GI endoscope reprocessing: a comparative review of organizational guidelines and guide for endoscopy units and regulatory agencies

Comparison of Brushing Efficacy for Gastroscopes Using Different Brush Types Under Simulated Contamination Conditions

BACKGROUND

Channel-cleaning brushes are an important tool in the reprocessing of endoscopes.

AIM

To investigate the efficacy of cleaning brushes composed of various materials in removing organic matter from the biopsy channels of flexible endoscopes.

METHODS

A total of 168 cleaned gastroscopes were randomly divided into six groups (A, B, C1, C2, C3, and D) based on the specific characteristics of four different types of cleaning brushes. A suspension containing 12% bovine serum and 10ˆ6 units of Escherichia coli was injected into the biopsy channels of each endoscope to ensure sufficient contamination. After a 5-minute incubation period, brushing and sampling were performed according to the experimental protocol. The effectiveness of the cleaning process was evaluated using a protein detection test (PDT) and an adenosine triphosphate test (ATP).

RESULTS

Cleaning brushes constructed from metal demonstrated superior performance in removing organic matter from flexible endoscopes compared to those made of plastic (p < 0.05). Similarly, brushes with bristles made of cylindrical DuPont fibres exhibited superior cleaning efficacy compared with those made of strip microfibres or caterpillar polyolefin (p < 0.05). The brush was passed through the biopsy channel four times and achieved better results than passing it once or twice (100%).

CONCLUSION

From the perspective of cleaning outcomes and economic benefits, the use of cylindrical DuPont fibre bristles and metal shaft cleaning brushes during the reprocessing of flexible endoscopes, combined with a cleaning technique involving four brushing passes through the biopsy channel, can more effectively remove organic matter.

Impact of duodenoscope reprocessing factors on duodenoscope contamination: a retrospective observational study

BACKGROUND

Despite adherence to reprocessing protocols, duodenoscopes frequently remain contaminated, highlighting significant knowledge gaps in reprocessing efficiency.

AIM

To identify risk factors in duodenoscope reprocessing procedures affecting contamination rates.

METHODS

Cultures from Pentax ED34-i10T2 duodenoscopes collected between February 2022 and December 2023 were included. Contamination was determined by the presence of micro-organisms of gut or oral origin (MGO). Data on duodenoscope use, reprocessing lead times and personnel were retrieved from electronic medical records. Risk factors were derived from reprocessing guidelines and literature. These included a delay >30 min in initiating manual cleaning, manual cleaning duration of ≤5 min, drying time <90 min, personnel reprocessing frequency, and storage exceeding seven days. A logistic mixed-effects model evaluated these factors' impact on duodenoscope contamination.

FINDINGS

Out of 307 duodenoscope cultures, 58 (18.9%) were contaminated with MGO. Throughout the study period, the duodenoscopes underwent 1296 reprocessing cycles. Manual cleaning times of ≤5 min significantly increased contamination odds (adjusted odds ratio (aOR): 1.61; 95% confidence interval (CI): 1.10-2.34; P = 0.01). Increased usage of a duodenoscope was associated with reduced odds of contamination (aOR: 0.80; 95% CI: 0.64-0.995; P = 0.045). Other studied risks showed no clear association with contamination rates.

CONCLUSION

Manual cleaning times of ≤5 min increased the odds of contamination with MGO. Delays in reprocessing initiation and incomplete drying, traditionally considered as risk factors, were not associated with an increased risk of contamination in this study. Future research should explore whether enhanced surveillance of reprocessing times can mitigate duodenoscope contamination.

Recommendations and guidelines for endoscope reprocessing: Current position statement of digestive endoscopic society of Taiwan

Reprocessing of gastrointestinal (GI) endoscopes and accessories is an essential part of patient safety and quality control in GI endoscopy centers. However, current endoscopic reprocessing guidelines or procedures are not adequate to ensure patient-safe endoscopy. Approximately 5.4 % of the clinically used duodenoscopes remain contaminated with high-concern microorganisms. Thus, the Digestive Endoscopy Society of Taiwan (DEST) sets standards for the reprocessing of GI endoscopes and accessories in endoscopy centers. DEST organized a task force working group using the guideline-revision process. These guidelines contain principles and instructions of step-by-step for endoscope reprocessing. The updated guidelines were established after a thorough review of the existing global and local guidelines, systematic reviews, and health technology assessments of clinical effectiveness. This guideline aims to provide detailed recommendations for endoscope reprocessing to ensure adequate quality control in endoscopy centers.

Promoting Research that Supports High-Quality Gastrointestinal Endoscopy in Children

PURPOSE OF REVIEW

Defining and measuring the quality of endoscopic care is a key component of performing gastrointestinal endoscopy in children. The purpose of this review is to discuss quality metrics for pediatric gastrointestinal endoscopy and identify where additional research is needed.

RECENT FINDINGS

Pediatric-specific standards and indicators were recently defined by the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) working group through a rigorous guideline consensus process. Although the aim of these guidelines is to facilitate best practices for safe and high-quality gastrointestinal endoscopy in children, they highlight the pressing need to expand upon the body of evidence supporting these standards and indicators as predictors of clinically relevant outcomes. In this review, we propose and discuss ideas for several high-yield research topics to engage pediatric endoscopists and promote best practices in pediatric endoscopy.

Innovations in GI-endoscopy

Gastrointestinal endoscopy covers both diagnosis and therapy. Due to its diagnostic accuracy and minimal invasiveness, several innovations have been made within the last years including artificial intelligence and endoscopic tumor resection. The present review highlights some of these innovation. In addition, a special focus is set on the experience made by our own research group trying to combine the expertise of endoscopists/ physicians as well as engineers and computer scientists.