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AIM: To correlate the length of endoscope hang time and number of bacteria cultured prior to use. METHODS: Prospectively, we cultured specimens from 19 gastroscopes, 24 colonoscopes and 5 side viewing duodenoscopes during the period of 2011 to 2015. A total of 164 results had complete data denoting date of cleansing, number of days stored and culture results. All scopes underwent initial cleaning in the endoscopy suite utilizing tap water, and then manually cleaned and flushed. High level disinfection was achieved with a Medivator© DSD (Medivator Inc., United States) automated endoscope reprocessor following manufacturer instructions, with Glutacide® (Pharmax Limited, Canada), a 2% glutaraldehyde solution. After disinfection, all scopes were stored in dust free, unfiltered commercial cabinets for up to 7 d. Prior to use, all scopes were sampled and plated on sheep blood agar for 48 h; the colony count was obtained from each plate. The length of endoscope hang time and bacterial load was analyzed utilizing unpaired t-tests. The overall percentage of positive and negative cultures for each type of endoscope was also calculated. RESULTS: All culture results were within the acceptable range (less than 200 cfu/mL). One colonoscope cultured 80 cfu/mL after hanging for 1 d, which was the highest count. ERCP scopes cultured at most 10 cfu, this occurred after 2 and 7 d, and gastroscopes cultured 50 cfu/mL at most, at 1 d. Most cultures were negative for growth, irrespective of the length of hang time. Furthermore, all scopes, with the exception of one colonoscope which had two positive cultures (each of 10 cfu/mL), had at most one positive culture. There was no significant difference in the number of bacteria cultured after 1 d compared to 7 d when all scopes were combined (day 2: P = 0.515; day 3: P = identical; day 4: P = 0.071; day 5: P = 0.470; day 6: P = 0.584; day 7: P = 0.575). There was also no significant difference in the number of bacteria cultured after 1 day compared to 7 d for gastroscopes (day 2: P = 0.895; day 3: P = identical; day 4: P = identical; day 5: P = 0.893; day 6: P = identical; day 7: P = 0.756), colonoscopes (day 2: P = 0.489; day 4: P = 0.493; day 5: P = 0.324; day 6: P = 0.526; day 7: P = identical), or ERCP scopes (day 2: P = identical; day 7: P = 0.685). CONCLUSION: There is no correlation between hang time and bacterial load. Endoscopes do not need to be reprocessed if reused within a period of 7 d.
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We present a 71-year-old man who underwent laparoscopic-assisted abdominoperineal resection for recurrence of rectal cancer, which was complicated by a urethral injury. Traumatic urinary catheter insertion was ruled out as an alternative etiology. This case highlights the importance of recognizing urethral injury as a possible complication of laparoscopic-assisted abdominoperineal resection surgery.
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BACKGROUND: Zenker diverticulum (ZD) is a rare disease usually seen in elderly patients who present with symptoms of worsening dysphagia and regurgitation. Although open surgical approach is still the standard management for symptomatic patients, the endoscopic technique has evolved as an alternative approach, especially for highly morbid patients. We are reporting our experience for treating ZD using endoscopic needle-knife papillotome. STUDY DESIGN: A total of 18 patients with a mean age of 80 years (range 68 to 91 years) were included in our prospective cohort study. All patients underwent endoscopic cricopharyngeal myotomy for symptomatic ZD using needle-knife papillotome at Brandon Regional Health Centre during a 7-year period. Mean follow-up was 27.5 months. A dysphagia score system from 0 (no dysphagia) to 4 (severe dysphagia) was used. All patients' baseline characteristics, pre- and postoperative symptoms, operative time, time to oral intake, length of hospital stay, recurrence of symptoms, and complications were analyzed. RESULTS: Dysphagia score and regurgitation symptoms improved substantially after treatment. Mean operative time was 28.4 minutes. Oral intake was resumed within 24 hours in all but 1 patient. Hospital stay for the majority was 24 to 48 hours. Only 1 patient had a microperforation treated conservatively and 2 patients had re-do procedures for persistence of dysphagia. CONCLUSIONS: Endoscopic cricopharyngeal myotomy using needle-knife papillotome is an effective approach to manage ZD for highly morbid patients. It is minimally invasive, decreases anesthetic time, shortens hospital stay, and has a low complication rate.
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Endoscopía Gastrointestinal/métodos , Divertículo de Zenker/cirugía , Anciano , Anciano de 80 o más Años , Deglución/fisiología , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Trastornos de Deglución/cirugía , Femenino , Estudios de Seguimiento , Humanos , Reflujo Laringofaríngeo/diagnóstico , Reflujo Laringofaríngeo/etiología , Reflujo Laringofaríngeo/cirugía , Tiempo de Internación , Masculino , Músculos Faríngeos/cirugía , Estudios Prospectivos , Recurrencia , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Divertículo de Zenker/complicaciones , Divertículo de Zenker/diagnósticoRESUMEN
Endoscopic repair using an endoclip device for colonic perforation following polypectomy is described. This is the first case report of a repair following a regular polypectomy-induced perforation described in the English literature.