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Introduction

While GI endoscopy units serve an integral role in screening and diagnosis of a plethora of clinical conditions but could also be a source of environmental waste generation and energy consumption in form of plastic, sharps, personal protective equipment (PPE), cleaning supplies and energy. Evaluation of large data from one endoscopy center could serve as an actionable model for other centers in the health-system for environmentally sustainable endoscopy units.

Aims & Methods

We prospectively collected data on total waste generation of a single large academic VA based endoscopy unit (average 3500 procedures per year) over May-June 2022. We stratified the waste generated from esophagogastro-duodenoscopy and colonoscopy into biohazardous, non-biohazardous, or recyclable items to determine opportunities to improve/maximize the recycling of waste. Data on each item used for each patient since entry to the endoscopy unit and discharge including the endoscopy procedure, amount of waste generation per day for the entire unit, type of waste, energy utilization for each day, and reprocessing related waste generation for each procedure were analyzed. We also performed a review of endoscopy inventory utilized and audit of items utilized in each procedure. No patient information was collected, and study was approved by the local institutional review board.

Results

Data of 400 procedures collected over the study period was analyzed providing total waste generation of 1010.65 kg which include sharps (51.57 kg) and biohazard waste (336.34 kg). Average per day land-fill waste generation was 30.63 kg which approximates to 9,189 kg for an entire year. Despite 44% of items taken out from the inventory being recyclable, only 28% of them were used in the procedure per audit adding to the 8.6 kg. waste per day. Thus, intra-procedure inventory audit could reduce landfill waste by 20% per day (Figure 1). By scope cleaning and reprocessing, additional 194 gallon of liquids waste (=735.26 kg.) per day was generated. Two football field sized landfill waste is generated this way when total annual waste generation is considered. On average 277.1 kW hour energy was utilized for endoscopy unit alone per day which equals to 8.2 gallons of gasoline use per day.

Conclusion

Measures to reduce waste generation in form of reducing landfill and water waste are needed. Auditing and only using the inventory absolutely needed in a case could reduce the landfill waste by 20%. Improvement in methods aimed at environmentally effective scope reprocessing measures are immediately needed since this contributes to a significant source of total waste generation from the GI endoscopy as well.

PROSPECTIVE STUDY OF WASTE GENERATION AND ENERGY CONSUMPTION FROM A LARGE ACADEMIC GI ENDOSCOPY CENTER: TIME TO TURN TO GREEN ENDOSCOPY

Harsh Patel 1, Madhav Desai 2, Sachin Srinivasan 1, Carly Campbell 2, April Higbee 2, Piyush Nathani 1, Dhruvil Radadiya 1, Abhilash Perisetti 2, Prateek Sharma 3

1 University of Kansas Medical Center, Kansas City, United States

2 Kansas City VA Medical Center, Kansas City, United States

3 University of Kansas School of Medicine, Leawood, United States

Conference

UEG Week Copenhagen 2023

Submission format

Abstract

Session

PP 11 Endoscopy general GI tract (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Mistakes In Articles

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Children and adolescents with chronic diseases requiring lifelong care face unique challenges that affect their daily lives and those of their families. Initially, these patients receive specialized care in pediatric facilities, where parents play a key role in treatment decisions. However, transitioning to adult healthcare facilities is inevitable, and this process, recognized as crucial years ago, involves moving adolescents with chronic conditions from child-centered to adult-oriented care. This transition can be complicated by varying age limits for pediatric care and the scarcity of adult care centers with specific expertise. The transition often requires cooperation between different centers or even countries due to patient mobility. The transition phase is critical, as it can lead to loss of follow-up, treatment suspension, and increased risks of complications or disease relapse. Beyond medical management, various factors influence the long-term prognosis of chronic conditions, making a well-organized transition program essential. While many hospitals have implemented transition models with mixed results in satisfaction, disease control, and follow-up adherence, there are frequent shortcomings in the process. This Mistakes In article will outline eight common mistakes made during the transition from pediatric to adult care, supported by literature and professional experience.

Mistakes in transitional care for children and young adults and how to avoid them

Patrizia Burra, Hans Törnblom, Jorge Amil Dias, Moriam Mustapha

Topics

Primary Care

Citation

Jorge Amil-Dias, Hans Törnblom, Moriam Mustapha and Patrizia Burra. Mistakes in transitional care for children and young adults and how to avoid them. UEG Education 2023; 23: 22-25.

Published

2023

UEG Mistakes In Articles

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A recent UEG survey indicated that dysphagia, heartburn, bloating, abdominal pain and changes to bowel habit are each reported by 5–15% of the general population.1 For patients with mild symptoms, negative tests provide reassurance and simple, symptomatic management might be all that is required (e.g. acid suppression, stool regulation). However, for those with severe symptoms that persist on therapy, ruling out life-threatening disease is not sufficient, and referral to the neurogastroenterology and motility (NGM) laboratory for physiological measurements is often indicated. Clinical investigations aim to explain the cause of symptoms and establish a diagnosis that can guide rational treatment. Until recently, it could be argued that manometry, scintigraphy, breath tests and related tests rarely provided this information. As a result, only patients with suspected major motility disorders (e.g. achalasia, severe reflux disease or faecal incontinence) were routinely referred to the NGM laboratory for tests. Technological advances, such as high-resolution manometry (HRM), now provide objective measurements not only of motility, but also of function in terms of the movement (and digestion) of ingested material within the gastrointestinal tract. Furthermore, the ability to associate events (such as bolus retention, reflux or gas production) with symptoms provides an indication of visceral sensitivity and can identify what is causing patient complaints. Here, I discuss frequent mistakes in clinical investigation of gastrointestinal motility and function based on a series of consensus documents published by members of the International Working Group for Disorders of Gastrointestinal Motility and Function.

Mistakes in clinical investigation of gastrointestinal motility and function

Mark Fox

Topics

Neurogastroenterology & Motility

Citation

Fox M. Mistakes in clinical investigation of gastrointestinal motility and function. UEG Education 2018; 18: 15–20.

Published

2024

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Aim

The primary aim of the European Society of Coloproctology (ESCP) Guideline Development Group (GDG) was to produce high-quality, evidence-based guidelines for the management of cryptoglandular anal fistula with input from a multidisciplinary group and using transparent, reproducible methodology.

Methods

Previously published methodology in guideline development by the ESCP has been replicated in this project. The guideline development process followed the requirements of the AGREE-S tool kit. Six phases can be identified in the methodology. Phase one sets the scope of the guideline, which addresses the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula in adult patients presenting to secondary care. The target population for this guideline are healthcare practitioners in secondary care and patients interested in understanding the clinical evidence available for various surgical interventions for anal fistula. Phase two involved formulation of the GDG. The GDG consisted of 21 coloproctologists, three research fellows, a radiologist and a methodologist. Stakeholders were chosen for their clinical and academic involvement in the management of anal fistula as well as being representative of the geographical variation among the ESCP membership. Five patients were recruited from patient groups to review the draft guideline. These patients attended two virtual meetings to discuss the evidence and suggest amendments. In phase three, patient/population, intervention, comparison and outcomes questions were formulated by the GDG. The GDG ratified 250 questions and chose 45 for inclusion in the guideline. In phase four, critical and important outcomes were confirmed for inclusion. Important outcomes were pain and wound healing. Critical outcomes were fistula healing, fistula recurrence and incontinence. These outcomes formed part of the inclusion criteria for the literature search. In phase five, a literature search was performed of MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews by eight teams of the GDG. Data were extracted and submitted for review by the GDG in a draft guideline. The most recent systematic reviews were prioritized for inclusion. Studies published since the most recent systematic review were included in our analysis by conducting a new meta-analysis using Review manager. In phase six, recommendations were formulated, using grading of recommendations, assessment, development, and evaluations, in three virtual meetings of the GDG.

Results

In seven sections covering the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula, there are 42 recommendations.

Conclusion

This is an up-to-date international guideline on the management of cryptoglandular anal fistula using methodology prescribed by the AGREE enterprise.

European Society of Coloproctology: Guidelines for diagnosis and treatment of cryptoglandular anal fistula

Lillian Reza

Publisher

European Society for Coloproctology

Guideline

Clinical Practice Guideline

Topics

Surgery Colorectal

Citation

Colorectal Dis. 2024; 26: 145–196

Published

2023

UEG Standards and Guidelines

Consensus

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ABSTRACT

Dysphagia is a prevalent symptom of the upper gastrointestinal tract causing health related consequences, impacting quality of life and is associated with global economic burden. Swallowing difficulties are classified into oropharyngeal dysphagia (OD) and esophageal dysphagia. Despite its clinical importance, dysphagia is associated with several uncertainties regarding its optimal diagnostic work-up and management, particularly, considering the progress with diagnostic modalities and technologies. A Delphi consensus was performed with experts from various disciplines who conducted a literature summary and voting process on 41 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus was reached for all the statements. The panel agreed with the definition and prevalence of esophageal and OD types. The role of endoscopy, high-resolution manometry, EndoFLIP, barium swallow and other imaging tests in evaluating esophageal dysphagia has reached overall strong agreement. Videofluoroscopic swallow study, alongside fiber-endoscopic evaluation of swallowing, as the methods of choice for the instrumental assessment of oropharyngeal dysfunction is a strong recommendation. Regarding treatment, a weak recommendation was achieved for the use of PPIs, calcium-channel blockers, nitrates, phosphodiesterase type 5 inhibitors, antidepressants or peppermint oil for the treatment of hypercontractile esophagus. A strong recommendation exists for endoscopic and surgical treatment of achalasia, while a weak recommendation is provided for other esophageal motility disorders. Regarding OD, a weak recommendation was achieved for swallow therapy, to improve swallowing mechanics, reduce symptoms, and enhance quality of life. Swallow therapy could be more effective when using validated assessment tools, consistent treatment parameters, and considering long-term follow-up. A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of dysphagia.

Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility

Amir Mari

Publisher

European Society of Neurogastroenterology and Motility

Guideline

Consensus

Topics

Neurogastroenterology & Motility Oesophagus

Citation

United European Gastroenterol J, 13: 855-901

Published

2025

UEG Podcast Episode

UEG Podcast

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Leaving the playing field

Egle Dieninyte - Misiune 1, Paul Fockens 2

1 Center of hepatology, gastroenterology and dietetics, Vilnius university Santaros Klinikos, Lithuania

2 Amsterdam UMC, Amsterdam, Netherlands

Published

2024

UEG Poster

Audio / Video Poster

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Introduction

COVID-19 pandemic has negatively affected treatment of H. pylori and has long-term consequences, in particular, bacterial susceptibility decreased to broad-spectrum antibiotics used in typical H. pylori eradication regimens. Currently, there is limited scientific data on the effectiveness and safety of standard eradication regimens in the post-COVID period. The aim of the study is to investigate the effectiveness and safety of 10- and 14-day H. pylori eradication regimens used during 2022-2025 and to compare their effectiveness and safety with 10-day regimens used during 2019-2021 in Ukraine, as well as to identify the relationship between unsuccessful treatment cases and anamnestic data.

Aims & Methods

We conducted retrospective multicenter observational study during 2019-2025 years. A comparative analysis of the effectiveness and safety of various eradication regimens for group I (n=82) treated during 2019-2021 years and group II patients (n=74) treated during 2022-2025 years was performed. We determined frequency, intensity, and spectrum of side effects in both groups. A multivariate regression analysis of relationship between unsuccessful treatment cases and anamnestic data was performed.

Results

Comparative analysis revealed no statistical difference in the eradication rates between groups I and II (p≥0.05). The lowest eradication rate among patients in group II was detected on three-component regimens esomeprazole + clarithromycin +amoxicillin (67%) and pantoprazole + clarithromycin/metronidazole/tinidazole (70%). The highest eradication rate was on quadruple regimen esomeprazole + levofloxacin +amoxicillin + furazolidone (100%). In group II, the frequency of side effects, their intensity, and spectrum significantly increased after 14-day treatment (p<0.001) in comparison with group I. Regression analysis revealed that male gender, history of COVID-19 infection, and first treatment attempts were significantly more frequently associated with unsuccessful treatment (p<0.05).

Conclusion

Standard 14-day three-component H. pylori eradication regimens esomeprazole + clarithromycin +amoxicillin, pantoprazole + clarithromycin/metronidazole/tinidazole, pantoprazole + amoxicillin + metronidazole/tinidazole have inappropriate eradication rates (≤70%). The 14-day quadruple esomeprazole + levofloxacin +amoxicillin + furazolidone regimen demonstrates a high eradication rate (>90%), but is accompanied by frequent and diverse side effects, reduced adherence to treatment. Treatment failure is significantly associated with male gender, previous COVID-19 infection, and first treatment attempts.