Introduction

Environmental pollution is significantly driven by endoscopic waste generation. Previous studies have found a range of 0.5 to 3.0 kg of waste per endoscopic procedure depending on the geographical origin.

Aims & Methods

This study aimed to evaluate endoscopic waste generation in hospitals and offices to assess its healthcare system impact and propose waste reduction strategies. A prospective, multicentre, observational study was conducted over four-week periods in two tertiary hospitals and two gastroenterology offices in Germany in 2023. Waste from 2275 patients in 2889 procedures was collected, sorted, and weighed. Recyclable waste was categorised. National waste generation from gastrointestinal endoscopies in Germany was estimated using insurance data.

Results

The mean quantity of waste generated per procedure was 1119 g (hospitals: 1167 g; offices: 1094 g). Office-based procedures generated significantly less solid waste compared to equivalent hospital-based procedures (EGD: -51%, colonoscopy: -50%, their combination: -47% and sigmoidoscopy: -69%, all p < 0.001). Combining consecutive procedures could reduce waste by up to 39% for EGD and colonoscopy and 33% for EUS and ERCP. Waste from suction bags had an impact of 35% per procedure and could be processed via the sewage system instead of being disposed. Replacing single-use gowns with reusable ones could reduce personal protective equipment waste by 54%. Furthermore, 23% of endoscopic waste was potentially recyclable.
Gastrointestinal endoscopies in Germany generate extrapolated 8024 tonnes of waste, annually, equivalent to the annual waste generation of 18533 German citizens. This resulted in a total of 3924 tonnes of greenhouse gas emissions.
This figure corresponded to approximately 33.7 million kilometres driven by passenger cars or 4242 economy flights from Frankfurt to New York. If this waste was recycled according to the present study results with a recycling share of 23%, the waste could have been reduced by the equivalent annual waste generation of 3616 German citizens and a reduction of 1427 tonnes of greenhouse gas equivalents. This reduction would have been equivalent to about 12.3 million kilometres driven by car or 1542 economy flights from Frankfurt to New York.

Conclusion

The mass of endoscopic waste generated in Germany is comparable with the domestic waste of a small town. Implementing a waste reduction system in endoscopic practices, prioritizing prevention, reduction, reuse, recycling, and recovery, could significantly reduce waste generation.

Disclosure

Nothing to disclose by the authors.

Introduction

Fecal incontinence is a diagnosis represented by recurrent uncontrolled passage of fecal material for at least 3 months. It is relatively common, with an assumed prevalence of up to 7% of the worldwide population. The therapy is challenging and often with insufficient clinical results. It should be specifically tailored to different symptom presentations meaning urge or passive incontinence. One of the relatively and therefore not widely used treatment options for incontinence is local sphincter stimulation which is a safe non or minimally invasive method. This stimulation could be performed in at home setting, so it presents a substantial time and cost-saving option for the patient and for the healthcare system. However, the data published on this topic so far are scarce with heterogeneous studied populations and results with no universally accepted treatment protocol.

Aims & Methods

This study aims to evaluate the effect of local sphincter stimulation on the functional parameters of sphincters and symptoms based on the different phenotypes. This is a retrospective single-center study analysis on patients with fecal incontinence (age> 18 years). The duration of the training was 12 weeks, with training once daily for 6 days a week. The parameters of the home stimulation device were as follows: Frequency: 40 Hz; Impulse Width: 0.2 s; Ramp-up time: 1s; Workout time: 6s; Rest: 15s. Training duration: 20min. During the perceived stimulation patients were instructed to squeeze the sphincter. 3D anorectal manometry was performed according to the IAPWG protocol at the initiation visit and the control visit. Clinical evaluation was performed by self-reporting Wexner’s score for fecal incontinence at both visits.

Results

Twenty-three patients (23) were consecutively screened for eligibility and assigned for the therapy. Three patients (3) did not adhere to the training due to various personal reasons one (1) patient did not tolerate stimulation. Therefore, 19 patients (10 passive, 9 urge) completed the full treatment protocol for 12 weeks and were considered for the final analysis. The total average increase in sphincter rest medium pressure was 22.53%, with significantly higher improvement in the urge group compared to the passive group (46.24% vs. 1.18% respectively). The total average increase in sphincter rest maximum pressure was 25.69%, with significantly higher improvement in the urge group compared to the passive group (46.92% vs. 6.59% respectively). The total average increase in sphincter maximum squeeze pressure was 36.13%, with significantly higher improvement in the urge group compared to the passive group (57.82% vs. 16.61% respectively). The average improvement in Wexner score was 3.1 points, with higher improvement in the urge group compared to the passive group (4.2 points vs. 2.1 points respectively).

Conclusion

The home-administered local anal sphincter stimulation for 12 weeks seems to be an effective treatment option for both types of fecal incontinence and significantly more effective in the urge type. Therefore this could be considered as a cost and time-effective treatment option compared to standard office-based therapy. Although a home stimulation device is simple to use, the ability of the patient to adhere to the protocol should be evaluated during the screening process.
Funding: European Parliament and Council Recovery and Resilience Plan of the Slovak Republic 2021 – 2027, code: 09I03-03-V04-00761

Introduction

To observe the long-term efficacy and complications of FMT in the treatment of diseases related to intestinal dysbiosis in China.

Aims & Methods

Collect clinical data of 15000 patients who received FMT treatment and were followed up for more than 3 months from May 2017 to September 2024; The inclusion criteria for cases are patients who meet the indications for FMT treatment; Among them, there were 8258 cases of constipation, 684 cases of CDI, 1730 cases of chronic diarrhea, 510 cases of inflammatory bowel disease, 432 cases of radiation enteritis, 1940 cases of irritable bowel syndrome, 365 cases of autism, 870 cases of postoperative gastrointestinal dysfunction, and 211 cases of neurodegenerative diseases. The treatment methods for intestinal microbiota transplantation include receiving continuous infusion of intestinal microbiota solution through the nasointestinal tube (into the jejunum) for 6 days after placement (upper gastrointestinal tract transplantation group), continuous oral administration of intestinal microbiota capsules for 6 days (oral capsule transplantation), and one-time injection of microbiota solution into the colon through colonoscopy (lower gastrointestinal tract transplantation group);The main observation indicators are the efficacy of intestinal microbiota transplantation treatment at 3, 12, and 36 months. The secondary outcome measures were the occurrence of short-term (within 2 weeks after treatment) and long-term (within 36 months after treatment) adverse reactions.

Results

A total of 15000 patients in the group were treated with upper gastrointestinal route in 11125 cases, oral capsule transplantation (oral capsule group) in 3597 cases, and lower gastrointestinal route in 278 cases. At 3, 12, and 36 months after treatment, the overall treatment efficacy rates were 71.8% (10763/15000), 64.4% (7600/11808), and 58.8% (3659/6218), respectively. The clinical improvement rates for constipation were 70.3% (5805/8258), 60.8% (3858/6345), and 56.5% (1894/3352), respectively. The clinical improvement rates for CDI were 85.8% (587/684), 72.3% (408/564), and 67.3% (218/324), respectively. The clinical improvement rates for chronic diarrhea were 81.0% (1401/1730), 78.1% (1198/1534), and 72.3% (633/876), respectively. The clinical improvement rates of intestinal diseases were 64.3% (328/510), 52.3% (249/476), and 46.6% (97/208), respectively. The clinical improvement rates of radiation enteritis were 77.3%, 65.4%, and 53.6%, respectively; The clinical improvement rates of the oral capsule group were 57.3% (2062/3597), 53.6% (1115/2081), and 45.0% (453/1006), respectively; The clinical improvement rates of the lower gastrointestinal pathway group in three time periods were 43.5% (121/278), 36.4% (48/132), and 14.9% (10/67), respectively. No serious adverse reactions occurred during treatment and follow-up. The most common adverse reactions in the upper gastrointestinal route group, oral capsule group, and lower gastrointestinal route group were respiratory discomfort (20.4%, 2269/11 125), nausea and vomiting during capsule swallowing (7.6%, 273/3597), and diarrhea (47.5%, 132/278), respectively; The above symptoms disappeared after the end of treatment. During a follow-up period of 36 months, 19 patients reported worsening of their pre-existing disease symptoms, 16 deaths were not directly related to FMT, and no abnormal systemic diseases were found after FMT.

Conclusion

FMT is effective in treating intestinal dysfunction and related extraintestinal diseases related to gut microbiota disorders in the long term, with no serious adverse events

References

• [1] Wang Y, Huang Y, Chase RC, et al. Global burden of digestive diseases: a systematic analysis of the global burden of diseases study, 1990 to 2019[J]. Gastroenterology, 2023, 165(3):773-783.e15. DOI: 10.1053/j.gastro.2023.05.050.
• [2] Fan Y, Pedersen O. Gut microbiota in human metabolic health and disease[J]. Nat Rev Microbiol, 2021, 19(1):55-71. DOI: 10.1038/s41579-020-0433-9.
• [3] Lynch SV, Pedersen O. The human intestinal microbiome in health and disease[J]. N Engl J Med, 2016, 375(24):2369-2379. DOI: 10.1056/NEJMra1600266.
• [4] Li YT, Cai HF, Wang ZH, et al. Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for Clostridium difficile infection[J]. Aliment Pharmacol Ther, 2016, 43(4):445-457. DOI: 10.1111/apt.13492.
• [5] Paramsothy S, Kamm MA, Kaakoush NO, et al. Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: a randomised placebo-controlled trial[J]. Lancet, 2017, 389(10075):1218-1228. DOI: 10.1016/S0140-6736(17)30182-4.
• [6] Mincic AM, Antal M, Filip L, et al. Modulation of gut microbiome in the treatment of neurodegenerative diseases: a systematic review[J]. Clin Nutr, 2024, 43(7):1832-1849. DOI: 10.1016/j.clnu.2024.05.036.
• [7] Cammarota G, Ianiro G, Tilg H, et al. European consensus conference on faecal microbiota transplantation in clinical practice[J]. Gut, 2017, 66(4):569-580. DOI: 10.1136/gutjnl-2016-313017.

Disclosure

None