1. Duodenal contamination was detected successful 11.2% of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) utilizing a modular duodenoscope and 3.8% of patients utilizing a disposable elevator headdress duodenoscope.
2. Both scopes were capable successful acquiring the aforesaid level of method success.
Level of Evidence Rating: 1 (Excellent)
Study Rundown: Endoscopic retrograde cholangiopancreatography (ERCP) is simply a captious instrumentality successful the absorption of conditions of the pancreas and biliary tree. Given the invasive quality of this procedure, it is imaginable that bacterial contamination whitethorn instrumentality place. This is combated with stringent methods of cleaning equipment, including duodenoscopes. Several caller designs for duodenoscopes person been developed successful caller years, including those with disposable elevator caps, which whitethorn trim the imaginable for contamination. The contiguous survey sought to measure the inferior of disposable elevator headdress duodenoscopes successful reducing contamination and maintaining beardown method show successful examination to modular duodenoscopes.
518 patients successful full were recruited successful this survey betwixt 2019 and 2022, including 529 patients successful the disposable headdress radical and 529 patients successful the modular duodenoscope group. 11.2% of scopes successful the modular duodenoscope radical had grounds of persistent bacterial contamination, portion lone 3.8% of the disposable headdress scopes did. Rates of method occurrence were equivalent betwixt the 2 groups (94.6% vs. 90.7%). There were nary important differences successful diligent tolerability oregon reported discomfort, nausea and abdominal distention betwixt the 2 groups. Finally, determination were nary important differences successful adverse outcomes, including ascending cholangitis, pancreatitis, bleeding, perforation and 30-day mortality betwixt the experimental and power groups.
Forbes et al demonstrated equivalent method and objective outcomes betwixt the disposable headdress and modular duodenoscopes successful performing ERCPs amongst Canadian adults, though rates of instrumentality bacterial colonization were importantly little with disposable scopes. Strengths of this proceedings included the ample fig of patients and the randomized design, which does good to power for confounding variables. Interpretation of this survey should beryllium cognizant that these results are circumstantial to the section microbial illustration astatine 2 prime healthcare centers, and therefore, outer validity is limited.
Click present to work this survey successful JAMA Internal Medicine
Click to work an accompanying editorial successful JAMA Internal Medicine
Relevant reading: Endoscopic retrograde cholangiopancreatography-related complications and their management: a “scoping” lit review
In-Depth [randomized controlled trial]: The Infection Control successful ERCP utilizing a Duodenoscope with a Disposable Cap (ICECAP) survey was a randomized, controlled proceedings conducted successful 2 Canadian centers. Eligible patients were adults undergoing ERCP who were capable to implicit 30-day follow-up. Randomization was done done a computer-based strategy successful a 1:1 fashion. The 2 outcomes of involvement were (1) measures of bacterial contamination pursuing scope cleaning (>10 colony-forming units of bacteria oregon gram-negative bacterial maturation wrong 72 hours) and (2) method occurrence of ERCP (determined by two, autarkic and blinded adjudicators based connected a priori) criteria. Standardized protocols were followed for the deployment of scopes and sterilization.
Significantly much persistent bacterial contamination was contiguous successful the modular duodenoscope radical than successful the disposable headdress radical (11.2% vs. 3.8%). The comparative hazard of bacterial contamination was 0.34 (95% assurance interval 0.16-0.75) successful favour of the experimental group. The method occurrence complaint was considered non-inferior successful the experimental radical (90.7%) versus the power radical (94.6%) (p=0.13). Rates for secondary outcomes were not importantly antithetic betwixt the 2 groups: cholangitis (0.8% vs 1.2%, P > .99), pancreatitis (3.1% vs 3.5%, P > .99), bleeding (1.9% vs 1.2%, P = .72), perforation (0.4% vs 0.0%, P > .99) and 30-day mortality (0.4% vs 0.4%, P > .99).
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