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Essam ME, Beintaris I, Rutter MD. Postcolonoscopy Diverticulitis. ACG Case Rep J 2024; 11:e01362. [PMID: 38737096 PMCID: PMC11086960 DOI: 10.14309/crj.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
Colonoscopy, generally safe but not devoid of risks, can lead to rare complications. We present 2 cases of postcolonoscopy diverticulitis (PCD). Case 1 was a 63-year-old woman, following colonoscopy, who developed acute sigmoid diverticulitis, despite a Diverticular Inflammation and Complication Assessment (DICA) score of 2, indicating extensive diverticulosis without inflammation. Conservative management with antibiotics led to recovery. Remarkably, she experienced a recurrent episode. Case 2 was a 74-year-old woman who had 2 colonoscopies, revealing pancolonic diverticulosis (DICA score: 2) without inflammation. After the second procedure, she developed severe sigmoid diverticulitis, managed conservatively with antibiotics. Discussion highlights PCD's rarity (prevalence: 0.04%-0.08%) and unclear pathogenesis. Both cases had DICA scores ≥2, suggesting a potential risk factor. Clinicians should recognize PCD, as it can mimic more common postcolonoscopy complications. Early recognition and management are vital.
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Affiliation(s)
- Mahmoud E. Essam
- Department of Gastroenterology, University Hospital of North Tees and Hartlepool, Stockton-On Tees, United Kingdom
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iosif Beintaris
- Department of Gastroenterology, University Hospital of North Tees and Hartlepool, Stockton-On Tees, United Kingdom
| | - Matthew D. Rutter
- Department of Gastroenterology, University Hospital of North Tees and Hartlepool, Stockton-On Tees, United Kingdom
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Goyal H, Larsen S, Perisetti A, Larsen NB, Ockert LK, Adamsen S, Tharian B, Thosani N. Gastrointestinal endoscope contamination rates - elevators are not only to blame: a systematic review and meta-analysis. Endosc Int Open 2022; 10:E840-E853. [PMID: 35692921 PMCID: PMC9187382 DOI: 10.1055/a-1795-8883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/31/2022] [Indexed: 10/27/2022] Open
Abstract
Background and study aims Duodenoscopes that are contaminated due to inadequate reprocessing are well-documented. However, studies have demonstrated poor reprocessing of other kinds of endoscopes as well, including echoendoscopes, gastroscopes, and colonoscopes. We estimated the contamination rate beyond the elevator of gastrointestinal endoscopes based on available data. Methods We searched PubMed and Embase from January 1, 2010 to October 10, 2020, for studies investigating contamination rates of reprocessed gastrointestinal endoscopes. A random-effects model was used to calculate the contamination rate of patient-ready gastrointestinal endoscopes. Subgroup analyses were conducted to investigate differences among endoscope types, countries, and colony-forming unit (CFU) thresholds. Results Twenty studies fulfilled the inclusion criteria, including 1,059 positive cultures from 7,903 samples. The total contamination rate was 19.98 % ± 0.024 (95 % confidence interval [Cl]: 15.29 %-24.68 %; I 2 = 98.6 %). The contamination rates of colonoscope and gastroscope channels were 31.95 % ± 0.084 and 28.22 % ± 0.076, respectively. Duodenoscope channels showed a contamination rate of 14.41 % ± 0.029. The contamination rates among studies conducted in North America and Europe were 6.01 % ± 0.011 and 18.16% ± 0.053 %, respectively. The contamination rate among studies using a CFU threshold > 20 showed contamination of 30.36 % ± 0.094, whereas studies using a CFU threshold < 20 showed a contamination rate of 11 % ± 0.026. Conclusions On average, 19.98 % of reprocessed gastrointestinal endoscopes may be contaminated when used in patients and varies between different geographies. These findings highlight that the elevator mechanism is not the only obstacle when reprocessing reusable endoscopes; therefore, guidelines should recommend more surveillance of the endoscope channels as well.
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Affiliation(s)
- Hemant Goyal
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology, Hepatology & Nutrition, McGovern Medical School, UTHealth, Houston, Texas, United States,Clinical Assistant Professor, Mercer University School of Medicine, Macon, Georgia, United States
| | | | - Abhilash Perisetti
- Division of Interventional Oncology & Surgical Endoscopy (IOSE). Parkview Cancer Institute, Wayne, Indiana, United States
| | | | - Lotte Klinten Ockert
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology, Hepatology & Nutrition, McGovern Medical School, UTHealth, Houston, Texas, United States
| | - Sven Adamsen
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology, Hepatology & Nutrition, McGovern Medical School, UTHealth, Houston, Texas, United States,Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Benjamin Tharian
- General and Advanced Endoscopy, Assoc. Prof of Medicine, University of Arkansas for Medical Sciences Little Rock, Arkansas, United States
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology, Hepatology & Nutrition, McGovern Medical School, UTHealth, Houston, Texas, United States
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Deb A, Perisetti A, Goyal H, Aloysius MM, Sachdeva S, Dahiya D, Sharma N, Thosani N. Gastrointestinal Endoscopy-Associated Infections: Update on an Emerging Issue. Dig Dis Sci 2022; 67:1718-1732. [PMID: 35262904 DOI: 10.1007/s10620-022-07441-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/07/2022] [Indexed: 02/06/2023]
Abstract
Over 17.7 million gastrointestinal (GI) endoscopic procedures are performed annually, contributing to 68% of all endoscopic procedures in the United States. Usually, endoscopic procedures are low risk, but adverse events may occur, including cardiopulmonary complications, bleeding, perforation, pancreatitis, cholangitis, and infection. Infections after the GI endoscopies most commonly result from the patient's endogenous gut flora. Although many studies have reported infection after GI endoscopic procedures, a true estimate of the incidence rate of post-endoscopy infection is lacking. In addition, the infection profile and causative organisms have evolved over time. In recent times, multi-drug-resistant microorganisms have emerged as a cause of outbreaks of endoscope-associated infections (EAI). In addition, lapses in endoscope reprocessing have been reported, with some but not all outbreaks in recent times. This systematic review summarizes the demographical, clinical, and management data of EAI events reported in the literature. A total of 117 articles were included in the systematic review, with the majority reported from North America and Western Europe. The composite infection rate was calculated to be 0.2% following GI endoscopic procedures, 0.8% following ERCP, 0.123% following non-ERCP upper GI endoscopic procedures, and 0.073% following lower GI endoscopic procedures. Pseudomonas aeruginosa was the most common culprit organism, followed by other Enterobacteriaceae groups of organisms and Gram-positive cocci. We have also elaborated different prevention methods such as antimicrobial prophylaxis, adequate sterilization methods for reprocessing endoscopes, periodic surveillance, and current evidence supporting their utilization. Finally, we discuss disposable endoscopes, which could be an alternative to reprocessing to minimize the chances of EAIs with their effects on the environmental and financial situation.
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Affiliation(s)
- Anasua Deb
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Abhilash Perisetti
- Advance Endoscopy, Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, 11050 Parkview Circle, Fort Wayne, IN, 46845, USA
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, 501 S. Washington Avenue, Scranton, PA, 18503, USA.
| | - Mark M Aloysius
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, 501 S. Washington Avenue, Scranton, PA, 18505, USA
- Geisinger Commonwealth School of Medicine, 525, Pine Street, Scranton, PA, 18510, USA
| | - Sonali Sachdeva
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Dushyant Dahiya
- Central Michigan University College of Medicine, 1000 Houghton Ave, Saginaw, MI, 48603, USA
| | - Neil Sharma
- Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, 11050 Parkview Circle, Fort Wayne, IN, 46845, USA
- Indiana University School of Medicine, Fort Wayne, IN, USA
| | - Nirav Thosani
- Division of Gastroenterology, Hepatology & Nutrition, Center for Interventional Gastroenterology at UTHealth (iGUT), Atilla Ertan MD Chair in Gastroenterology, Hepatology & Nutrition, McGovern Medical School, UTHealth, Houston, USA
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Endoscopic excision as a viable alternative to major resection for early duodenal cancers: A population-based cohort study. Int J Surg 2022; 101:106644. [PMID: 35500880 DOI: 10.1016/j.ijsu.2022.106644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/29/2022] [Accepted: 04/26/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Duodenal cancer presents an elusive therapeutic challenge for clinicians to treat because of its highly malignant behavior and anatomical complexity. Endoscopic excision has been administered to treat early-stage cancers of upper gastrointestinal tract, especially esophagus and stomach cancer. There is currently a scarcity of data regarding the application and efficacy of endoscopic resection for early duodenal cancer due to its rarity. This study aimed at exploring the prevalence and efficacy of endoscopic excision in treatment for early duodenal cancer in comparison with major surgery. METHODS This cohort study retrospectively collected patients with primary Tis/T1-N0-M0 duodenal cancer in the Surveillance, Epidemiology, and End Results database from 2004 to 2017. Prevalence of endoscopic excision in duodenal cancer treatment, overall survival (OS) and disease-specific survival (DSS) of patients who received different tumor-resection procedures were estimated. RESULTS A total of 1354 patients with Tis/T1-stage duodenal cancer were identified. Most patients (69.4%) underwent tumor resection as initial treatments. Among them, 65.7% underwent endoscopic excision, while 34.3% underwent major surgery. The multivariable Cox analyses revealed that endoscopic excision was associated with a significantly favorable OS (HR: 0.70; 95% CI: 0.52-0.95, p = 0.02) and DSS (HR: 0.32; 95% CI: 0.17-0.60, p < 0.001), compared to major surgery, for Tis/T1-stage cancer patients. In addition to cancer-related deaths (p < 0.001), endoscopic resection manifested significantly lower cumulative mortality rate of post-operative infectious diseases (p = 0.03). CONCLUSION Endoscopic resection currently accounted for approximately two-thirds of all procedures to resect Tis/T1-stage duodenal tumor. Endoscopic resection represents a viable therapeutic option in the management of Tis/T1-stage duodenal cancer for its oncological superiorities to major surgery and its capacity to reduce operative traumas and morbidities.
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Li DF, Shi RY, Tian YH, Xu ZL, Zhou YS, Sun XJ, Cai JW, Fang YY, Peng H, Wang JM, Dong T, Cai YD, Yao J, Wang LS. The feasibility and safety of disposable endoscope vs. conventional endoscope for upper gastrointestinal tract examination: a multicenter, randomized, parallel, non-inferiority trial. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:1314-1319. [PMID: 34768288 PMCID: PMC9477113 DOI: 10.1055/a-1555-0568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background
A disposable upper gastrointestinal endoscope can effectively decrease infectious outbreaks associated with endoscope reuse. In the present study, we aimed to evaluate the feasibility and safety of a disposable endoscope for upper gastrointestinal examination.
Methods
In a prospective, randomized trial, 144 upper endoscopic procedures were allocated to either the disposable endoscope group or the conventional endoscope group. The primary outcomes were rates of excellent and good image qualities and maneuverability satisfaction. The second outcome included procedure duration, endoscopic diagnosis, and adverse events.
Results
A total of 144 subjects were enrolled in the present analysis and prospectively randomized to 2 study groups. Finally, 70 and 69 subjects were enrolled in the novel disposable endoscope group and the conventional endoscope group, respectively, due to the schedule cancellation of 5 subjects. The baseline characteristics of the patients were similar in both groups. The excellent and good image quality rates and maneuverability satisfaction of the novel disposable endoscope were not inferior to the conventional endoscope (p = 0.99 and p = 0.99, respectively). Moreover, no significant between-group difference was observed in the endoscopic results and adverse events (p = 0.30 and p = 1, respectively). However, the procedure duration in the novel disposable endoscope was longer compared with the conventional endoscope (8.40 ± 4.28 min
vs.
5.12 ± 2.65 min, p < 0.001).
Conclusions
The novel disposable endoscope was as safe, effective, and maneuverable as a conventional endoscope. However, the novel disposable endoscope was associated with a longer procedure duration.
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Affiliation(s)
- De-Feng Li
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
| | - Rui-Yue Shi
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
| | - Yan-Hui Tian
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
| | - Zheng-Lei Xu
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
| | - Ying-Sheng Zhou
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Xian-Jiu Sun
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Jin-Wei Cai
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Yuan-Yuan Fang
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Huan Peng
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Jia-Min Wang
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Tao Dong
- Shenzhen Pengrui Intelligent Image Co., Ltd
| | | | - Jun Yao
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
| | - Li-Sheng Wang
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
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Huang HE, Yen SY, Chu CF, Suk FM, Lien GS, Liu CW. Autonomous navigation of a magnetic colonoscope using force sensing and a heuristic search algorithm. Sci Rep 2021; 11:16491. [PMID: 34389760 PMCID: PMC8363733 DOI: 10.1038/s41598-021-95760-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/30/2021] [Indexed: 12/22/2022] Open
Abstract
This paper presents an autonomous navigation system for cost-effective magnetic-assisted colonoscopy, employing force-based sensors, an actuator, a proportional-integrator controller and a real-time heuristic searching method. The force sensing system uses load cells installed between the robotic arm and external permanent magnets to derive attractive force data as the basis for real-time surgical safety monitoring and tracking information to navigate the disposable magnetic colonoscope. The average tracking accuracy on magnetic field navigator (MFN) platform in x-axis and y-axis are 1.14 ± 0.59 mm and 1.61 ± 0.45 mm, respectively, presented in mean error ± standard deviation. The average detectable radius of the tracking system is 15 cm. Three simulations of path planning algorithms are presented and the learning real-time A* (LRTA*) algorithm with our proposed directional heuristic evaluation design has the best performance. It takes 75 steps to complete the traveling in unknown synthetic colon map. By integrating the force-based sensing technology and LRTA* path planning algorithm, the average time required to complete autonomous navigation of a highly realistic colonoscopy training model on the MFN platform is 15 min 38 s and the intubation rate is 83.33%. All autonomous navigation experiments are completed without intervention by the operator.
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Affiliation(s)
- Hao-En Huang
- Department of Electrical Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 10617, Taiwan (R.O.C.).
| | - Sheng-Yang Yen
- Department of Electrical Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 10617, Taiwan (R.O.C.)
| | - Chia-Feng Chu
- Department of Electrical Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 10617, Taiwan (R.O.C.)
| | - Fat-Moon Suk
- Division of Gastroenterology, Department of Internal Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (R.O.C.).,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (R.O.C.)
| | - Gi-Shih Lien
- Division of Gastroenterology, Department of Internal Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (R.O.C.).,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (R.O.C.)
| | - Chih-Wen Liu
- Department of Electrical Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 10617, Taiwan (R.O.C.)
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Kim JS, Jung E, Kang SH, Ji JS, Cho YK, Lee BI, Cho YS, Kim BW, Choi H, Jeong HY, Choi MG, Park JM. Safety of Endoscopy in Peritoneal Dialysis Patients. Clin Transl Gastroenterol 2021; 12:e00379. [PMID: 34193802 PMCID: PMC8345910 DOI: 10.14309/ctg.0000000000000379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Endoscopic procedures can provoke peritonitis in patients receiving peritoneal dialysis (PD). The aim of this study was to assess the development of peritonitis after endoscopic procedures in PD patients. METHODS We retrospectively reviewed the data from PD patients who underwent endoscopies in 3 tertiary hospitals between 2008 and 2018. The patients were grouped into nonprophylactic, prophylactic, and prior antibiotic therapy groups. The incidence of peritonitis within 7 days of endoscopy was assessed. We also examined the factors associated with peritonitis. RESULTS There were 1,316 endoscopies performed in 570 PD patients. The peritonitis rate after endoscopy was 3.0%. Specifically, the peritonitis rate was 1.8% for esophagogastroduodenoscopies, 4.2% for the colonoscopy group, and 5.3% for the sigmoidoscopy group. The prior antibiotic therapy group showed a significantly higher risk of peritonitis (odds ratio = 4.6; 95% confidence interval: 2.2-9.6; P < 0.01). Prophylactic antibiotics were not associated with reducing peritonitis. Therapeutic colonoscopies such as polypectomy were associated with an increased risk of developing peritonitis (odds ratio = 6.5; 95% confidence interval: 1.6-25.9). However, biopsies were not associated with an increased risk of peritonitis. DISCUSSION Prophylactic antibiotics did not reduce the risk of peritonitis after endoscopy in PD patients. Therapeutic colonoscopies such as polypectomy and prior antibiotic therapy before endoscopy were associated with an increased risk of peritonitis.
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Affiliation(s)
- Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eunha Jung
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeong-Seon Ji
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu Kyung Cho
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Seok Cho
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hwang Choi
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Yong Jeong
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Myung Park
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Ng ZQ, Tan JH, Tan HCL, Theophilus M. Post-colonoscopy diverticulitis: A systematic review. World J Gastrointest Endosc 2021; 13:82-89. [PMID: 33763188 PMCID: PMC7958466 DOI: 10.4253/wjge.v13.i3.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/31/2020] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Post-colonoscopy diverticulitis is increasingly recognized as a potential complication. However, the evidence is sparse in the literature.
AIM To systematically review all available evidence to describe the incidence, clinical course with management and propose a definition.
METHODS The databases PubMed, EMBASE and Cochrane databases were searched using with the keywords up to June 2020. Additional manual search was performed and cross-checked for additional references. Data collected included demographics, reason for colonoscopy, time to diagnosis, method of diagnosis (clinical vs imaging) and management outcomes.
RESULTS A total of nine studies were included in the final systematic review with a total of 339 cases. The time to diagnosis post-colonoscopy ranged from 2 h to 30 d. Clinical presentation for these patients were non-specific including abdominal pain, nausea/vomiting, per rectal bleeding and chills/fever. Majority of the cases were diagnosed based on computed tomography scan. The management for these patients were similar to the usual patients presenting with diverticulitis where most resolve with non-operative intervention (i.e., antibiotics and bowel rest).
CONCLUSION The entity of post-colonoscopy diverticulitis remains contentious where there is a wide duration post-procedure included. Regardless of whether this is a true complication post-colonoscopy or a de novo event, early diagnosis is vital to guide appropriate treatment. Further prospective studies especially registries should include this as a complication to try to capture the true incidence.
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Affiliation(s)
- Zi Qin Ng
- Department of General Surgery, St John of God Midland Hospital, Midland 6056, Western Australia, Australia
| | - Jih Huei Tan
- Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru 80100, Johor, Malaysia
| | - Henry Chor Lip Tan
- Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru 80100, Johor, Malaysia
| | - Mary Theophilus
- Department of General Surgery, St John of God Midland Hospital, Midland 6056, Western Australia, Australia
- Curtin Medical School, Curtin University, Bentley 6102, Western Australia, Australia
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9
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Ciuti G, Skonieczna-Żydecka K, Marlicz W, Iacovacci V, Liu H, Stoyanov D, Arezzo A, Chiurazzi M, Toth E, Thorlacius H, Dario P, Koulaouzidis A. Frontiers of Robotic Colonoscopy: A Comprehensive Review of Robotic Colonoscopes and Technologies. J Clin Med 2020; 9:E1648. [PMID: 32486374 PMCID: PMC7356873 DOI: 10.3390/jcm9061648] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
Flexible colonoscopy remains the prime mean of screening for colorectal cancer (CRC) and the gold standard of all population-based screening pathways around the world. Almost 60% of CRC deaths could be prevented with screening. However, colonoscopy attendance rates are affected by discomfort, fear of pain and embarrassment or loss of control during the procedure. Moreover, the emergence and global thread of new communicable diseases might seriously affect the functioning of contemporary centres performing gastrointestinal endoscopy. Innovative solutions are needed: artificial intelligence (AI) and physical robotics will drastically contribute for the future of the healthcare services. The translation of robotic technologies from traditional surgery to minimally invasive endoscopic interventions is an emerging field, mainly challenged by the tough requirements for miniaturization. Pioneering approaches for robotic colonoscopy have been reported in the nineties, with the appearance of inchworm-like devices. Since then, robotic colonoscopes with assistive functionalities have become commercially available. Research prototypes promise enhanced accessibility and flexibility for future therapeutic interventions, even via autonomous or robotic-assisted agents, such as robotic capsules. Furthermore, the pairing of such endoscopic systems with AI-enabled image analysis and recognition methods promises enhanced diagnostic yield. By assembling a multidisciplinary team of engineers and endoscopists, the paper aims to provide a contemporary and highly-pictorial critical review for robotic colonoscopes, hence providing clinicians and researchers with a glimpse of the major changes and challenges that lie ahead.
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Affiliation(s)
- Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Karolina Skonieczna-Żydecka
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland;
- Endoklinika sp. z o.o., 70-535 Szczecin, Poland
| | - Veronica Iacovacci
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Hongbin Liu
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 7EH, UK;
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London W1W 7TY, UK;
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, 10126 Torino, Italy;
| | - Marcello Chiurazzi
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, 20502 Malmö, Sweden;
| | - Henrik Thorlacius
- Department of Clinical Sciences, Section of Surgery, Lund University, 20502 Malmö, Sweden;
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
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10
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Abstract
The purpose of this study is to review the cases of postcolonoscopy appendicitis (PCA) reported in the literature. A comprehensive search using PubMed, EMBASE, Scopus, and Google Scholar identified 57 cases. The median age at presentations of PCA was 55 years. PCAs typically occurred during the first 24 hours after colonoscopy, and the majority developed after diagnostic colonoscopy. Clinical presentations were similar to those with common acute appendicitis, though with a high perforation rate. Most patients were correctly diagnosed using ultrasound or computed tomography scan. Treatment included open appendicectomy, laparoscopic appendicectomy or cecotomy, radiologic drainage of the abscess, nonoperative treatment with antibiotics. In addition to barotrauma, fecalith impaction into the appendiceal lumen, direct trauma to the appendiceal orifice, and underlying ulcerative colitis, a pre-existing subclinical disease of the appendix seems to play an important role in the pathogenesis. For PCA, timely diagnosis and management are crucial to attain a satisfactory outcome.
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Larsen S, Kalloo A, Hutfless S. The hidden cost of colonoscopy including cost of reprocessing and infection rate: the implications for disposable colonoscopes. Gut 2020; 69:197-200. [PMID: 31413166 PMCID: PMC6984057 DOI: 10.1136/gutjnl-2019-319108] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/23/2019] [Accepted: 08/08/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Sara Larsen
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Anthony Kalloo
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Susan Hutfless
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States .,Gastrointestinal Epidemiology Research Center, Johns Hopkins University, Baltimore, Maryland, United States.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
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12
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Rauwers AW, Troelstra A, Fluit AC, Wissink C, Loeve AJ, Vleggaar FP, Bruno MJ, Vos MC, Bode LG, Monkelbaan JF. Independent root-cause analysis of contributing factors, including dismantling of 2 duodenoscopes, to investigate an outbreak of multidrug-resistant Klebsiella pneumoniae. Gastrointest Endosc 2019; 90:793-804. [PMID: 31102643 DOI: 10.1016/j.gie.2019.05.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Worldwide, an increasing number of duodenoscope-associated outbreaks are reported. The high prevalence rate of contaminated duodenoscopes puts patients undergoing ERCP at risk of exogenous transmission of microorganisms. The contributing factors of the duodenoscope design to contamination are not well understood. This article reports on the investigation after the outbreak of a multidrug-resistant Klebsiella pneumoniae (MRKP) related to 2 Olympus TJF-Q180V duodenoscopes. METHODS We conducted a contact patient screening and microbiologic laboratory database search. Reprocessing procedures were audited, and both duodenoscopes were fully dismantled to evaluate all potential contamination factors. Outcomes were reviewed by an experienced independent expert. RESULTS In total, 102 patients who had undergone an ERCP procedure from January to August 2015 were invited for screening. Cultures were available of 81 patients, yielding 27 MRKP-infected or -colonized patients. Ten patients developed an MRKP-related active infection. The 2 duodenoscopes had attack rates (the number of infected or colonized cases/number of exposed persons) of 35% (17/49) and 29% (7/24), respectively. Identical MRKP isolates were cultured from channel flushes of both duodenoscopes. The review revealed 4 major abnormalities: miscommunication about reprocessing, undetected damaged parts, inadequate repair of duodenoscope damage, and duodenoscope design abnormalities, including the forceps elevator, elevator lever, and instrumentation port sealing. CONCLUSIONS Outbreaks are associated with a combination of factors, including duodenoscope design issues, repair issues, improper cleaning, and systemic monitoring of contamination. To eliminate future duodenoscope-associated infections, a multipronged approach is required, including clear communication by all parties involved, a reliable servicing market, stringent surveillance measures, and eventually new duodenoscope designs and reprocessing procedures with a larger margin of safety.
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Affiliation(s)
- Arjan W Rauwers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Annet Troelstra
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ad C Fluit
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Camiel Wissink
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arjo J Loeve
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands; Co van Ledden Hulsebosch Center for Forensic Science and Medicine, Amsterdam, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lonneke G Bode
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan F Monkelbaan
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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