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At least 19 recordsLinked to original sources
PubMed1999

The GASTER project: building a computer network in digestive endoscopy: the experience of the European Society for Gastrointestinal Endoscopy. Gastrointestinal Endoscopy Application for Standards in Telecommunication, Education and Research.

Digestive endoscopy is currently the main diagnostic procedure for investigation of the digestive tract whenever a digestive disease is suspected. From 1970 to 1985, digestive endoscopy was performed with endoscopes equipped with fiberoptic bundles, whereas the last decade was marked by the development of electronic endoscopes, characterized by the presence of a CCD (charge coupled device) at the tip of the endoscope. Thus the physician looks at a TV screen to control the procedure and examine in detail the gut wall. Endoscopes examine the foregut until the duodenum and the hindgut, up to the three last intestinal loops. When the endoscopic workstation comprises a computer, it is possible to acquire electronic images during the endoscopy and use these images as support of the information about the results of the procedure. These numeric images can then be stored in databases containing text attached to them. Starting with these images, one may expect many developments in the near future that will change the management of the patient with digestive diseases. Physicians will become able to exchange images and text related to one patient or one procedure, although they are equipped with different workstations. Therefore, it is obvious that the information exchanged must be written in a standard format that makes it understandable by all systems. The European Society of Gastrointestinal Endoscopy is a scientific society that groups most of the gastroenterologists in Europe. This society has initiated a research program to develop standards for the exchange of images and text. The Gastrointestinal Endoscopy Applications for Standards in Telecommunication, Education, and Research (GASTER) project intends to implement a multimedia database of endoscopic images based on a standard format of images and a standard terminology for descriptive terms. These standards must be validated by use in different endoscopy units. The database will collect images from these centers that will be linked to the coordinating center through a network based on an integrated services digital network (fast electronic connection). This database will then be used for the development of computer applications. The output of the GASTER project will bring advances at three levels: (1) The physicians will be able to exchange images about the procedures their patients have undergone and will thus obtain more complete information, improving quality of care. They will also benefit from help-to-decision applications based on validated reference images from the database. (2) At the patient level, the quality of care will be improved through a better dissemination of information between the physicians in charge of the patient, thus there is better follow-up of the patient and a decrease in redundant examinations. (3) At the level of national health care systems, the benefit will be a decrease in cost of care due to a better follow-up of the patients, a decrease in redundant examinations, and a faster decision made to treat the patient. The possibility of consulting a database of a scientifically validated images used as reference material will also improve quality control in digestive endoscopy.

Computer Communication Networks↗
PubMed1995

Hands-on endoscopy training: an evaluation of the SADE endoscopy course. Scandinavian Association of Digestive Endoscopy.

The Scandinavian Association of Digestive Endoscopy course in advanced practical endoscopy has been arranged on a regular basis since 1980, representing a joint Scandinavian effort to offer hands-on endoscopy training with expert supervision at major endoscopy centers. The course has been aimed at gastroenterologists with previous endoscopic experience, focusing on special techniques, practical hints and expert solutions in special cases. Three days of practical training throughout Scandinavia are completed with two days of review lectures, case reports and special techniques. An inquiry among previous course participants indicates that the course has indeed been of practical value for their daily work, and that personal training as well as watching "experts at work" were useful for their ensuing endoscopic practice. The course model does, however, require close co-operation with the endoscopy units hosting the practical part of the course.

Curriculum↗
PubMed2002

Evaluation of a virtual endoscopy simulator for training in gastrointestinal endoscopy.

BACKGROUND AND STUDY AIMS: Skills in gastrointestinal endoscopy mainly depend on experience and practice. Training on endoscopy simulators may decrease the time needed to reach competency in endoscopy. The purpose of the study was to determine whether the GI-Mentor, a virtual reality endoscopy simulator, can distinguish between beginners and experts in endoscopy and to assess whether training improves the performance of beginners. METHODS: A total of 13 beginners and 11 experts (more than 1,000 procedures) in gastrointestinal endoscopy were included. The baseline assessment consisted of virtual endoscopies and skill tests. The beginners were randomly allocated to receive training (n = 7) or no training (n = 6). The training group was allowed to practice using the simulator for 2 hours per day. After 3 weeks participants were re-evaluated with two new virtual endoscopy cases and one virtual skill test. Insertion time, correctly identified pathologies, adverse events and skill test performance were recorded. RESULTS: The baseline assessment revealed significant differences favoring the experts for virtual endoscopies and skill tests. Significant differences in favor of experts were found for successful retroflection during esophagogastroduodenoscopy (EGD) (P < 0.005); adverse events during colonoscopy (P < 0.02); insertion time (P < 0.001); correctly identified pathologies in gastroscopy and colonoscopy (P < 0.02); and skill test performance (P < 0.01). The final evaluation showed significant differences between training and no-training groups, in favor of the training group, for the number of adverse events during virtual endoscopy (P < 0.04), for the insertion time during colonoscopy (P < 0.03); and for skill test performance (P < 0.01). The training group improved its abilities on the simulator significantly. Differences between experts and the training group were no longer seen. CONCLUSION: This virtual endoscopy simulator is capable of identifying differences between beginners and experts in gastrointestinal endoscopy. A 3-week training improves the performance of beginners significantly. This quite fast improvement in endoscopic skills certainly cannot be seen in clinical practice; no conclusions can be made about the impact of virtual simulator training on real-life endoscopy, and this must be evaluated.

Adult↗
PubMed1996

Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy unit.

BACKGROUND AND STUDY AIMS: This prospective study tested the appropriateness of referrals for upper gastrointestinal endoscopy in an open-access endoscopy unit, using the criteria of the American Society for Gastrointestinal Endoscopy. It also examined whether there was any relationship between appropriateness of use and the presence of significant lesions detected by endoscopy. METHODS: Four hundred fifty consecutive upper gastrointestinal endoscopies were studied prospectively. The referral indication was recorded by the endoscopist before the procedure was performed, and was compared with the current criteria of the American Society for Gastrointestinal Endoscopy and with endoscopic findings. RESULTS: The appropriateness of referral was assessed in 442 consecutive endoscopies. Of these, 252 (57%) were judged to be appropriate. In 168 (88%) of the 190 endoscopies rated as inappropriate, the reason was that the patient had not undergone empirical anti-ulcer therapy before endoscopy. The probability of finding a significant lesion did not differ between the endoscopies judged to be appropriate (50%) and those judged to be inappropriate (46%) CONCLUSIONS: Upper gastrointestinal endoscopy was frequently used for inappropriate indications. The main reason for inappropriate use was insufficient treatment, or no treatment, of dyspeptic symptoms prior to endoscopy. In this study, the criteria for appropriateness did not predict the probability of finding a significant endoscopic lesion.

Adult↗
PubMed2000

Virtual endoscopy of the nasal cavity in comparison with fiberoptic endoscopy.

PURPOSE: To apply virtual-endoscopic mode to display the nasal cavity and to evaluate clinical application of virtual endoscopy in comparison with nasal fiberoptic endoscopy. MATERIALS AND METHODS: Eleven patients were examined by virtual endoscopy after axial spiral computed tomography (CT) scanning was performed. In addition, 9 out of these 11 patients underwent fiberoptic endoscopy. Spiral CT scanning was performed with 1-mm collimation, 0.5- to 1-mm increment, 25-250 mA s, and pitch 1-2. Virtual endoscopy was performed by Explorer software package. RESULTS: Virtual endoscopy could clearly demonstrate anatomic structures in the nasal cavity, septal deviation, stenosis and obstruction of the middle meatus, turbinate hyperplasia, and pathological masses larger than 3 mm in diameter. However, "false adhesions" may appear in virtual endoscopy. The main limitation of virtual endoscopy was the inability to evaluate mucosa and its surface. CONCLUSION: Virtual endoscopy of the nasal cavity is a new and noninvasive method. It can demonstrate normal and pathological structures in the nasal cavity. Its ability to visualize is comparable with fiberoptic endoscopy except for evaluating mucosal surface and secretions. In the future, this method will probably be a basic instrument of computer-assisted surgery in the midfacial region.

Adult↗
PubMed1977

Fiberoptic endoscopy of the gastrointestinal tract in infants and children. I. Upper endoscopy in 53 children.

Fiberoptic endoscopy of the upper gastrointestinal tract was performed on 53 patients without incident, ranging in age between two months and 18 years, of whom 35 were out patients at the time of examination. Of 27 patients with recurrent abdominal pain and normal upper gastrointestinal series, eight had abnormal findings at endoscopy: a duodenal ulcer in four, a gastric ulcer in two and duodenitis in two. Of 18 patients with hematemesis and/or melena, esophageal varices were demonstrated both by endoscopy and x-ray in two, gastric ulcer by endoscopy in three and x-ray in one, duodenal ulcer by endoscopy in three and by x-ray in two, esophagitis by endoscopy only in one patient, erosive gastritis by endoscopy in five and by x-ray in two and duodenitis by endoscopy in three and by x-ray in two. Of the remaining eight patients with abnormal x-rays findings and other symptomatology, endoscopy demonstrated foreign bodies in two (coins, esophagus and stomach), duodenitis in two, a gastric ulcer in one, a duodenal ulcer in one and normal examination in two. The data indicate that fiberoptic endoscopy significantly improves diagnostic accuracy in the evaluation of disorders of the upper gastrointestinal tract in children and is a safe and effective procedure in ambulatory pediatric patients.

Abdomen↗
PubMed1998

Guidelines of the European Society of Gastrointestinal Endoscopy (E.S.G.E.) antibiotic prophylaxis for gastrointestinal endoscopy. European Society of Gastrointestinal Endoscopy.

There are two situations when antibiotic prophylaxis is recommended. The first is associated with procedures known to be followed by high rates of bacteraemia, involving organisms prone to cause endocarditis. These include oesophageal dilatation, variceal sclerotherapy and laser therapy in the upper gastrointestinal tract. As bacteraemia following these procedures is usually harmless in average risk patients antibiotic prophylaxis is recommended only for a patient with a lesion susceptible to endocarditis or one who is at increased risk of symptomatic bacteraemia due to neutropenia or immunosuppression. In most cases parenteral amoxycillin and gentamicin is recommended plus metronidazole for neutropenic patients. Vancomycin or teicoplanin replace amoxycillin in a case of allergy. The second situation concerns procedures with a high incidence of local infection or which may lead to serious sepsis. These include therapeutic retrograde cholangiopancratography and percutaneous endoscopic gastrostomy where antibiotic prophylaxis is recommended even in average risk patients. Several antibiotics are recommended including oral ciprofloxacin or parenteral gentamicin or quinolone for ERCP and amoxycillin for PEG or cephalosporin or ureidopenicillin for both.

Adult↗
PubMed2003

Open-access endoscopy: are age-based guidelines justified? An audit of experience of 1000 open-access endoscopies at a district general hospital.

BACKGROUND AND STUDY AIMS: Open-access endoscopy has been developed to meet the increasing demand for endoscopy, and guidelines have been produced for selecting suitable patients. This study was designed to assess the appropriateness of these guidelines in patients referred to open-access endoscopy services at a district general hospital. PATIENTS AND METHODS: A series of 1000 consecutive patients referred for open-access endoscopy was audited. The waiting time was 18 weeks and patients continued to take any acid-suppressing medication prescribed by their general practitioner. The endoscopy findings were compared in those who met and did not meet currently accepted guidelines. In addition the outcome for all patients in whom gastro-oesophageal malignancy was detected was reviewed. RESULTS: 301 patients (30.1 %) did not meet accepted guidelines for open-access endoscopy. No cases of malignancy would have been missed if the guidelines had been implemented. Gastro-oesophageal malignancy was detected in 17 patients, all of whom died. When malignancy was excluded, there were no statistically significant differences between the detection rates for pathology in the two groups. The commonest finding, in 32.3 % of patients, was of a normal endoscopic appearance. CONCLUSIONS: If current guidelines are applied, all cases of malignancy may be picked up, but identification of patients with curable disease is poor. Use of the guidelines did not select patients with other upper gastrointestinal disease, although many patients were receiving acid-suppression therapy at the time of their endoscopy. Implementation of test-and-treat strategies would result in a significant reduction in the workload of open-access endoscopy.

Adult↗
PubMed2002

Transurethral resection for bladder cancer using 5-aminolevulinic acid induced fluorescence endoscopy versus white light endoscopy.

PURPOSE: Endoscopy done under fluorescence induced by 5-aminolevulinic acid has proved to be a procedure with high sensitivity for detecting transitional cell carcinoma of the bladder. In this multicenter, parallel group, phase III study we compared 5-aminolevulinic acid fluorescence endoscopy guided transurethral bladder resection with transurethral bladder resection done using only white light endoscopy. The proportion of tumor-free resected cases in the 2 groups was evaluated. MATERIALS AND METHODS: After patient stratification according to participating centers and European Organization for the Research and Treatment of Cancer risk score 65 and 64 were randomized to the 5-aminolevulinic acid fluorescence and white light endoscopy groups, respectively. Residual tumor was evaluated in the 2 groups by repeat transurethral resection 10 to 14 days later. Analysis was performed according to the intent to treat principle with all patients randomized, followed by per protocol analysis. RESULTS: Intent to treat analysis revealed that in the white light endoscopy group 40.6% of cases were resected tumor-free at primary resection, whereas with 5-aminolevulinic acid fluorescence endoscopy guided transurethral resection 61.5% were resected tumor-free (p <0014). On protocol analysis 46.9% patients in the white light and 67.3% in the 5-aminolevulinic acid fluorescence endoscopy groups were resected tumor-free (p <0.031). No difference was noted in the 2 groups in regard to side effects or laboratory findings. CONCLUSIONS: The risk of residual tumor after transurethral resection of transitional cell carcinoma is significantly decreased by 5-aminolevulinic acid fluorescence endoscopy.

Adult↗
PubMed2002

Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system: a prospective observational study based on the Maastricht guidelines.

AIM: To test the appropriateness of referrals for upper gastrointestinal endoscopy in Campania, Italy, using the criteria of the Maastricht Consensus. PATIENTS: Patients undergoing endoscopy during a 1-week period in 21 Endoscopy Services were considered prospectively. The reasons for endoscopy were dyspeptic symptoms, history of peptic ulcer and assessment after treatment. The age, sex, symptoms, history of peptic ulcer (previous endoscopic or radiographic examinations and treatment), endoscopic diagnosis and H. pylori status were recorded. The indications for endoscopy were evaluated according to the Maastricht guidelines. RESULTS: Two hundred and sixteen of 706 patients presented with reflux symptoms, 430 with dyspeptic symptoms, 38 with alarm symptoms and 22 with atypical symptoms. Endoscopy was normal in 376 cases (53.2%); duodenal ulcer was found in 219, gastric ulcer in 45, oesophagitis in 82 and gastric cancer in six. All patients with cancer were older than 45 years, and four presented with alarm symptoms. In 398 cases (56%), endoscopy was considered not to be indicated: 250 patients with a previous diagnosis of ulcer without a change in symptoms, 38 patients in order to confirm eradication and 110 patients younger than 45 years with dyspepsia without alarm symptoms. CONCLUSIONS: A large number of endoscopic examinations could be avoided by following the guidelines of the Maastricht Consensus. In order to reduce endoscopic workload, strategies for educating physicians should be pursued.

Adolescent↗
PubMed2000

Changes in cardiopulmonary parameters during upper gastrointestinal endoscopy in patients with heart disease: towards safer endoscopy.

BACKGROUND AND STUDY AIMS: Gastrointestinal endoscopy is an invasive examination. The aims of this study were to elucidate the effects and risks of upper gastrointestinal endoscopy with regard to cardiopulmonary functions in patients with heart disease, and to establish safety guidelines for use during endoscopy in this particular group of patients. PATIENTS AND METHODS: The patients involved were 53 inpatients in whom upper gastrointestinal endoscopy was carried out before cardiac surgery. Their cardiac functions had been evaluated previously. Electrocardiography with two leads (II, V5) was used, and blood pressure and peripheral oxygen saturation (SpO2) were monitored throughout the procedure. The relationship between the changes in cardiopulmonary parameters during endoscopy and the cardiac functions was analyzed. RESULTS: Heart rate increased immediately after insertion of the endoscope (P < 0.01). There was a significantly higher incidence of ventricular and supraventricular extrasystoles during observation of the second portion of the duodenum (P < 0.05). A lower cardiac index (P < 0.05) and a higher New York Heart Association (NYHA) functional classification (P < 0.05) were found in patients with oxygen desaturation than in patients without it. Two patients with severe coronary artery lesions showed marked ST-T depression, and these ischemic changes were thought to be due to increase in cardiac work during endoscopy. CONCLUSIONS: Upper gastrointestinal endoscopy has many adverse effects on cardiopulmonary functions in patients with heart disease. In our study, the clinical value of very close monitoring and administration of oxygen for patients with heart disease was confirmed by objective data.

Aged↗
PubMed2002

Tele-endoscopy: influence of data compression, bandwidth and simulated impairments on the usability of real-time digital video endoscopy transmissions for medical diagnoses.

BACKGROUND AND STUDY AIMS: Real-time digital video transmission (rtDVT) at an acceptable quality through networks has been possible for several years. This technique can be used for telemedical applications, such as tele-endoscopy. The hypotheses of the present study were that the quality of real-time DVT depends on the technical equipment used, and that the resulting image quality influences the usability of the system for diagnostic purposes. MATERIALS AND METHODS: An experimental network was established between two German referral endoscopy centers, using the Asynchronous Transfer Mode (ATM) protocol. At first, rtDVTs of routine gastrointestinal video endoscopies were transferred through the network for prospective evaluation of the feasibility of the technical equipment and its usability for diagnostic tele-endoscopy, based on the video image quality. Secondly, the image quality and usability for correct telemedical diagnosis were evaluated prospectively in a double-blind experimental setting in relation to variations in the methods of data compression used, transmission bandwidths, and simulated transmission errors. Fourteen endoscopists evaluated 27 variations of an endoscopic video sequence. RESULTS: Compression with the Moving Picture Expert Group 2 (MPEG2 [4 : 2 : 2]) standard, the ATM protocol, and a bandwidth of 40 megabits per second (Mb/s) were used successfully in 40 routine tele-endoscopies for practical evaluation. Doctors were able to handle the system with ease, and its availability was 100%. There were no detectable differences between the original video image and the transferred image, and the images were usable for diagnosis in all cases. The set-up used clinically was therefore considered to provide the optimal conditions for comparisons in the experimental part of the study. Experimentally, any technical variation was found to cause a reduction in the overall image quality and hence a reduction in diagnostic usability: compression algorithm (MPEG2 [4 : 2 : 2] vs. others: P = 0.001), bandwidth (> or = 8 vs. < 8 Mb/s: P = 0.001), and error rate (10 (-8) vs. 10 (-7): P = 0.001). CONCLUSIONS: rtDVT using MPEG2 [4 : 2 : 2] compression and a bandwidth of 40 Mb/s did not effectively differ from the original video images in routine tele-endoscopy. The qualitative requirements in diagnostic video endoscopy, however, are obviously much higher than previously assumed, since experienced endoscopists detected a loss of image quality and a reduction in diagnostic usability with any reduction in the technical specification. Modern methods of data compression, broadband networks and a network protocol with good quality-of-service guarantees are therefore prerequisites for diagnostic rtDVT.

Algorithms↗
PubMed1998

A randomized trial of endoscopy vs no endoscopy in the management of seronegative Helicobacter pylori dyspepsia.

BACKGROUND: It is unclear whether endoscopy influences the management of Helicobacter pylori negative dyspepsia. AIM: To determine whether endoscopy alters health-care resource utilization, quality of life and symptom outcome in H. pylori seronegative dyspeptic patients aged under 45 years; and to determine which factors predict outcome of symptoms. METHOD: One hundred and fifty-four H. pylori seronegative subjects were randomized to have an endoscopy or no endoscopy before subsequent management by their GPs. Assessment was carried out at 6 months and supplementary information obtained at 12 months. RESULTS: There was no significant difference between the two groups for progression of dyspeptic symptoms (better, same and worse) at 6 months (47%, 46%, 7% vs 43%, 52%, 5%), and at 12 months (55%, 34%, 11% vs 57%, 28%, 15%). Prescriptions were lower in both groups at 6 and 12 months than on entry into the study, independent of endoscopy. Endoscopy did not influence quality of life, visits to GPs and days lost from work. Prognostic factors for symptom resolution at 6 months were lower severity of initial symptoms, non-smoking, non-Caucasians, less anxious patients and those not on acid suppressants. CONCLUSIONS: H. pylori negative dyspeptic patients aged under 45 years without sinister symptoms could be managed without the need of an endoscopy.

Adolescent↗
PubMed2000

Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease.

BACKGROUND: Heartburn affects 25% of the adult population on a monthly basis and represents the core symptom of gastro-oesophageal reflux disease (GORD). Treatment is readily available and puts a large demand on healthcare budgets. Research in the past has focused largely on the treatment of oesophagitis. A majority of GORD patients show no endoscopic abnormalities and in daily practice most patients are treated empirically. OBJECTIVES: Summarise, quantify and compare the efficacy of the short-term use of proton pump inhibitors (PPI), H2-receptor antagonists (H2RA) and prokinetics in the empirical treatment of GORD and the treatment of endoscopy negative reflux disease (ENRD). SEARCH STRATEGY: Electronic searches were performed of the Cochrane Controlled Trials Register, MEDLINE and EMBASE. Bibliographies were screened. SELECTION CRITERIA: Included were randomised controlled trials focussing on symptomatic outcome after short-term treatment for GORD using proton pump inhibitors, H2-receptor antagonists or prokinetic agents. Participants had to be classifiable in the empirical treatment group (no endoscopy used in treatment allocation) or in the endoscopy negative reflux disease group (no endoscopic signs of erosive oesophagitis). DATA COLLECTION AND ANALYSIS: Data from included trials were extracted by two reviewers independently. The impact of interventions was expressed as relative risks (RR) together with 95% confidence intervals (95% CI). Meta-analysis was only performed if there were sufficient trials of similar comparisons reporting the same outcomes. Relative risks were combined for binary outcomes. MAIN RESULTS: Twenty-one trials were included: eleven in the empirical treatment group, seven in the ENRD group and three in both. In empirical treatment of GORD the RR for heartburn remission in placebo-controlled trials for PPI was 0.35 (1 trial, 95% CI 0.26 to 0.46), for H2RAs 0.77 (2 trials, 95% CI 0.60 to 0.99) and for prokinetics 0.86 (1 trial, 95% CI 0.73 to 1.01). In direct comparison PPIs were significantly (p<0.05) more effective than H2RAs (3 trials, RR 0.67, 95% CI 0.57 to 0.80) and prokinetic's (2 trials, RR 0.53, 95% CI 0.32 to 0.87). In treatment of ENRD, RR for heartburn remission for PPI versus placebo was 0.68 (4 trials, 95% CI 0.53 to 0.88) and for H2RA versus placebo was 0.84 (2 trials, 95% CI 0.74 to 0.95). The RR for PPI versus H2RA was 0.69 (2 trials, 95% CI 0.39 to 1.20) and versus prokinetic 0.72 (1 trial, 95% CI 0.56 to 0.92). REVIEWER'S CONCLUSIONS: The findings in this review suggest that antisecretory drugs are effective in the empirical treatment of complaints likely to originate from GORD and in treatment of ENRD and furthermore that PPIs are superior to H2RAs in empirical treatment of typical GORD symptoms.

Endoscopy, Digestive System↗
PubMed1993

Endoscopy, gastric ulcer, and gastric cancer. Follow-up endoscopy for all gastric ulcers?

The practice of following benign-appearing gastric ulcers until healing was critically evaluated in a retrospective manner by reviewing all gastric ulcers that were followed with serial endoscopy and all gastric cancers diagnosed at the University of Alabama at Birmingham. The stated purpose of following ulcers to healing is to detect those gastric cancers that may be masquerading as benign ulcer and were not correctly diagnosed at initial endoscopy. Over a five-year period, 148 gastric ulcers were followed with serial endoscopy and in no case was an unsuspected carcinoma found at follow-up endoscopy. In addition, of 67 gastric cancers diagnosed between 1979 and 1986, 62 were suspected of being malignant by the endoscopist at initial examination for an accuracy of 92%. The accuracy rate based solely on biopsy and/or brush cytology was 94%. When endoscopic and biopsy and/or cytology impressions were combined, only one case of gastric carcinoma was not suspected. The overall accuracy was 99%. These results suggest that if either the endoscopic impression or the biopsy and cytology is suspicious for malignancy, then follow-up endoscopy until healing should be done. On the other hand, if, at the initial examination, the ulcer appears benign and biopsy plus cytology are negative, then serial endoscopy has a low benefit relative to its cost.

Alabama↗
PubMed1993

Aldehyde disinfectants and health in endoscopy units. British Society of Gastroenterology Endoscopy Committee.

Summary of main recommendations(1) Glutaraldehyde, used in most endoscopy units in the United Kingdom for the disinfection of flexible gastrointestinal endoscopes, is a toxic substance being an irritant and a sensitiser; symptoms associated with glutaraldehyde exposure are common among staff working in endoscopy units.(2) The Control of Substances Hazardous to Health Regulations 1988 (COSHH) obliges the employer to make a systematic assessment of risk to staff of exposure to glutaraldehyde and institute measures to deal effectively with exposure.(3) At present glutaraldehyde remains the first line agent for the disinfection of flexible gastrointestinal endoscopes. Other agents are being developed; a standard means of assessment for flexible endoscope disinfectants should be devised.(4) Equipment and accessories that are heat stable should be sterilised by autoclaving; disposable accessories should be used wherever possible.(5) Flexible gastrointestinal endoscopes should be disinfected within automated washer/disinfectors; trays, bowls or buckets for this purpose are unacceptable.(6) Local exhaust ventilation must be used to control glutaraldehyde vapour. Extracted air may be discharged direct to the atmosphere or passed over special absorbent filters and recirculated. Such control measures must be regularly tested and records retained.(7) Endoscope cleaning and disinfection should be carried out in a room dedicated to the purpose, equipped with control measures to maintain the concentration of glutaraldehyde vapour at a level certainly below the current occupational exposure standard of 0.2 ppm and preferably below the commonly used working limit of 0.1 ppm. Sites other than the endoscopy unit where endoscopy is regularly performed, such as the radiology department, should have their own fully equipped cleaning and disinfection room.(8) COSHH limits the use of personal protective equipment to those situations where other measures cannot adequately control exposure. Such equipment includes nitrile rubber gloves, apron, chemical grade eye protection, and respiratory protective equipment for organic vapours.(9) Monitoring of atmospheric levels of glutaraldehyde should be performed by a competent person such as an occupational hygienist; the currently preferred method of sampling uses a filtration technique, the commercially available meters being less reliable.(10) Health surveillance of staff is mandatory; occupational health records must be retained for 30 years.(11) Endoscopy staff must be informed of the risks of exposure to glutaraldehyde and trained in safe methods of its control. Only staff who have completed such an education and training programme should be allowed to disinfect endoscopes.(12) The unsafe use of glutaraldehyde has significant health and legal consequences; the safe use of glutaraldehyde may have revenue consequences that contribute significantly to the cost of gastrointestinal endoscopy.

Aldehydes↗