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The Efficacy of a New Bees-Like Disposable Brush for the Scope Cleaning
*S1529 The Impact of Colonscopic Electrocautery on Pacemaker Function Navin Kumar, Hemant Roy, Alan Zunamon, Eva Gliwa, Mick Meiselman, Michael Goldberg, Tat-Kin Tsang, Randall Brand Background: While some guidelines advocate inactivation of pacemakers prior to use of electrocautery for colonoscopic polypectomy, this is not done by most endoscopists. These recommendations are based upon expert opinion, small non-blinded studies and anecdotal case reports. In order to provide evidencebased insight into this issue, we performed a pilot study analyzing the risk of electrocardiographic abnormalities during cautery. Methods: A total of 19 patients were enrolled in this study. Each patient had rhythm strips run preand post-colonoscopy, when the cecum was reached and during all episodes of cautery use. Continuous ECG rhythm monitoring was also performed during the colonoscopy. The technique (continuous vs. brief, short bursts) of cautery was dependent on the endoscopist preference. The grounding electrode was placed on the patient’’s buttock or thigh. Identified pre- and post-procedure strips along with either an unidentified cecal (control) or cautery strip were grouped together and evaluated by a cardiologist blinded to the cautery status of the third strip. Results: Eight of the 19 patients underwent a total of 18 polypectomies using electrocautery. No incidence of pacemaker dysfunction or change in cardiac rhythm occurred in the control or cautery groups. All 19 patients tolerated each colonoscopy without any other adverse cardiac events or complications. Conclusion: This study suggests that electrocautery use is safe in patients with pacemakers as along as the electrocautery pad is positioned on the lower part of the body away from the pacemaker. To our knowledge this is the first blinded, prospective trial demonstrating the safety of performing electrocautery during colonoscopy in patients with a pacemaker. If confirmed with larger patient numbers, this would strongly argue for new practice recommendations.
because of length of the hood, edge of the hood interferes with view of colonoscope, and colonic mucosa may be captured by suction into inside of the hood. A much shorter cap might resolve these shortcomings. The aim of this study is to evaluate the usefulness of the short cap for total colonoscopy. PATIENTS AND METHODS: From September 1 2003 to November 30 2003, consecutive 139 patients were randomly allocated to non-capped colonoscopes or capped colonoscopes. All examinations were performed with PCF230I or PCF240I (Olympus, Tokyo, Japan). Evaluated outcomes were completeness of the examination to the cecum, insertion time to the cecum, patient’s tolerance and complications. RESULTS: Of 139 patients, 64 patients were allocated to capped colonoscopes and 75 patients to non-capped colonoscopes. Total colonoscopy could be achieved in all cases. The median insertion time to the cecum was 13.5 minutes in capped colonoscope group and 13.0 minutes in non-capped colonoscope group (p=0.6). No difference was found in patient’s tolerance, and no complication occurred. There was no significant difference according to gender, history of abdominal open surgery, bowel movement and endoscopic findings (e.g. diverticula). However, in the cases whose BMI (Body Mass Index) were over 23, median insertion time to the cecum showed significant difference; 10.5minutes in capped colonoscope group (28 cases) vs 14.5 minutes in non-capped colonoscope group (33 cases)(p<0.05, Mann-Whitney U-test). There was no difference in the cases whose BMI was below 23. CONCLUSION: Attaching a short cap may contribute to facilitate total colonoscopy in the patients with obese tendency.
*S1530 The Efficacy of a New Bees-Like Disposable Brush for the Scope Cleaning Masayuki Kato, Koji Matsuda, Chizuko Honda, Hisao Tajiri [Background and Aim] A couple of new disinfectants such as hyperacetic acid and orthofuthalaldehyde have been developed to shorten the period of scope cleaning based on the standard precaution. However, it is needless to say that the most important process is the meticulous mechanical cleaning using brush and sponge. The aim of this study is to evaluate the efficacy of a new bees-like disposable brush as an alternative to the conventional scope brush. [Method] A total of twenty-two consecutive scopes for EGD immediately after the procedures were enrolled in this study. This new round-shape brush (BIOTO Co.,Ltd. Tokyo, Japan) looks like a bees sized as 3mm in diameter with very minute ‘villi’ around the surface. The control specimens were obtained aspirating 200ml of purified water immediately after the procedure. The specimens for the bees group (group A: n=11) were obtained as follows: One bees-like disposable brush was aspirated from the tip of the scope through the working channel, followed by 40ml of saline). On the other hands, the specimens for the conventional brush group (group B: n=11) were obtained aspirating 40ml of saline after the standard brushing process. The detergents were not used. The obtained specimens were cultured and the values of the protein were measured using the pyrogallol red-molybdate(IV) method. [The results] The detected bacterial species were as follows: Klebsiella pneumoniae: Klebsiella oxytoca: Stenotrophomonas maltophilia: Haemophilus parainfluenzae: a-Strept.: GPR: Serratia marcescens: Strept.viridans: Candida albicans: Candida glabrata: Staph.aureus: Enterobacter cloacae: Aeromonas hydrophilia: E.coli:Strept.non-hemolyticus: Enterobacter aerogenes: Non-fermenter sp. The decreased and diminished rates of the amounts of bacteria in group A and B were 91%(10/11):91%(10/11), 36%(4/11):46%(5/11), respectively. The decreased rates of the values of protein were 36%(4/11):64%(7/11), respectively. [Conclusion] This bees-like disposable brush seems as effective as the conventional scope cleaning brush in order to wash out the bacteria and protein in the working channel. We feel that this technology has the potential to automate the scope cleaning without any manual process in near future.
*S1531 Usefulness of Attaching a Short Cap for Colonoscopy of Obese Patients Shintaro Kondo, Miki Ohta, Hirotsugu Watabe, Yutaka Yamaji, Makoto Okamoto, Takao Kawabe, Masao Omata BACKGROUND: Attaching a hood to the tip of a colonoscope is considered to facilitate total colonoscopy. By using the hood, it has been reported that an operator can easily keep distance between lens of colonoscope and colonic mucosa, and can obtain a better view by straightening haustra of colon. However,
VOLUME 59, NO. 5, 2004
*S1532 The Value of Peracetic Acid (SCOTELINÒ) for Endoscopic Disinfection Jin-Bae Kim, Dong-Soo Han, Jong-Pyo Kim, Hang-Lak Lee, Joo-Hyun Sohn, Yun-Ju Jo, Joon-Soo Hahm Background/Aims: Two percent glutaradehyde has been the reference disinfectant for high-level disinfection, but often requires long periods of exposure up to 45 minutes. The aims of this study were to evaluate the effectiveness of a new endoscopic disinfector that uses 0.2% peracetic acid (PA) as a disinfectant and to compare the culture-positive rate (CPR) in each different endoscope. . Methods: Three different endoscopes (A, B, C; followed in purchase year array from recent times) were used in gastroduodenal examination. After examination, they were cleaned manually and disinfected with PA using 2 different washers (a, b; followed in purchase year array from recent times) for 10 minutes. Cultures were taken from biopsy channel (S1: rinsing), tip of endoscope (S2: swab), and control knob (S3: swab). A total of 86 gastroduodenal endoscopes were included in the study and divided into four groups according to the different type of endoscope and washer used (Aa, 35; Ab, 17; Bb, 26; Cb, 8). Results: Overall CPR was 37.2%, majority of which came from S1 specimens. The mean colony-forming unit (CFU) of S1 specimens was 24.3. There was a significant difference in CPR/CFU among 4 groups (p<0.001)(Aa, 11.4%/0.4; Ab, 47.1%/3.1; Bb, 50%/9.6, Cb, 87.5%/53.1). G(+) bacilli was the most frequently cultured organism but its CFU was not significant (<6). On the other side, some significant pathogens forming CFU up to 100 were found in Bb and Cb groups. Both the types of endoscope and washer used in this study were risk factors determining culture positivity. Multivariate analysis disclosed that type of washer is more significant than that of endoscope as an independent risk factor. Of the 28 Helicobactor pylori (HP) positive cases, there was 1 HP DNA PCR positive case (1/19), but no HP cultured case found (0/16). Conclusions: When new endoscope and washer is used, PA is as effective as conventional disinfectant in spite of short exposure time. Significant difference in culture rate according to the different machine used might come from the difference of cleaning power of washer. In addition, biofilm-dislodging activity of PA might have an additional role.
GASTROINTESTINAL ENDOSCOPY
P119
because of length of the hood, edge of the hood interferes with view of colonoscope, and colonic mucosa may be captured by suction into inside of the hood. A much shorter cap might resolve these shortcomings. The aim of this study is to evaluate the usefulness of the short cap for total colonoscopy. PATIENTS AND METHODS: From September 1 2003 to November 30 2003, consecutive 139 patients were randomly allocated to non-capped colonoscopes or capped colonoscopes. All examinations were performed with PCF230I or PCF240I (Olympus, Tokyo, Japan). Evaluated outcomes were completeness of the examination to the cecum, insertion time to the cecum, patient’s tolerance and complications. RESULTS: Of 139 patients, 64 patients were allocated to capped colonoscopes and 75 patients to non-capped colonoscopes. Total colonoscopy could be achieved in all cases. The median insertion time to the cecum was 13.5 minutes in capped colonoscope group and 13.0 minutes in non-capped colonoscope group (p=0.6). No difference was found in patient’s tolerance, and no complication occurred. There was no significant difference according to gender, history of abdominal open surgery, bowel movement and endoscopic findings (e.g. diverticula). However, in the cases whose BMI (Body Mass Index) were over 23, median insertion time to the cecum showed significant difference; 10.5minutes in capped colonoscope group (28 cases) vs 14.5 minutes in non-capped colonoscope group (33 cases)(p<0.05, Mann-Whitney U-test). There was no difference in the cases whose BMI was below 23. CONCLUSION: Attaching a short cap may contribute to facilitate total colonoscopy in the patients with obese tendency.
*S1530 The Efficacy of a New Bees-Like Disposable Brush for the Scope Cleaning Masayuki Kato, Koji Matsuda, Chizuko Honda, Hisao Tajiri [Background and Aim] A couple of new disinfectants such as hyperacetic acid and orthofuthalaldehyde have been developed to shorten the period of scope cleaning based on the standard precaution. However, it is needless to say that the most important process is the meticulous mechanical cleaning using brush and sponge. The aim of this study is to evaluate the efficacy of a new bees-like disposable brush as an alternative to the conventional scope brush. [Method] A total of twenty-two consecutive scopes for EGD immediately after the procedures were enrolled in this study. This new round-shape brush (BIOTO Co.,Ltd. Tokyo, Japan) looks like a bees sized as 3mm in diameter with very minute ‘villi’ around the surface. The control specimens were obtained aspirating 200ml of purified water immediately after the procedure. The specimens for the bees group (group A: n=11) were obtained as follows: One bees-like disposable brush was aspirated from the tip of the scope through the working channel, followed by 40ml of saline). On the other hands, the specimens for the conventional brush group (group B: n=11) were obtained aspirating 40ml of saline after the standard brushing process. The detergents were not used. The obtained specimens were cultured and the values of the protein were measured using the pyrogallol red-molybdate(IV) method. [The results] The detected bacterial species were as follows: Klebsiella pneumoniae: Klebsiella oxytoca: Stenotrophomonas maltophilia: Haemophilus parainfluenzae: a-Strept.: GPR: Serratia marcescens: Strept.viridans: Candida albicans: Candida glabrata: Staph.aureus: Enterobacter cloacae: Aeromonas hydrophilia: E.coli:Strept.non-hemolyticus: Enterobacter aerogenes: Non-fermenter sp. The decreased and diminished rates of the amounts of bacteria in group A and B were 91%(10/11):91%(10/11), 36%(4/11):46%(5/11), respectively. The decreased rates of the values of protein were 36%(4/11):64%(7/11), respectively. [Conclusion] This bees-like disposable brush seems as effective as the conventional scope cleaning brush in order to wash out the bacteria and protein in the working channel. We feel that this technology has the potential to automate the scope cleaning without any manual process in near future.
*S1531 Usefulness of Attaching a Short Cap for Colonoscopy of Obese Patients Shintaro Kondo, Miki Ohta, Hirotsugu Watabe, Yutaka Yamaji, Makoto Okamoto, Takao Kawabe, Masao Omata BACKGROUND: Attaching a hood to the tip of a colonoscope is considered to facilitate total colonoscopy. By using the hood, it has been reported that an operator can easily keep distance between lens of colonoscope and colonic mucosa, and can obtain a better view by straightening haustra of colon. However,
VOLUME 59, NO. 5, 2004
*S1532 The Value of Peracetic Acid (SCOTELINÒ) for Endoscopic Disinfection Jin-Bae Kim, Dong-Soo Han, Jong-Pyo Kim, Hang-Lak Lee, Joo-Hyun Sohn, Yun-Ju Jo, Joon-Soo Hahm Background/Aims: Two percent glutaradehyde has been the reference disinfectant for high-level disinfection, but often requires long periods of exposure up to 45 minutes. The aims of this study were to evaluate the effectiveness of a new endoscopic disinfector that uses 0.2% peracetic acid (PA) as a disinfectant and to compare the culture-positive rate (CPR) in each different endoscope. . Methods: Three different endoscopes (A, B, C; followed in purchase year array from recent times) were used in gastroduodenal examination. After examination, they were cleaned manually and disinfected with PA using 2 different washers (a, b; followed in purchase year array from recent times) for 10 minutes. Cultures were taken from biopsy channel (S1: rinsing), tip of endoscope (S2: swab), and control knob (S3: swab). A total of 86 gastroduodenal endoscopes were included in the study and divided into four groups according to the different type of endoscope and washer used (Aa, 35; Ab, 17; Bb, 26; Cb, 8). Results: Overall CPR was 37.2%, majority of which came from S1 specimens. The mean colony-forming unit (CFU) of S1 specimens was 24.3. There was a significant difference in CPR/CFU among 4 groups (p<0.001)(Aa, 11.4%/0.4; Ab, 47.1%/3.1; Bb, 50%/9.6, Cb, 87.5%/53.1). G(+) bacilli was the most frequently cultured organism but its CFU was not significant (<6). On the other side, some significant pathogens forming CFU up to 100 were found in Bb and Cb groups. Both the types of endoscope and washer used in this study were risk factors determining culture positivity. Multivariate analysis disclosed that type of washer is more significant than that of endoscope as an independent risk factor. Of the 28 Helicobactor pylori (HP) positive cases, there was 1 HP DNA PCR positive case (1/19), but no HP cultured case found (0/16). Conclusions: When new endoscope and washer is used, PA is as effective as conventional disinfectant in spite of short exposure time. Significant difference in culture rate according to the different machine used might come from the difference of cleaning power of washer. In addition, biofilm-dislodging activity of PA might have an additional role.
GASTROINTESTINAL ENDOSCOPY
P119