Saturday, 9 December 2017

Cleansing and disinfection

Patients need to be reassured that decontamination processes are up to date and effective. Guidelines on cleaning and disinfection of endoscopes and endoscopic devices have been developed by the ESGE-ESGENA

It is recommended that decontamination policies and procedures be compliant with national or panEuropean guidelines based on accepted, published recommendations and standards and should be audited against defined indicators. The policies should be available in the endoscopy department and updated regularly

Kit - technologies for improving insertion of the colonoscope  

A variety of endoscope technologies may facilitate caecal intubation and improve patient tolerance. These include variable stiffness instruments, magnetic tracking devices and wire-guided techniques.

A recent meta-analysis (Othman et al. 2009) of variable stiffness colonoscopes identified seven randomised trials involving 1923 patients: four trials comparing adult variable stiffness colonoscopes with standard adult colonoscopes in adults, and three evaluating the paediatric variable stiffness colonoscope. The caecal intubation rate was higher with the use of variable stiffness colonoscopes. The variable stiffness colonoscope was associated with lower abdominal pain scores and decreased need for sedation during colonoscopy. Intubation times were unaffected by the variable stiffness colonoscope (I). The use of variable stiffness colonoscopes is recommended for screening colonoscopy

The present bibliographic search did not yield any relevant publications on improvement of completeness of colonoscopy through wire-guided techniques. This new technology has been investigated in endoscopic management of obstructive tumours 

Two RCTs of the magnetic endoscopic imaging (MEI) device showed improved performance of endoscopists, both with variable stiffness colonoscopy and with traditional colonoscopy, in terms of patient tolerance and caecal intubation rates, in particular when little or no sedation is used (Shah et al. 2000; Shah et al. 2002) (II). The utilisation of magnetic endoscope imaging (MEI) technology may be considered for patients requiring colonoscopy, particularly when little or no sedation is used 

Kit – techniques and technologies to enhance detection, characterisation and removal of high-risk lesions 

Image enhancing techniques and technology promise to improve management of high-risk lesions in three ways.

1. First, they might improve the detection of lesions. This will only add value if the lesions detected are important biologically: identifying more biologically unimportant lesions will add workload and risk. 
2. Second, they might better define the margins of the lesion to help the endoscopist ensure that it is completely excised. 
3. Third, they might help characterise the nature of the lesion, helping the endoscopist decide whether to remove it. This third aspect is of critical importance because it might be more appropriate not to remove the lesion because of an increased risk of malignancy. Alternatively, if an endoscopist can safely leave lesions that do not need to be removed, such as small hyperplasic polyps, considerable time could be saved and small risks of polypectomy avoided.  

Essentially there are two approaches to enhanced lesion recognition and characterisation: dyespraying or chromoendoscopy, and image manipulation techniques or image-enhancing technology. 

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