Reprocessing of single-use endoscopic variceal band ligation devices: a pilot study

Abstract

Background and study aims The preferred management of bleeding esophageal varices includes endoscopic band ligation. Endoscopic ligation devices (ELDs) are expensive and designed for single use, limiting their uptake in developing countries. We aimed to assess the efficacy of reprocessing ELDs using terminal microbial cultures and adenosine triphosphate (ATP) testing.

Materials and methods ELDs were recovered after clinical use and their components (cap, handle, and cord) were subjected to reprocessing. This included manual cleaning, automated high-level disinfection (HLD), and drying with forced air. Using sterile technique, ELD components were sampled for ATP at three stages: before manual cleaning, after manual cleaning, and after HLD. Components were sent to an external laboratory for culturing. Cultures were interpreted as positive upon identification of Gram-negative bacilli.

Results A total of 14 clinically used ELDs were studied, and 189 ATP tests and 41 cultures were evaluated. Overall, 95 % (39/41) of components and 86 % (12/14) of ELDs were culture-negative or did not yield Gram-negative bacilli. Two components (5 %; one handle and one cord) harbored Gram-negative bacilli in quantities of 1 CFU per component. There was no apparent correlation between ATP at any juncture of reprocessing and terminal cultures.

Conclusions Reprocessing of ELDs is effective, resulting in infrequent and minimal microbial contamination. Microbial culturing can be used to ensure adequacy of ELD reprocessing if pursued. Until reusable ELDs are commercially available, continued efforts to better define the adequacy and long-term effects of reprocessing ELDs are needed.

• References

• 1 Garcia-Tsao G, Sanyal AJ, Grace ND. et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46: 922-938
• 2 de Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clin Liver Dis 2001; 5: 645-663
• 3 D’Amico G, De Franchis R, Cooperative Study G. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology 2003; 38: 599-612
• 4 de Franchis R, Baveno VIF. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743-752
• 5 Liu J, Petersen BT, Tierney WM. et al. Endoscopic banding devices. Gastrointest Endosc 2008; 68: 217-221
• 6 Kayamba V, Sinkala E, Mwanamakondo S. et al. Trends in upper gastrointestinal diagnosis over four decades in Lusaka, Zambia: a retrospective analysis of endoscopic findings. BMC Gastroenterol 2015; 15: 127
• 7 Archampong TN, Tachi K, Agyei AA. et al. The significance of variceal haemorrhage in Ghana: a retrospective review. Ghana Med J 2015; 49: 142-146
• 8 Reprocessing Guideline Task Force, Petersen BT, Cohen J et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update. Gastrointest Endosc 2017; 85: 282-294 e1
• 9 ASGE Technology Committee, Komanduri S, Abu Dayyeh BK et al. Technologies for monitoring the quality of endoscope reprocessing. Gastrointest Endosc 2014; 80: 369-373
• 10 Centers for Disease Control and Prevention. Interim duodenoscope culture method. Available from: https://www.cdc.gov/hai/settings/lab/lab-duodenoscope-culture-method.html (Accessed February 1, 2017)
• 11 Lee YY, Tee HP, Mahadeva S. Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding. World J Gastroenterol 2014; 20: 1790-1796
• 12 Beilenhoff U, Neumann CS, Rey JF. et al. ESGE-ESGENA guideline for quality assurance in reprocessing: microbiological surveillance testing in endoscopy. Endoscopy 2007; 39: 175-181
• 13 Heeg P. Reprocessing endoscopes: national recommendations with a special emphasis on cleaning – the German perspective. J Hosp Infect 2004; 56 (Suppl. 02) 23-26
• 14 Saviuc P, Picot-Gueraud R, Shum Cheong Sing J. et al. Evaluation of the quality of reprocessing of gastrointestinal endoscopes. Infect Control Hosp Epidemiol 2015; 36: 1017-1023
• 15 Scanlon P, Flaherty K, Reilly EA. et al. Association between storage interval and contamination of reprocessed flexible endoscopes in a pediatric gastrointestinal procedural unit. Infect Control Hosp Epidemiol 2017; 38: 131-135
• 16 Alfa MJ, Fatima I, Olson N. Validation of adenosine triphosphate to audit manual cleaning of flexible endoscope channels. Am J Infect Control 2013; 41: 245-248
• 17 Hansen D, Benner D, Hilgenhoner M. et al. ATP measurement as method to monitor the quality of reprocessing flexible endoscopes. Ger Med Sci 2004; 2: Doc04
• 18 Visrodia K, Hanada Y, Pennington KM. et al. Duodenoscope reprocessing surveillance with adenosine triphosphate testing and terminal cultures: a clinical pilot study. Gastrointest Endosc 2017; 86: 180-186
• 19 Alfa MJ, Fatima I, Olson N. The adenosine triphosphate test is a rapid and reliable audit tool to assess manual cleaning adequacy of flexible endoscope channels. Am J Infect Control 2013; 41: 249-253
• 20 ASGE Quality Assurance in Endoscopy Committee, Petersen BT, Chennat J et al. Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011. Gastrointest Endosc 2011; 73: 1075-1084
• 21 ASGE Technology Committee, Parsi MA, Sullivan SA et al. Automated endoscope reprocessors. Gastrointest Endosc 2016; 84: 885-892
• 22 Ofstead CL, Wetzler HP, Doyle EM. et al. Persistent contamination on colonoscopes and gastroscopes detected by biologic cultures and rapid indicators despite reprocessing performed in accordance with guidelines. Am J Infect Control 2015; 43: 794-801
• 23 Lemoine M, Eholie S, Lacombe K. Reducing the neglected burden of viral hepatitis in Africa: strategies for a global approach. J Hepatology 2015; 62: 469-476
• 24 Ell C, May A, Wurster H. The first reusable multiple-band ligator for endoscopic hemostasis of variceal bleeding, nonvariceal bleeding and mucosal resection. Endoscopy 1999; 31: 738-740
• 25 Robinson R, Thomas M, Norwood M. et al. Endoscopic variceal band ligation (EVBL) at the 37 military hospital, Accra-Ghana: our experience with the Euro-ligator-universal (Euro Multiband Ligator). Gut 2016; 65: A282