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RISS 인기검색어
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- 저자 : Shivanand Bomman (검색결과 2 건)
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Shivanand Bomman,Munish Ashat,Navroop Nagra,Mahendran Jayaraj,Shruti Chandra,Richard A Kozarek,Andrew Ross,Rajesh Krishnamoorthi 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.1
Background/Aims: Multiple outbreaks of multidrug-resistant organisms have been reported worldwide due to contaminatedduodenoscopes. In 2015, the United States Food and Drug Administration recommended the following supplemental enhancedsurveillance and reprocessing techniques (ESRT) to improve duodenoscope disinfection: (1) microbiological culture, (2) ethyleneoxide sterilization, (3) liquid chemical sterilant processing system, and (4) double high-level disinfection. A systematic review andmeta-analysis was performed to assess the impact of ESRT on the contamination rates. Methods: A thorough and systematic search was performed across several databases and conference proceedings from inceptionuntil January 2021, and all studies reporting the effectiveness of various ESRTs were identified. The pooled contamination rates ofpost-ESRT duodenoscopes were estimated using the random effects model. Results: A total of seven studies using various ESRTs were incorporated in the analysis, which included a total of 9,084 post-ESRTduodenoscope cultures. The pooled contamination rate of the post-ESRT duodenoscope was 5% (95% confidence interval [CI]:2.3%–10.8%, inconsistency index [I2]=97.97%). Pooled contamination rates for high-risk organisms were 0.8% (95% CI: 0.2%–2.7%,I2=94.96). Conclusions: While ESRT may improve the disinfection process, a post-ESRT contamination rate of 5% is not negligible. Ongoingefforts to mitigate the rate of contamination by improving disinfection techniques and innovations in duodenoscope design toimprove safety are warranted.
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Shivanand Bomman,Sofya Malashanka,Adil Ghafoor,David J. Sanders,Shayan Irani,Richard A. Kozarek,Andrew Ross,Michal Hubka,Rajesh Krishnamoorthi 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.5
Background/Aims: Transoral incisionless fundoplication (TIF) is an accepted anatomic treatment for gastroesophageal reflux disease in selected patients. In this report, we analyze our institution’s programmatic allocation of resources during the safe implementation of TIF as a new procedure. Methods: A retrospective analysis of all patients who underwent TIF from January 2020 to February 2021 at our institution was per- formed. The process of initially allocating the operating room (OR) with overnight admission and postoperative esophagram for added safety, and subsequently transitioning TIF to the endoscopy suite (ES) as an outpatient procedure was described. Patient safety and out- comes were evaluated during transition. Results: Thirty patients who underwent TIF were identified. The mean age was 51.2±16.0 years. TIF was performed in an OR in nine patients (30%) and 21 (70%) in the ES. All the OR patients were admitted overnight and had routine esophagogram. In contrast, four (19%) from the ES group required clinically-indicated admission and three (14.2%) required esophagram. The mean procedure dura- tion was significantly lower in the ES group (65.7 min vs. 84 min, p=0.02). Conclusions: A stepwise, resource-efficient process was described that allowed safe initiation of TIF as a new technique and its effec- tive transition to a fully outpatient procedure.
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