe and has a high diagnostic yield. CONCLUSION: M2A video CE is likely to become an integral part of the algorithm of diagnostic of occult gastrointestinal bleeding after exclusion of other causes of anemia and negative upper and lower endoscopy work-up.

Adult↗
PubMed2004

Diagnostic and surgical endoscopy in functional septorhinoplasty.

Endoscopy has altered our ability to diagnose pathology accurately during the preoperative assessment, and it has also offered surgeons the ability to perform surgeries in a minimally invasive manner. In this article, we review the senior author's experience with diagnostic and surgical endoscopy in functional septorhinoplasty. A thorough examination of the nasal cavity in the patient seeking cosmetic rhinoplasty along with correction of nasal obstruction is enhanced by the performance of office nasal endoscopy. Endoscopically guided septoplasty is useful as a minimally invasive approach for isolated septal deformities, and it is an indispensable approach in difficult revision nasal surgeries in which obstructing septal deviation persists. Endoscopy is a critical diagnostic and surgical tool in patients seeking cosmetic nasal surgery who also have functional nasal complaints.

Endoscopy↗
PubMed2005

[Combined simulation training: a new concept and workshop is useful for crisis management in gastrointestinal endoscopy].

INTRODUCTION: Crisis management as well as realistic emergency situations can be trained in the new developed simulation workshop "Gastrointestinal Endoscopy and Crisis Resource Management" by combining a full-scale simulator and the Erlanger Endoscopy Trainer. The aim of the current study was to evaluate the efficiency of the newly developed simulation workshop. METHODS: Endoscopists with more than 12 months experience can train their endoscopic skills and crisis resource management with the help of different simulators. In addition, two different scenarios (GI bleeding with significant blood loss and sedation overdoses) embedded in a realistic surrounding (emergency room) have to be managed by the participants. Vital parameters, endoscopic skills, as well as personal interactions were recorded and graded. RESULTS: 100 participants took part in the newly developed workshop (between June and December 2003). The participants showed a significantly better endoscopic performance and a significantly better crisis management after the standardized training program. CONCLUSIONS: Simulation training plays an essential role in aviation and minimizes the risk for human errors. In the current study it is clearly shown that simulation training is also useful in gastrointestinal endoscopy. The newly developed workshop may thus be of crucial importance to improve personal crisis management. Simulation also leads to an improvement of endoscopic and emergency skills. Accordingly, simulation training should be recommended or offered as an education option in gastrointestinal endoscopy.

Computer-Assisted Instruction↗
PubMed2005

How good is zoom endoscopy for assessment of villous atrophy in coeliac disease?

BACKGROUND AND STUDY AIMS: The advent of magnification endoscopy may allow the macroscopic detection of unrecognised villous atrophy in patients with unsuspected coeliac disease. In addition, it may also be possible to use this method to assess the degree of villous atrophy. The aim of this study was to determine the accuracy of zoom endoscopy for the macroscopic evaluation of villous atrophy, in comparison with histological evaluation. PATIENTS AND METHODS: The zoom endoscope provided a magnification capability of x 115. A scoring system (Z score) was devised for grading the appearances of villous atrophy: "Z1" for normal mucosa, "Z2" for stunted villi, "Z3" for markedly stunted villi (with ridges and pits) and "Z4" for a flat mucosa. A total of 53 consecutive patients with treated coeliac disease were followed up over almost 2 years using the Olympus GIF-Q240Z zoom endoscope; a total of 80 procedures were carried out. Four biopsies from the second part of the duodenum were taken from each patient for histological assessment. Histological assessment of villous atrophy was made by a pathologist blinded to the Z score. The correlation between the Z score and the histological score was assessed using the weighted kappa method. RESULTS: The kappa score for the correlation between the macroscopic assessment of villous atrophy and the histology was 0.631, indicating fair to good reproducibility. Agresti's method revealed a very strong baseline association between the two methods ( P < 0.001). Zoom endoscopy had a positive predictive value of 83 % and a negative predictive value of 77 % in detecting villous atrophy. CONCLUSIONS: Our findings suggest that zoom endoscopy may be valuable in assessing the degree of villous atrophy. However, further studies are needed to assess its efficacy in routine practice as a screening or case-finding tool.

Adult↗
PubMed2006

The role of simeticone in small-bowel preparation for capsule endoscopy.

BACKGROUND AND STUDY AIMS: Capsule endoscopy is a new diagnostic method allowing painless visualization of the entire small bowel. However, there is as yet no standardized protocol for bowel preparation before the examination. The aim of this study was to assess the effectiveness of simeticone in reducing bowel gas bubbles in patients undergoing capsule endoscopy. PATIENTS AND METHODS: A randomized, prospective, and controlled study was conducted, including 56 patients, from March to October 2004. The patients were randomly allocated to groups receiving either simeticone or no simeticone, on the basis of a computer-generated random number table. Patients in the simeticone group (n = 28) received 300 mg simeticone for bowel preparation 20 min before capsule endoscopy, while patients in the non-simeticone group (n = 28) received no medication for bowel preparation. Two experienced endoscopists assessed and graded the visibility of the mucosa and intraluminal gas bubbles in a single-blinded fashion. RESULTS: The visibility of the mucosa in the proximal small bowel in patients who received preparation with simeticone was considered to be better, with fewer intraluminal bubbles, than in those without bowel preparation ( P < 0.025). Interobserver agreement was excellent ( R > or = 0.8, P < 0.05). No adverse effects of simeticone were observed. CONCLUSIONS: Simeticone administration before capsule endoscopy improves the visualization of the mucosa in the proximal small intestine.

Adolescent↗
PubMed2006

Autofluorescence endoscopy in surveillance of Barrett's esophagus: a multicenter randomized trial on diagnostic efficacy.

BACKGROUND AND STUDY AIMS: The reference surveillance method in patients with Barrett's esophagus is careful endoscopic observation, with targeted as well as random four-quadrant biopsies. Autofluorescence endoscopy (AFE) may make it easier to locate neoplasia. The aim of this study was to elucidate the diagnostic accuracy of surveillance with AFE-guided plus four-quadrant biopsies in comparison with the conventional approach. PATIENTS AND METHODS: A total of 187 of 200 consecutive Barrett's esophagus patients who were initially enrolled (73 % male, mean age 67 years, mean Barrett's segment length 4.6 cm), who underwent endoscopy for Barrett's esophagus in four study centers, were randomly assigned to undergo either AFE-targeted biopsy followed by four-quadrant biopsies or conventional endoscopic surveillance, also including four-quadrant biopsies (study phase 1). After exclusion of patients with early cancer or high-grade dysplasia, who underwent endoscopic or surgical treatment, as well as those who declined to participate in phase 2 of the study, 130 patients remained. These patients were examined again with the alternative method after a mean of 10 weeks, using the same methods described. The main study parameter was the detection of early cancer/adenocarcinoma or high-grade dysplasia (HGD), comparing both approaches in study phase 1; the secondary study aim in phase 2 was to assess the additional value of the AFE-guided approach after conventional surveillance, and vice versa. Test accuracy measures were derived from study phase 1. RESULTS: In study phase 1, the AFE and conventional approaches yielded adenocarcinoma/HGD rates of 12 % and 5.3 %, respectively, on a per-patient basis. With AFE, four previously unrecognized adenocarcinoma/HGD lesions were identified (4.3 % of the patients); with the conventional approach, one new lesion (1.1 %) was identified. Of the 19 adenocarcinoma/HGD lesions detected during AFE endoscopy in study phase 1, eight were visualized, while 11 were only detected using untargeted four-quadrant biopsies (sensitivity 42 %). Of the 766 biopsies classified at histology as being nonneoplastic, 58 appeared suspicious (specificity 92 %, positive predictive value 12 %, negative predictive value 98.5 %). In study phase 2, AFE detected two further lesions in addition to the initial alternative approach in 3.2 % of cases, in comparison with one lesion with conventional endoscopy (1.7 %). CONCLUSIONS: In this referral Barrett's esophagus population with a higher prevalence of neoplastic lesions, the AFE-guided approach improved the diagnostic yield for neoplasia in comparison with the conventional approach using four-quadrant biopsies. However, AFE alone was not suitable for replacing the standard four-quadrant biopsy protocol.

Adenocarcinoma↗
PubMed1998

A scientific relational database combined with a report generator for endoscopy in networks: EndoNet.

BACKGROUND AND STUDY AIMS: The flexibility required in academic endoscopy units is not provided by the available database systems. In a project involving substantial cooperation between endoscopists and computer scientists, we have developed an adaptable database, combined with a report generator embedded in the hospital's intranet. PATIENTS AND METHODS: Six workstations in different areas of the hospital were clustered with a UNIX operating system to implement multi-user capability and access control. A relational database was used to design an application appropriate to the specific needs of the endoscopy unit in a teaching hospital engaged in scientific research. Both the terminology used in standardized endoscopy nomenclature and a free text block facility were included. A graphical user interface was developed to assemble pertinent data, generate the reports, and supervise the database. RESULTS: A total of 4936 examinations including 2988 patients were entered consecutively during continuous routine operation of the system. Complete report generation required five minutes (median; range 1-9 minutes). Both structured items and free text were used in all the reports. Querying of the database was possible, concerning matters such as the need for repeated endoscopic therapy in acute gastrointestinal bleeding (4%), the search for Helicobacter pylori in appropriate patients (64%), the rate of accidental pancreatic duct visualization in endoscopic retrograde cholangiography (24%), and links between examinations and active trials (2%). Indicating improved report quality, the number and the diameter of esophageal varices in patients with varices were more frequently reported with the new report system than with previous typed reports (P<0.001). An anonymous questionnaire revealed that the readability of the computer-generated reports was better than that of the previous typewritten reports (P=0.01). CONCLUSIONS: This report describes the creation of a database application and a report generator meeting the needs of scientific and routine use, and the successful application of this system in an academic endoscopy unit.

Computer Communication Networks↗
PubMed1997

Italian National Survey of Digestive Endoscopy Disinfection Procedures.

BACKGROUND AND STUDY AIMS: Inadequate disinfection of endoscopes and associated instrumentation can result in transmission of bacterial infections to patients. The aim of this study was to investigate the disinfection procedures carried out in the Italian centers of digestive endoscopy. MATERIALS AND METHODS: An anonymous postal questionnaire on the methods of cleaning and disinfecting endoscopy equipment in Italy was sent to 781 digestive endoscopy centers; 386 units (49.4 %) replied. RESULTS: Automatic washers were available in 47.6% of units. Nearly all the respondets (99.2%) cleaned the instruments before disinfection, using detergent, germicidal or enzymatic cleaner, but only 69.7% carried out brushing. Most centers (89.2 %) used a glutaraldehyde-based disinfectant (51 % used 2 % glutaraldehyde; 26.9% used 0.4% glutaraldehyde with 1.41% phenol and 0.26% sodium phenate; 5.9% used either; 5.4% did not specify glutaraldehyde formulation). The contact time of the disinfectant was < 10 minutes (1.8%), between 10 and 19 minutes (47.4%), between 20 and 29 minutes (31.9 %) and > or = 30 minutes (16.6%). The use-life of the disinfectant was > or = 14 days in 27.3 % of the centers with automatic washers and 30.8% in all centers. Only 25.4% of the centers carried out some form of sterilization for biopsy forceps. The majority (83.4 %) modified their disinfection procedures in the case of infectious disease patients. Quality control tests on the efficacy of the endoscopy disinfection procedures were carried out in 44.6 % of units. Only 43 % of the centers were based in hospitals with an infection control (surveillance) program. CONCLUSIONS: The data collected in the study showed that, in general, there is compliance with the Società Italiana di Endoscopia Digestiva (SIED) and Società Italiana di Gastroenterologia (SIGE) guidelines, although with some important exceptions.

Data Collection↗