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BackgroundThe challenging disinfection process for the elevator mechanism on duodenoscopes and linear echoendoscopes has been identified as a source of clinically significant bacterial transmission. Despite increased awareness, there continues to be a lack of definitive guidelines for bacterial culturing protocols for elevator-containing endoscopes.AimsTo compare two different prospective bacterial surveillance protocols for duodenoscopes and linear echoendoscopes with regard to accuracy, efficiency, and cost.MethodsConsecutive duodenoscopes and linear echoendoscopes used at a single tertiary care center were reprocessed following hospital and manufacturer guidelines, dried using an automatic endoscope-drying machine, and hung overnight in an upright position. Following reprocessing, culture samples were sequentially obtained from each endoscope using two methods, first, the brush protocol followed immediately by the swab protocol.ResultsA total of 532 primary cultures were collected from 17 duodenoscopes and eight linear echoendoscopes. Of these, 266 cultures gathered using the brush protocol were negative, while 266 cultures gathered using the swab protocol resulted in three positive cultures (1.1%). Positive cultures showed Enterobacter cloacae and Klebsiella pneumoniae from one duodenoscope and two linear echoendoscopes. Yearly, the brush protocol amounts to approximately 520 nursing hours, and the swab protocol takes an estimated 42 nursing hours. Annually, the swab protocol could save over $26,500 and 478 nursing hours.ConclusionsThe proposed swab protocol was superior to the brush protocol when evaluating the presence of residual bacteria on elevator-containing endoscopes following reprocessing and saves cost and nursing hours.

BackgroundEndoscopic foreign body (FB) removal forms an important aspect of emergency & routine endoscopic procedures. This is an analysis of the types of FB encountered & the experience with their removal over a period of three years.MethodsThis is a retrospective analysis of endoscopies performed for FB removal. The data recorded was the age, sex, symptoms, nature of the FB, bowel injury & endoscopic success/failure.ResultsA total of 225 FBs in 225 patients, 65.77% within the reach of the endoscope were removed from 2017 to 2020, >95% being accidental ingestions.Male to Female ratio was 1.25:1. The median age was 6 years (the oldest: 67 years & the youngest: 4 months old).24.00% of the total FBs were sharps(GroupS), 67.11% non-sharps(GroupNS) & 8.88% corrosives(GroupC). Almost two thirds (62.66%) of FBs had a diameter > 2cm & 12% had a length >5 cms. Bowel injury was present in 20.37% of GroupS (p=0.030), 4.63% of GroupNS (p<0.05) and 45% of GroupC FB (p<0.05). The total no of patients with symptoms were 8.88% with 75% having dysphagia. 44% of patients with bowel injury had symptoms and 3.5% without injury had symptoms (p<0.05). Off the 78 FBs that weren’t within the reach of the endoscope,65.38% had diameter > 2 cm (p=0.53),8.97% had length >5 cm (p=0.30),with 19.23% (p=0.22), 71.79% (p=0.27) & 8.97% (p= 0.97) being from Groups S, NS & C respectively. We failed in the removal of only 2/147 FBs within endoscopic reach, both > 2 cm in diameter & > 5 cm in length. There were no deaths due to FB ingestion.ConclusionsThis is the largest study of Endoscopic FB removal from Western India. This study showed that the majority of the FB were ingested by children. Even those with injury to the bowel were asymptomatic. Since the size of FB did not determine it being within the reach of the endoscope and Groups S, NS & C FBs are associated with injury to the bowel; we propose an attempt at removal should be made in all patients, whether symptomatic or not.

Wireless capsule endoscopy (WCE) offers a non-invasive evaluation of the digestive system, eliminating the need for sedation and the risks associated with conventional endoscopic procedures. Its significance lies in diagnosing gastrointestinal tissue irregularities, especially in the small intestine. However, existing commercial WCE devices face limitations, such as the absence of autonomous lesion detection and treatment capabilities. Recent advancements in micro-electromechanical fabrication and computational methods have led to extensive research in sophisticated technology integration into commercial capsule endoscopes, intending to supersede wired endoscopes. This Review discusses the future requirements for intelligent capsule robots, providing a comparative evaluation of various methods’ merits and disadvantages, and highlighting recent developments in six technologies relevant to WCE. These include near-field wireless power transmission, magnetic field active drive, ultra-wideband/intrabody communication, hybrid localization, AI-based autonomous lesion detection, and magnetic-controlled diagnosis and treatment. Moreover, we explore the feasibility for future “capsule surgeons”. future requirements for intelligent wireless capsule endoscopy, providing a comparative evaluation of various methods’ merits and disadvantages, and highlighting recent developments in six technologies.

Background Peristaltic or undulating flow plays a significant role in various biomedical and industrial processes, where it provides an efficient mechanism for transporting fluids through flexible conduits such as catheters and endoscopic channels. Understanding such flow behavior is essential for improving medical devices and industrial applications involving non-Newtonian fluids. Methods This study investigates the peristaltic motion of a Carreau fluid whose viscosity varies with both temperature and concentration within a flexible, axisymmetric channel composed of two overlapping cylindrical tubes. The outer wall of the channel exhibits a sinusoidal wave pattern, simulating a realistic endoscopic configuration. The governing nonlinear, nonhomogeneous partial differential equations were formulated in cylindrical coordinates under the assumption of a long wavelength and low Reynolds number. The equations were transformed into a dimensionless form and solved using the uniform perturbation method. Graphical analyses were performed using Mathematica software. Results The results illustrate the combined effects of temperature-dependent and concentration-dependent viscosity on the velocity distribution and pressure gradient within the channel. Increasing temperature and solute concentration were found to enhance fluid velocity and reduce flow resistance. Conclusions The study provides a comprehensive understanding of peristaltic transport in variable-viscosity Carreau fluids under realistic physiological conditions. These findings may contribute to optimizing the design and performance of endoscopic and biomedical fluid transport systems.

The use of reusable flexible endoscopes has increased dramatically over the past decade, however despite improvements in endoscope reprocessing, the continued emergence of endoscopy-associated outbreaks as a result of multi-drug resistant bacteria has highlighted the need for a new approach to disinfection. Here, the use of plasma activated liquids (PALs) for the elimination of mixed species biofilm contamination within the working channels of endoscopes was evaluated. Cold atmospheric pressure plasma was used to chemically activate water and a commercially available pH buffered peracetic acid to create PALs. Polytetrafluoroethylene endoscope surrogate test pieces were contaminated with clinically relevant mixed species biofilms. The efficacy of PALs for the decontamination of narrow lumens was compared against the commercial disinfectant. Plasma activation was found to increase the antibiofilm capabilities of pH buffered peracetic acid by introducing reactive chemical species into the solution. Disinfection of endoscopic test pieces with plasma activated disinfectant (PAD) resulted in a 7.30 log 10 reduction of biofilm contamination in 5 min, surpassing the 4.39 log 10 reduction observed with the currently used endoscope disinfection method. PAD also resulted in reduced regrowth and recolonization of the surface of the endoscopic test pieces. Minimal changes to the surface morphology and composition were observed following exposure to PAD in comparison to the commercial disinfectant, suggesting the developed approach is no more aggressive than current disinfection approaches.

IntroductionMeasurement of the distance of an endoscope tip from mouth guard is estimated visually in the dark by the endoscopist. To improve the precision and ease of measurement, we developed a prototype device that attaches to any endoscope externally so that this measurement can be displayed on-screen in real-time for recording and review.MethodsA prototype ultrasonic measurement device that clamps to the endoscope outside the patient was devised and tested by an experienced and novice endoscopist with multiple repeated measurements made of a fixed Z line at 39cm. Paired measurements were made with the endoscopist’s own done by usual visual inspection. The device measures how much of the endoscope is outside the patient to calculate the distance of the scope tip within the patient. This study was performed in a Koken EGD simulator (GTSimluators, Davie, Florida, USA) ResultsFifteen paired measurements each were performed by both endoscopists with the results summarized in this table (Table 1.):Abstract PTU-54 Table 1 Mean (Range) cm Median (1SD) cm Paired student t-test (2 tailed) Experienced endoscopist results 39.1 (39-39.5) 39 p=0.183 Device Results 40 (37-46) 39 (2.5) Experienced endoscopist results 39.1 (39-39.5) 39 P=0.167 Device Results 38 (34-43) 38 (2.6) There were no significant differences in the measurements made by the device compared with either endoscopists. The device did not impede endoscopy in any way, The initial study guided improvements in the design and data processing to reduce variability.ConclusionsThis early proof of concept feasibility study has encouraged us to develop a workable prototype device that we will test in a series of upper GI endoscopies in patients (ScopeMeasure Study IRAS Ref 20/SC/0387). This device will be compatible with any endoscope and will be reusable within a disposable sterile sleeve. We hope that automated on-screen display of measurements during endoscopy will make it easier, and encourage more endoscopists to record with more precision the location and size of any landmarks or lesions found.

INTRODUCTION:International guidelines suggest different possibilities for drying of endoscopes during reprocessing. Clinical results of these available drying methods are not satisfactory. The aim of this study was to compare the drying cycle of a standard endoscope washer-disinfector (EWD) (standard drying method [SD]) with a shortened mandatory drying by the EWD followed by a special drying device using laminar and turbulent air flow (novel drying method [ND]).METHODS:Sixty endoscopes (duodenoscopes, colonoscocopes, and gastroscopes) from 3 different manufacturers underwent high-level disinfection and drying depending on the randomization group. Operational time of drying was measured for both groups. Residual fluid in the channels was measured using a laboratory scale. After a 14-day storage period, a sample of the endoscope channels was obtained to determine bacterial contamination.RESULTS:ND had significantly fewer residual water in endoscope channels (SD: 90% vs ND: 0%; P < 0.001) after high-level disinfection and drying and less bacterial contamination after storage for 14 days (SD: 47% vs ND: 20%; P = 0.028). Time consumed for drying in ND was also significantly shorter (SD: 16 minutes 4 seconds vs ND: 5 minutes 59 seconds; P < 0.001).DISCUSSION:Drying with a special automatic drying device was superior compared with an EWD's drying program as evidenced by no measurable residual water, reduced microbiological contamination, and a more than 2-fold decrease in operational time. Thus, drying by laminar and turbulent airflow may represent an attractive alternative to the currently used standard approach in the reprocessing process of flexible endoscopes.

Introduction Endoscopy was first employed in the surgical treatment of neurosurgical diseases early in the twentieth century, but did not become an established practice for a long time, mainly because of poor technology and clinical results. After a slow re-appearance in the 1980s, the 1990s saw an explosion of techniques and instrumentation. Continuing technological improvement has led to further expansion of surgical techniques and indications for use of neuroendoscopy. Discussion The expansion of ventricular endoscopy has led to significant understanding of CSF disorders. Aqueduct stenosis as cause of hydrocephalus and arachnoid cysts are an example of pathologies, the concept and understanding of which now is considerably enhanced, due to the application of neuroendoscopy in their treatment. Management of loculated hydrocephalus has been facilitated considerably with the use of the endoscope. The concepts of aqueductoplasty, septostomy, and foraminoplasty of the foramina of Monro and Magendie emerged, which were previously unknown. Skull base surgery, especially surgery for craniopharyngioma, has seen dramatic improvement in results with the use of the endoscope. Coupling of the endoscope with neuronavigation has expanded technical capabilities even further. Overall, we can do a lot more with the endoscope now in comparison to 30 years ago. Conclusion We should always remember that the endoscope is only a tool. Its use has indications and limitations related to its design and our ability to extract the maximum, in the context of its shortcomings. Further technological advances will push surgical frontiers even more in years to come.

[This corrects the article DOI: 10.1371/journal.pone.0206568.].

Background To prevent cross-contamination between patients, adequate reprocessing is necessary when using flexible endoscopes (FEs) without a working channel. The current reprocessing process using an Endoscope Washer Disinfector (EWD) is time-consuming. Ultraviolet light group C (UV-C) exposition is an alternative and fast disinfection method and has previously been shown to adequately reduce Colony Forming Units (CFUs) on FEs without a working channel. The objective of this study was to examine whether UV-C light is as effective in reducing CFUs on contaminated FEs without a working channel compared to the EWD. Methods FEs without a working channel were collected in three different Otorhinolaryngology Departments in the Netherlands. After pharyngolaryngoscopy, a manual pre-cleaning with tap water was performed and a culture was collected by rolling the distal 8–10 cm of the FE over an agar plate. Next, the FE was randomly assigned to be disinfected with UV-C light (D60) or the EWD (gold standard). After disinfection, another culture was taken. The primary outcome was microbiological contamination, defined by Colony Forming Units (CFU). Results 600 FEs without a working channel were randomized. After clinical use and manual pre-cleaning, 239/300 (79.7%) FEs in the UV-C group and 262/300 (87.3%) FEs in the EWD group were contaminated (i.e., > 0 CFU). FEs without culture confirmed contamination were excluded from further analysis. After UV-C light disinfection, 195/239 (81.6%) FEs showed 0 CFUs, compared to 187/262 (71.4%) FEs disinfected with the EWD ( p  < 0.01). A multivariate logistics regression analysis showed an increased odds of 0 CFUs when using UV-C light (OR 1.83, 95% CI 1.19–2.79; p  < 0.01), conditional on participating hospitals and types of FE. Conclusions UV-C light disinfection of FEs without a working channel appears more effective in reducing CFUs compared to the EWD and might be a good alternative disinfection method. Trial registration Not applicable.