Need for Safety Goggles for Endoscopy

Inhaltsübersicht

Although new techniques such as spectroscopy have been developed for endoscopy and have found their way into clinical application, endoscopists’ eyes are still the most important tool in everyday work [1]. However, the eyes are the instrument that is most at risk during an endoscopist’s career. Macular damage after intensive light exposure during endoscopy has been described [2]. It has also been suspected that exposure to ionizing radiation during endoscopic retrograde cholangiopancreatography (ERCP) may cause injury to the lenses of endoscopists’ eyes [3].

During a routine colonoscopic examination in a patient with a chronic stage of Crohn’s disease, with a frequency of seven diarrhea episodes per day, jet washing was required and biopsies were taken. Splashing from the instrument channel into the endoscopist’s face was noticed in the course of the examination. Two hours later, the right eye began to itch and turned red. During the following 4 h, secretion of a suppurative fluid started, which was subsequently transported to the left eye as a result of rubbing. The left eye developed the same signs of infection (Figure [1]). A diagnosis of bacterial conjunctivitis was made, and antibiotic therapy was started. The symptoms disappeared during the subsequent 24 h, with the exception of the reddening, which continued for another 5 days.

Figure 1 Reddening and suppuration in both eyes due to bacterial conjunctivitis following a routine colonoscopic examination in a patient with Crohn’s disease.

Contamination of the orbit of the eye often occurs during endoscopic procedures without being noticed. In a urological study, splashes into the eye were detectable with sodium fluorescein in 17 of 20 consecutive endoscopic procedures [4].

Staff involved in any part of an endoscopic procedure should be trained for their role and should be aware of the relevant health and safety procedures. Suitable visors or goggles should be provided in endoscopy units. It is still a matter of debate whether it is really necessary to wear lead aprons or to restrict each endoscopist to seven ERCPs a month [5].

References

• 1 Haringsma J, Tytgat G N.. The value of fluorescence techniques in gastrointestinal endoscopy: better than the endoscopist’s eye? 1: The European experience.  Endoscopy. 1998;  30 416-418
• 2 Kaiser H J, Flammer J, Miller G.. Chronic light damage to the macula of an endoscopist.  Gastrointest Endosc. 1992;  38 401-402
• 3 Cohen R V, Aldred M A, Paes W S. et al. . How safe is ERCP to the endoscopist?.  Surg Endosc. 1997;  11 615-617
• 4 Taylor J D.. AIDS and Hepatitis B and C contamination risk at transurethral resection: a study using sodium fluorescein as a marker.  Med J Aust. 1990;  153 257-260
• 5 Selmaier M, Stillkrieg W, Muller R G. et al. . Radiation burden in diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) [in German].  Z Gastroenterol. 1994;  32 671-674