Digestive Endoscopy 2015; 27: 636–638
doi: 10.1111/den.12486
WEO Newsletter Absent
Present
WEO COMMITTEE PARTICIPATES IN THE DEVELOPMENT OF DIAGNOSTIC ALGORITHM FOR EARLY GASTRIC CANCER By Mitsuru Kaise, WEO Gastric Cancer Subcommittee Chair and Hisao Tajiri, WEO Upper GI Cancer Committee Chair
The WEO Upper GI Cancer Committee, chaired by Professor Hisao Tajiri, has been instrumental in the development of a new algorithm for the detection of early gastric cancer. In particular, members of the Gastric Cancer Subcommittee, headed by Professor Mitsuru Kaise, actively participated in the research efforts that led to the final version of the algorithm. In cooperation between the Japanese Gastroenterological Association (JGA), the Japanese Gastrointestinal Endoscopy Society (JGES) and the Japanese Gastric Cancer Association (JGCA), a task force was put together and initiated its activities in early 2013. The main goal of the initiative was to create a unified, international algorithm of magnifying endoscopy for the diagnosis of early gastric cancer, using an evidencebased approach. Since then, the task force has been working consistently to develop the diagnostic algorithm. All findings were reviewed by the task force in February 2015 during the international symposium ‘Diagnostic algorithms for early gastric cancer –international consensuses’ – held during the 11th Annual Meeting of the JGA, in Tokyo, Japan. The international members of the WEO Gastric Cancer Subcommittee were present, and the participants reached the necessary international consensuses. The algorithms cover gastric cancer diagnosis as well as endoscopic imaging of non-neoplastic gastric mucosa, including mucosa in Helicobacter pylori-associated chronic gastritis, and metaplastic mucosa. Figure 1 shows the main schema of the diagnostic algorithm for early gastric cancer using magnifying endoscopy. Figure 2 demonstrates representative endoscopic images of early
bs_bs_banner
636
Figure 1 Diagnostic algorithm schema. GCA, gastric cancer algorithm; MS, microsurface pattern; MV, microvascular pattern.
gastric cancer and non-cancerous depressions that mimic cancer with white light endoscopy and chromoendoscopy. The next step is to submit the algorithm for publication. The task force expects that it will soon be published in the journal Digestive Endoscopy (DEN).
Figure 2 Endoscopic images of early gastric cancer. (A) regular MV pattern, (B) regular MS pattern and (C) irregular MV and MS pattern.
© 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society
Digestive Endoscopy 2015; 27: 636–638
WEO Newsletter
DUODENOSCOPE REPROCESSING: A SEEMINGLY MUNDANE TASK WITH MAJOR IMPLICATIONS FOR PATIENT SAFETY By John Baillie, Director of Endoscopy, Virginia Commonwealth University, Richmond, VA, USA
Cannulating the duodenal papilla for endoscopic retrograde cholangiopancreatography.
As it is technically difficult, time-consuming and expensive to sterilize endoscopes, endoscopy units have had to settle for high-grade disinfection instead. For most of the 45 years or so that endoscopic retrograde cholangiopancreatography (ERCP) has been available as an ‘advanced endoscopic procedure’, this level of cleaning – now done in automated ‘washing machines’ – has proven generally adequate to eliminate harmful pathogens. However, the specter of nosocomial infection from duodenoscopes has always lurked in the shadows, as evidenced by occasional outbreaks of bacterial infections in patients who have undergone ERCP. Typically, these involved ‘exotic’ pathogens, such as Pseudomonas aeruginosa and Serracia marescens, and fatalities were reported. These outbreaks were usually traced to inadequate disinfection protocols or defective automated cleaning systems. Recently, duodenoscope-transmitted infections with carbapenem-resistant Enterobacteriaceae (CRE) species have been reported from some major centers in the USA, including the Virginia Mason Medical Center in Seattle, WA, the University of Pittsburgh, PA and UCLA (Cedars Sinai Hospital), Los Angeles, CA. The source of these infections appears to be the elevator mechanism at the tip of the duodenoscope equipment channel. This mechanism has always required special attention during cleaning, as it tends to retain solid material. For this reason, the elevator site gets vigorously brushed as part of the process. Unfortunately, it appears that even special attention does not completely eliminate the risk of CRE infection from the elevator. In the wake of huge publicity and public concern, the US Food and Drug Administration (FDA) and Center for Disease
637
Control (CDC) have convened panels to solicit expert input from industry, microbiologists, safety experts and, of course, ERCP endoscopists on how duodenoscope reprocessing can be improved. Endoscopy units in the USA have been encouraged to culture all of their ERCP endoscopes to look specifically for CRE, and report the results to the CDC. The CDC recently issued interim guidelines for duodenoscope reprocessing (http://www.cdc.gov/hai/organisms/cre/cre-duodenoscope-surveillance-protocol.html) suggesting bacterial cultures monthly, or after every 60 ERCP procedures, whichever comes first. Endoscopic ultrasound (EUS) endoscopes which incorporate elevator devices will be subject to the same requirement. A final ruling on the issue by the FDA is expected by the summer of 2015. It seems likely that a redesign of duodenoscope tips to render them detachable for cleaning will be mandated. The author is aware that the three principal duodenoscope manufacturers are already working on this. The elevator mechanism may need to become disposable, as it appears impossible to guarantee its freedom from contamination using current sterilization techniques. Those who carry out ERCP are encouraged to monitor the progress of this fast-moving discussion through their USbased professional organizations, such as the American Society for Gastrointestinal Endoscopy (ASGE) (www.asge.org).
WEO STRENGTHENS RELATIONSHIPS IN THE MIDDLE-EAST AND NORTHERN AFRICA
Dr Rey’s presentation during the VCE course In April this year, WEO had the honor to be involved in two educational initiatives in the Middle-East and Northern Africa, which served to cement the collaboration with endoscopic societies in the region. On 1 April 2015, as an official pre-activity of the annual congress of the Emirates Gastroenterology & Hepatology Society (EGHS) held in Dubai, United Arab Emirates (UAE), two WEO courses were delivered: Video Capsule Endoscopy (VCE) training; and Advanced Diagnostic Endoscopy Course
© 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society
638
WEO Newsletter
(ADEC) for a set of attentive participants from UAE and surrounding countries. Dr Jean-Francois Rey (France), Prof Naohisa Yahagi (Japan) and Dr Edward Despott (UK), acted as the international faculty and were joined by the two local faculty, Dr Basheer Elfaki and Dr Wagdy Emile. All faculty worked seamlessly during the hands-on training to support participants during the full-day course. Participants’ feedback was extremely positive for this first course, and both societies hope this partnership will continue. Immediately after the event in Dubai, WEO supported the organization of the Postgraduate Course which took place in Cairo, Egypt. Directed by Professor Anthony Axon (UK) and Professor Magdi El-Serafy (Egypt), the course had ‘Quality in Endoscopy’ as its main theme. It was held during 4–5 April and was a result of the scientific collaboration between WEO and the Egyptian Society for the Study of Endoscopy and Hepato-Gastroenterology (ESEHG). The program attracted a high number of participants with approximately 250 Egyptian and Arab doctors in attendance. Professor El-Serafy commented on the success of the course: ‘Our young colleagues gave us positive feedback and many suggestions to repeat similar educational meetings. It is my intention to follow through with their suggestions’.
ESGE/EASL/ESGAR PRESENT: QUALITY IN ENDOSCOPY ERCP AND EUS Spearheaded by the European Society of Gastrointestinal Endoscopy (ESGE), the upcoming ERCP and EUS symposium will continue the successful series of cutting-edge Quality in Endoscopy events. ESGE is closely affiliated to WEO, representing the European / Mediterranean zone. Date: 13–14 November 2015 Event organizers: ESGE/EASL/ESGAR Venue: Aquincum Hotel, Budapest, Hungary
Digestive Endoscopy 2015; 27: 636–638
The ERCP & EUS symposium is tailored for doctors, especially young fellows and junior physicians, across the fields of gastroenterology/endoscopy, surgery, surgical endoscopy, interventional radiology, and internal medicine. The symposium will cover topics including preparations for ERCP and EUS, conquering the papilla, biliary stone disease, biliary strictures, and pancreatitis as well as diagnostic and therapeutic EUS. Interaction, including the exchange of ideas, clinical experiences and knowledge between faculty and participants is a central element of the symposia. ESGE’s Quality in Endoscopy symposia have demonstrated that the combination of highly communicative teaching with a strong, supportive and dedicated faculty is the key to the success of these meetings. Alongside senior speakers, presenters from the up-andcoming younger generation will contribute to innovative and lively sessions. To find out more about this event, please visit the Quality in Endoscopy website www.quality-in-endoscopy.org
WEO ENDORSED MEETINGS WEO is proud to endorse the following meetings taking place in the second semester of 2015: • 1st Asian EUS Congress to be held September 11-12 at Asan Medical Center, Seoul, Korea. For more information, visit the website http://www. interventionaleus2015.com/images/1st_asian_eus_ congress_seoul,_korea.pdf • Jakarta International GI Endoscopy Symposium & Live Demonstration 2015 to be held October 30-31, in Jakarta, Indonesia. For more information, please contact the Indonesian Society for Digestive Endoscopy (ISDE) by email at [email protected]
© 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society
doi: 10.1111/den.12486
WEO Newsletter Absent
Present
WEO COMMITTEE PARTICIPATES IN THE DEVELOPMENT OF DIAGNOSTIC ALGORITHM FOR EARLY GASTRIC CANCER By Mitsuru Kaise, WEO Gastric Cancer Subcommittee Chair and Hisao Tajiri, WEO Upper GI Cancer Committee Chair
The WEO Upper GI Cancer Committee, chaired by Professor Hisao Tajiri, has been instrumental in the development of a new algorithm for the detection of early gastric cancer. In particular, members of the Gastric Cancer Subcommittee, headed by Professor Mitsuru Kaise, actively participated in the research efforts that led to the final version of the algorithm. In cooperation between the Japanese Gastroenterological Association (JGA), the Japanese Gastrointestinal Endoscopy Society (JGES) and the Japanese Gastric Cancer Association (JGCA), a task force was put together and initiated its activities in early 2013. The main goal of the initiative was to create a unified, international algorithm of magnifying endoscopy for the diagnosis of early gastric cancer, using an evidencebased approach. Since then, the task force has been working consistently to develop the diagnostic algorithm. All findings were reviewed by the task force in February 2015 during the international symposium ‘Diagnostic algorithms for early gastric cancer –international consensuses’ – held during the 11th Annual Meeting of the JGA, in Tokyo, Japan. The international members of the WEO Gastric Cancer Subcommittee were present, and the participants reached the necessary international consensuses. The algorithms cover gastric cancer diagnosis as well as endoscopic imaging of non-neoplastic gastric mucosa, including mucosa in Helicobacter pylori-associated chronic gastritis, and metaplastic mucosa. Figure 1 shows the main schema of the diagnostic algorithm for early gastric cancer using magnifying endoscopy. Figure 2 demonstrates representative endoscopic images of early
bs_bs_banner
636
Figure 1 Diagnostic algorithm schema. GCA, gastric cancer algorithm; MS, microsurface pattern; MV, microvascular pattern.
gastric cancer and non-cancerous depressions that mimic cancer with white light endoscopy and chromoendoscopy. The next step is to submit the algorithm for publication. The task force expects that it will soon be published in the journal Digestive Endoscopy (DEN).
Figure 2 Endoscopic images of early gastric cancer. (A) regular MV pattern, (B) regular MS pattern and (C) irregular MV and MS pattern.
© 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society
Digestive Endoscopy 2015; 27: 636–638
WEO Newsletter
DUODENOSCOPE REPROCESSING: A SEEMINGLY MUNDANE TASK WITH MAJOR IMPLICATIONS FOR PATIENT SAFETY By John Baillie, Director of Endoscopy, Virginia Commonwealth University, Richmond, VA, USA
Cannulating the duodenal papilla for endoscopic retrograde cholangiopancreatography.
As it is technically difficult, time-consuming and expensive to sterilize endoscopes, endoscopy units have had to settle for high-grade disinfection instead. For most of the 45 years or so that endoscopic retrograde cholangiopancreatography (ERCP) has been available as an ‘advanced endoscopic procedure’, this level of cleaning – now done in automated ‘washing machines’ – has proven generally adequate to eliminate harmful pathogens. However, the specter of nosocomial infection from duodenoscopes has always lurked in the shadows, as evidenced by occasional outbreaks of bacterial infections in patients who have undergone ERCP. Typically, these involved ‘exotic’ pathogens, such as Pseudomonas aeruginosa and Serracia marescens, and fatalities were reported. These outbreaks were usually traced to inadequate disinfection protocols or defective automated cleaning systems. Recently, duodenoscope-transmitted infections with carbapenem-resistant Enterobacteriaceae (CRE) species have been reported from some major centers in the USA, including the Virginia Mason Medical Center in Seattle, WA, the University of Pittsburgh, PA and UCLA (Cedars Sinai Hospital), Los Angeles, CA. The source of these infections appears to be the elevator mechanism at the tip of the duodenoscope equipment channel. This mechanism has always required special attention during cleaning, as it tends to retain solid material. For this reason, the elevator site gets vigorously brushed as part of the process. Unfortunately, it appears that even special attention does not completely eliminate the risk of CRE infection from the elevator. In the wake of huge publicity and public concern, the US Food and Drug Administration (FDA) and Center for Disease
637
Control (CDC) have convened panels to solicit expert input from industry, microbiologists, safety experts and, of course, ERCP endoscopists on how duodenoscope reprocessing can be improved. Endoscopy units in the USA have been encouraged to culture all of their ERCP endoscopes to look specifically for CRE, and report the results to the CDC. The CDC recently issued interim guidelines for duodenoscope reprocessing (http://www.cdc.gov/hai/organisms/cre/cre-duodenoscope-surveillance-protocol.html) suggesting bacterial cultures monthly, or after every 60 ERCP procedures, whichever comes first. Endoscopic ultrasound (EUS) endoscopes which incorporate elevator devices will be subject to the same requirement. A final ruling on the issue by the FDA is expected by the summer of 2015. It seems likely that a redesign of duodenoscope tips to render them detachable for cleaning will be mandated. The author is aware that the three principal duodenoscope manufacturers are already working on this. The elevator mechanism may need to become disposable, as it appears impossible to guarantee its freedom from contamination using current sterilization techniques. Those who carry out ERCP are encouraged to monitor the progress of this fast-moving discussion through their USbased professional organizations, such as the American Society for Gastrointestinal Endoscopy (ASGE) (www.asge.org).
WEO STRENGTHENS RELATIONSHIPS IN THE MIDDLE-EAST AND NORTHERN AFRICA
Dr Rey’s presentation during the VCE course In April this year, WEO had the honor to be involved in two educational initiatives in the Middle-East and Northern Africa, which served to cement the collaboration with endoscopic societies in the region. On 1 April 2015, as an official pre-activity of the annual congress of the Emirates Gastroenterology & Hepatology Society (EGHS) held in Dubai, United Arab Emirates (UAE), two WEO courses were delivered: Video Capsule Endoscopy (VCE) training; and Advanced Diagnostic Endoscopy Course
© 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society
638
WEO Newsletter
(ADEC) for a set of attentive participants from UAE and surrounding countries. Dr Jean-Francois Rey (France), Prof Naohisa Yahagi (Japan) and Dr Edward Despott (UK), acted as the international faculty and were joined by the two local faculty, Dr Basheer Elfaki and Dr Wagdy Emile. All faculty worked seamlessly during the hands-on training to support participants during the full-day course. Participants’ feedback was extremely positive for this first course, and both societies hope this partnership will continue. Immediately after the event in Dubai, WEO supported the organization of the Postgraduate Course which took place in Cairo, Egypt. Directed by Professor Anthony Axon (UK) and Professor Magdi El-Serafy (Egypt), the course had ‘Quality in Endoscopy’ as its main theme. It was held during 4–5 April and was a result of the scientific collaboration between WEO and the Egyptian Society for the Study of Endoscopy and Hepato-Gastroenterology (ESEHG). The program attracted a high number of participants with approximately 250 Egyptian and Arab doctors in attendance. Professor El-Serafy commented on the success of the course: ‘Our young colleagues gave us positive feedback and many suggestions to repeat similar educational meetings. It is my intention to follow through with their suggestions’.
ESGE/EASL/ESGAR PRESENT: QUALITY IN ENDOSCOPY ERCP AND EUS Spearheaded by the European Society of Gastrointestinal Endoscopy (ESGE), the upcoming ERCP and EUS symposium will continue the successful series of cutting-edge Quality in Endoscopy events. ESGE is closely affiliated to WEO, representing the European / Mediterranean zone. Date: 13–14 November 2015 Event organizers: ESGE/EASL/ESGAR Venue: Aquincum Hotel, Budapest, Hungary
Digestive Endoscopy 2015; 27: 636–638
The ERCP & EUS symposium is tailored for doctors, especially young fellows and junior physicians, across the fields of gastroenterology/endoscopy, surgery, surgical endoscopy, interventional radiology, and internal medicine. The symposium will cover topics including preparations for ERCP and EUS, conquering the papilla, biliary stone disease, biliary strictures, and pancreatitis as well as diagnostic and therapeutic EUS. Interaction, including the exchange of ideas, clinical experiences and knowledge between faculty and participants is a central element of the symposia. ESGE’s Quality in Endoscopy symposia have demonstrated that the combination of highly communicative teaching with a strong, supportive and dedicated faculty is the key to the success of these meetings. Alongside senior speakers, presenters from the up-andcoming younger generation will contribute to innovative and lively sessions. To find out more about this event, please visit the Quality in Endoscopy website www.quality-in-endoscopy.org
WEO ENDORSED MEETINGS WEO is proud to endorse the following meetings taking place in the second semester of 2015: • 1st Asian EUS Congress to be held September 11-12 at Asan Medical Center, Seoul, Korea. For more information, visit the website http://www. interventionaleus2015.com/images/1st_asian_eus_ congress_seoul,_korea.pdf • Jakarta International GI Endoscopy Symposium & Live Demonstration 2015 to be held October 30-31, in Jakarta, Indonesia. For more information, please contact the Indonesian Society for Digestive Endoscopy (ISDE) by email at [email protected]
© 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society
