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At least 19 recordsLinked to original sources
PubMed2026

Predictive value of Rectal and Throat-nose Screening for the presence of Multidrug-Resistant Organisms in Duodenal Fluid as a Risk of Duodenoscope Contamination: A Multicenter Study.

BACKGROUND: Duodenoscopes have been implicated in patient-to-patient transmission of multidrug-resistant organisms (MDROs). Current gastrointestinal MDRO surveillance relies on rectal screening, yet the duodenum is the primary site of duodenoscope exposure. This study evaluated the predictive value of rectal and throat-nose screening for detecting duodenal MDROs as a marker of duodenoscope contamination risk. METHODS: Adult patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at tertiary care centers in the Netherlands and India were included. Rectal swabs, throat-nose swabs, and duodenal aspirates were analyzed for MDROs. The detected MDROs were compared using species identification, antibiotic susceptibility patterns, and whole-genome sequencing. RESULTS: Among 512 participants (Netherlands: 339; India: 173), rates of duodenal and rectal MDRO carriage were higher in India (56.6% (98/173); 79.8% (138/173), respectively) than in the Netherlands (5.6% (19/339); 10.3% (35/339)). Given the low prevalence of throat-nose carriage, only the predictive value of rectal screening was assessed. Rectal screening sensitivity for genetically related strains in duodenal fluid was 32.7% in India and 68.4% in the Netherlands . For detecting any duodenal MDRO, sensitivity reached 91.8% in India and 84.2% in the Netherlands, with specificities of 36.0% and 94.1%. Positive predictive value (PPV) was low (India: 65.2%; Netherlands: 45.7%), while negative predictive value was 77.1% and 99%, respectively. CONCLUSIONS: Rectal screening is unreliable for detecting strain-specific duodenal MDROs and overestimates true carriage due to low PPV values. However, it provides excellent rule-out value in low-prevalence settings. Consequently, its utility for guiding infection prevention strategies for duodenoscope contamination is greatest in low-MDRO-prevalence regions.

Bacterial↗
PubMed1977

Duodenoscopic sphincterotomy and gallstone removal.

Duodenoscopic sphincterotomy was attempted in 265 patients. The procedure was successful in 243 patients (92%). Indications for sphincterotomy were: 185 patients with choledocholithiasis, 52 patients with papillary stenosis, and 6 patients with ampullary carcinoma. The clinical and biochemical evidence of cholestasis resolved in 222 of the 243 successful patients (91%). Complications consisting of hemorrhage, perforation, pancreatitis, cholangitis, and instrumental injury resulted in three deaths, an over-all mortality of 1.2%. Emergency laparotomy was required in 6 cases (2.5%). Duodenoscopic sphincterotomy is a relatively safe and effective means of relieving certain instances of extrahepatic cholestasis. The complication and mortality rates appear lower than those with equivalent conventional surgical techniques.

Adult↗
PubMed1976

Duodenoscopic papillotomy and gallstone removal.

Using an experimental insulated duodenoscope and a diathermy wire, papillotomy has been performed on 10 patients under diazepam sedation. Seven patients had common bile duct stones (6 following cholecystectomy) and 3 had papillary stenosis. Nine of the patients had severe medical or surgical contraindications to further operative treatment. Papillotomy was successful in all patients, with no significant bleeding or other complications. Repeat endoscopy 6-14 days after papillotomy demonstrated a healed biliary orifice of 7-10 mm diameter. Stones had already passed in 3 of the 7 patients; in 2 others, stones were extracted using balloon catheters or Dormia type baskets. Two larger stones could not be removed; in one of these patients the stone and basket became impacted at the papilla and had to be removed surgically 2 days later. Endoscopic papillotomy is an acceptable alternative to surgery in high risk patients, particularly in the treatment of retained common bile duct stones. If long term results prove satisfactory, the technique will have wider application.

Adult↗
PubMed1978

Bacteriological efficiency of a standardized cleansing and disinfection technique for duodenoscopes.

Adequate cleansing and disinfection of the endoscopes is desirable to prevent bacteriaemia and septicemia following gastrointestinal endoscopy, especially endoscopic retrograde cholangiopancreatography and duodenoscopic sphincterotomy. A practical method, proved in our department over a period of 12 months, is described. As the result of this standardized cleansing and disinfection technique using the aldehyde derivative Gigasept (succine dialdehyde and 2,5-dimethoxytetrahydrofuran) in a 10% concentration as chemical disinfectant, sterile cultures from the biopsy channel were obtained in 75% of tested instruments. The remaining fiberscopes exhibited only a few bacteria left, resulting in a sufficient success of disinfection according to hygienic standards.

Aldehydes↗
PubMed1977

Duodenoscopic guided biopsy of the biliary and pancreatic duct.

First experiences with duodenoscopic guided biopsy of the biliary and the pancreatic duct on 11 cases using a special designed forceps showed that this method gave good and representative results in the biliary duct and from the papilla. However, in the present stage of development guided biopsy from the pancreatic duct does not aid exact differential diagnosis of benign or malignant lesions. In 3 out of 4 cases with pancreatic cancer the histological diagnosis was false negative. The biopsy specimens are very small and need an exact preparation and great experience of the histologist. Cytologic criteria must be relied on more here as in other areas of the GI-tract. However, the criteria of malignancy rest not in the nature of the individual cell but in the manner of proliferation, namely the infiltration of the deeper layers. This is the advantage of guided biopsy compared to cytological examination. Complications of the method may be avoided by exact guiding of the forceps and by limiting the numbers of specimens.

Aged↗
PubMed1979

Depression of exocrine pancreatic secretion by collection through duodenoscopic catheters.

Two dogs were equipped with gastric and duodenal cannulas permitting quantitative collection of pure pancreatic juice. Two series of experiments were performed: 1) collection through a short catheter, length 35 cm, volume 0.3 ml, and internal diameter 1.0 mm, and 2) collection through a long catheter used for duodenoscopic cannulation in man, length 110 cm, volume 1.7 ml, and internal diameter 1.0 mm at the tip and 1.4 mm in the other part of the catheter. After a basal period of 30 min the secretion was stimulated with secretin in the doses 0.1, 0.5, and 2.0 clinical units/kg/h, each dose being infused over a period of 30 min. With the long catheter the dose-response curve for fluid and bicarbonate was shifted to the right. The basal secretion of fluid was depressed 40%; with increasing secretory rates the depression was less pronounced. No significant depression of the bicarbonate concentration was seen. The protein secretion was insignificantly reduced.

Animals↗
PubMed1975

A bismuth-peptide complex in the treatment of duodenal ulceration. A double-blind duodenoscopic study.

A bismuth-protein complex (Bicitropeptide, BCP-Compound) active at an acid pH was studied in a trial of treatment in ambulant patients with duodenal ulcers. BCP is said to have an affinity for actively granulating tissue, and to coat the ulcer with a protective layer, allowing healing to occur. A double-blind trial of BCP and placebo was undertaken in 60 patients with duodenal ulcers. Assessments were made by duodenoscopy. Healing of the ulcers occurred in 89% of patients on BCP, and the mean time for the disappearance of symptoms on BCP was 4,9 days. Only 16% of ulcers healed on placebo, and the mean time for disappearance of symptoms on placebo was 6,8 days. This result is highly significant and in favour of BCP (X-2 equals 30,52 P less than 0,0005). No side-effects were observed.

Adolescent↗
PubMed1977

[Basic pressure in the pancreatic duct and in the bile duct: results from 50 standardized duodenoscopic transpapillary pressure measurements (author's transl)].

In 90 patients pressure measurements in the pancreatic duct (50 cases) and in the common bile duct (20 cases) were performed endoscopically. In the normal pancreas an averaged basis pressure in Wirsung's duct of 22.2 cm H2O was found with a range of 9.6 to 37.0 cm H2O. In two cases of marked chronic pancreatitis and in one case of pancreatic carcinoma the secretion pressure was considerably diminished. The mean basic pressure of the common bile duct amounted to 12.0 cm H2O with a range of 7.3 to 17.0 cm H2O. The pressure values in the duodenum were found to be considerably lower than in the pancreatic duct and the bile duct; they amounted to 5.3 cm H20 with a range of 0.6 to 10.9 cm H20. In both ducts two different patterns of ondulations were found: tracings of slight ondulations, i.e. slow pressure changes with a constant average pressure and tracings of coarse ondulations with quick increase and drop in pressure. It will be discussed, how these findings can be related to physiology and pathophysiology of the pancreatic and biliary duct system. The clinical relevance for detection of excretory insufficiency of the pancreas and of pathologic changes leading to stenosis of the duct system are considered.

Adult↗
PubMed2026

Outbreak of aztreonam-avibactam-resistant NDM-5-producing Escherichia coli isolates in a hospital of Paris.

The emergence of aztreonam-avibactam resistance among NDM-producing Escherichia coli represents a major therapeutic and infection control concern. Four cases of aztreonam-avibactam-resistant (AZAR) NDM-producing E. coli, recovered from three blood cultures and one rectal surveillance culture in a hospital of Paris, prompted an investigation based on whole-genome sequencing. The three isolates responsible for bloodstream infection, which were clonally related, belonged to the ST405 and produced NDM-5, DHA-1, CTX-M-15, and TEM-1 β-lactamases. They also had a penicillin-binding protein 3 (PBP3) modified by the insertion of four amino acids (YRIK). On the other hand, the isolate recovered from the rectal swab belonged to another sequence type (ST2083). It produced NDM-5, CMY-42, and TEM-1 β-lactamases and had an altered PBP3 by the insertion of four other residues (YRIN). Epidemiological investigation identified endoscopic retrograde cholangiopancreatography as a potential risk factor, leading to the detection of three additional patients infected with the ST405 clone after exposure to the same duodenoscope. The outcome of the bloodstream infections was favorable except for one patient. In total, seven patients infected or colonized by AZAR NDM-5-producing E. coli were identified over a 5-month period in 2025, six with duodenoscope exposure.IMPORTANCEThis study underlines the emergence of aztreonam-avibactam resistance among NDM-producing Escherichia coli isolates in France. To our knowledge, this report describes the first clonal outbreak due to aztreonam-avibactam-resistant NDM-producing E. coli.

Humans↗
PubMed1978

Exocrine pancreatic secretion and immunoreactive secretin (IRS) release after intraduodenal instillation of bile in man.

Six subjects with a normal endoscopic pancreatogram were investigated after an overnight fast by means of a side-viewing duodenoscope. After cannulation of the main pancreatic duct, juice was collected in five-minute samples for 20 minutes. An iso-osmolar solution of 6 g cattle bile was then infused into the duodenum through a separate catheter attached to the outside of the duodenoscope, and pancreatic juice collected in five-minute samples for another 20 minutes. Blood was frequently drawn from an arm vein through an indwelling catheter for estimation of immunoreactive secretin (IRS) by radioimmunassay. The flow rate of pancreatic juice and outputs of bicarbonate, amylase, and protein increased significantly after intraduodenal infusion of bile. A significant rise in plasma IRS was also found after instillation of bile in the duodenum.

Adult↗