Efficacy of spray flushing in the reprocessing of flexible endoscopes:A randomized controlled trial

BACKGROUND Commonly used cleaning brushes in the reprocessing of flexible endoscopes often cause damage within the working channels.AIM To develop a spray flushing system to achieving effective cleaning of the working channels while minimizing damage.METHODS This prospective study included 60 used endoscopes and 60 Teflon tubes randomly divided into a control group(n=30)and an experimental group(n=30).The material of Teflon tubes was the same as that of the endoscope working channel.Endoscopes in the control group were manually cleaned using traditional cleaning brushes,while those in the experimental group were cleaned using the newly developed spray flushing system.ATP levels,cleanliness,and microbiological testing of the working channels were measured.Additionally,Teflon tubes in the control group underwent 500 passes with a cleaning brush,while those in the experimental group were subjected to the spray flushing system,and channel damage was evaluated.RESULTS The ATP levels(RLU)in the two groups were 32.5(13-66)and 26(16-40),respectively(P>0.05).Cleanliness scores were 1.5(1-2)and 1(1-2),respectively(P>0.05).Debris was found in 73.3%of the control group,which was significantly higher than 46.7%in the experimental group(P<0.05).Microbiological tests for both groups yielded negative results.Teflon tube damage in the control group was rated at 4(4-5.25),which was significantly higher than in the experimental group 4(3-4)(P<0.01).CONCLUSION The spray flushing system demonstrated superior efficacy in removing debris and resulted in less damage to the endoscope working channels compared with traditional cleaning brushes.

Beyond boundaries:Feasibility of curved linear array echoendoscope in appendiceal neoplasm detection

We recently read with great interest a study by Zhang et al in the World Journal of Gastroenterology.In our practice,we focus specifically on examining appendiceal mucinous neoplasms(AMNs)with endoscopic ultrasound(EUS)using different scopes.AMNs are rare neoplastic lesions characterized by an accumulation of mucin inside a cystic dilatation of the appendix.Clinically,they can present as nonspecific acute appendicitis.AMNs can turn into a life-threatening condition,termed pseudomyxoma peritonei,in which the ruptured appendix causes accumulation of mucin in the abdomen.Therefore,accurate and rapid diagnosis of AMN is essential.EUS is able to confirm and stage AMNs;although,EUS examination was once limited to the rectal and anal regions due to the conven-tional oblique-view scopes.With the emergence of new forward-view linear echoendoscopes and instruments like EUS miniprobes and overtubes,the scope of examination is changing.Herein,we discuss the feasibility of using the curved linear array echoendoscopes to examine cecal and appendiceal orifice lesions.

A Novel Sensing Imaging Equipment Under Extremely Dim Light for Blast Furnace Burden Surface:Starlight High-Temperature Industrial Endoscope

Blast furnace(BF)burden surface contains the most abundant,intuitive and credible smelting information and acquiring high-definition and high-brightness optical images of which is essential to realize precise material charging control,optimize gas flow distribution and improve ironmaking efficiency.It has been challengeable to obtain high-quality optical burden surface images under high-temperature,high-dust,and extremelydim(less than 0.001 Lux)environment.Based on a novel endoscopic sensing detection idea,a reverse telephoto structure starlight imaging system with large field of view and large aperture is designed.Combined with a water-air dual cooling intelligent self-maintenance protection device and the imaging system,a starlight high-temperature industrial endoscope is developed to obtain clear optical burden surface images stably under the harsh environment.Based on an endoscope imaging area model,a material flow trajectory model and a gas-dust coupling distribution model,an optimal installation position and posture configuration method for the endoscope is proposed,which maximizes the effective imaging area and ensures large-area,safe and stable imaging of the device in a confined space.Industrial experiments and applications indicate that the proposed method obtains clear and reliable large-area optical burden surface images and reveals new BF conditions,providing key data support for green iron smelting.

Is appendoscope a new option for the treatment of acute appendicitis?

Acute appendicitis is a common surgical emergency.It is commonly caused by obstruction of the appendiceal lumen due to fecaliths,tumors,or lymphoid hyperplasia.For over a century,appendectomy has been the primary treatment for acute appendicitis.Abraham Groves performed the first open appendectomy in 1883.In 1983,Kurt Semm completed the first laparoscopic appendectomy,heralding a new era in appendectomy.However,appendectomy is associated with certain complications and a rate of negative appendectomies.Studies have suggested controversy over the impact of appendectomy on the development of inflammatory bowel disease and Parkinson’s disease,but an increasing number of studies indicate a possible positive correlation between appendectomy and colorectal cancer,gallstones,and cardiovascular disease.With the recognition that the appendix is not a vestigial organ and the advancement of endoscopic technology,Liu proposed the endoscopic retrograde appendicitis therapy.It is an effective minimally invasive alternative for treating uncomplicated acute appendicitis.Our team has developed an appendoscope with a disposable digital imaging system operated through the biopsy channel of a colonoscope and successfully applied it in the treatment of appendicitis.This article provides an overview of the progress in endoscopic treatment for acute appendicitis and offers a new perspective on the future direction of appendiceal disease treatment.

Optical scanning endoscope via a single multimode optical fiber

Optical endoscopy has become an essential diagnostic and therapeutic approach in modern biomedicine for directly observing organs and tissues deep inside the human body,enabling non-invasive,rapid diagnosis and treatment.Optical fiber endoscopy is highly competitive among various endoscopic imaging techniques due to its high flexibility,compact structure,excellent resolution,and resistance to electromagnetic interference.Over the past decade,endoscopes based on a single multimode optical fiber(MMF)have attracted widespread research interest due to their potential to significantly reduce the footprint of optical fiber endoscopes and enhance imaging capabilities.In comparison with other imaging principles of MMF endoscopes,the scanning imaging method based on the wavefront shaping technique is highly developed and provides benefits including excellent imaging contrast,broad applicability to complex imaging scenarios,and good compatibility with various well-established scanning imaging modalities.In this review,various technical routes to achieve light focusing through MMF and procedures to conduct the scanning imaging of MMF endoscopes are introduced.The advancements in imaging performance enhancements,integrations of various imaging modalities with MMF scanning endoscopes,and applications are summarized.Challenges specific to this endoscopic imaging technology are analyzed,and potential remedies and avenues for future developments are discussed.

Effect of a disposable endoscope precleaning kit in the cleaning procedure of gastrointestinal endoscope:A multi-center observational study

BACKGROUND Precleaning is a key step in endoscopic reprocessing.AIM To develop an effective and economic endoscope cleaning method by using a disposable endoscope bedside precleaning kit.METHODS Altogether,228 used gastrointestinal endoscopes were selected from five high-volume endoscopy units and precleaned by a traditional precleaning bucket(group T)or a disposable endoscope bedside precleaning kit(group D).Each group was further subdivided based on the replacement frequency of the cleaning solution,which was replaced every time in subgroups T1 and D1 and every several times in subgroups Ts and Ds.The adenosine triphosphate(ATP)level and residual proteins were measured three times:Before and after precleaning and after manual cleaning.RESULTS After precleaning,the precleaning kit significantly reduced the ATP levels(P=0.034)and has a more stable ATP clearance rate than the traditional precleaning bucket.The precleaning kit also saved a quarter of the cost of enzymatic detergent used during the precleaning process.After manual cleaning,the ATP levels were also significantly lower in the precleaning kit group than in the traditional precleaning bucket group(P<0.05).Meanwhile,the number of uses of the cleaning solution(up to four times)has no significant impact on the cleaning effect(P>0.05).CONCLUSION Considering its economic cost and cleaning effect,the use of a disposable endoscope bedside precleaning kit can be an optimal option in the precleaning stage with the cleaning solution being replaced several times in the manual cleaning stage.

Development of multi-band and high-speed visible endoscope diagnostic on EAST with catadioptric optics

A new multi-band and high-speed endoscope diagnostic for the observation of visible light has been successfully developed on the Experimental Advanced Superconducting Tokamak.The mirror with an aperture is designed at the head of the optical system.Based on two dichroic mirrors,the system is divided into three imaging mirror groups with different bands,i.e.B(380-500 nm),G(500-580 nm)and R(580-750 nm)bands,and its focal length is 16 mm with a relatively large aperture of D/f=1:4.The spatial resolution is less than 5 mm near the object distance of 1750 mm with the camera NAC ACS-1 M60.This optical system will be used to contrastively study both the spatial distribution and time evolution of different impurities in the same field of view.The experimental results confirm that it can be applied to the recognition of plasma boundary and related physical research.

Evaluation of appendiceal mucinous neoplasms by curved lineararray echoendoscope:A preliminary study

BACKGROUND Preoperative diagnosis of appendiceal mucinous neoplasms is challenging,and there are few reports regarding the endosonographic characteristics of these neoplasms.AIM To provide a retrospective assessment of the imaging features of appendiceal mucinous neoplasms using endoscopic ultrasound(EUS)by curved linear-array echoendoscope.METHODS A database of all patients with appendiceal mucinous neoplasms who had received EUS examination at our hospital between January 2018 and July 2023 was retrospectively analyzed.The EUS characteristics and patients’clinical data were reviewed.RESULTS Twenty-two patients were included in the study.The linear-array echoendoscope successfully reached the ileocecal region in every patient.In the endoscopic view,we could observe the protrusion in the appendiceal orifice in all patients.A volcano sign was observed in two patients,and an atypical volcano sign was seen in two patients.EUS showed that all 22 lesions were submucosal cystic hypoechoic lesions with clear boundaries.No wall nodules were observed,but an onion-peeling sign was observed in 17 cases.CONCLUSION Linear-array echoendoscope is safe to reach the ileocecal region under the guidance of EUS.Image features on endoscopic and echoendosonograhic views could be used to diagnose appendiceal mucinous neoplasms.

Animal experimental studies using small intestine endoscope

AIM To assess the feasibility and safety of a novel enteroscope,negative-pressure suction endoscope in examining the small intestine of a porcine model.METHODS In vitro experiments in small intestinal loops from 20pigs and in vivo experiments in 20 living pigs were conducted.RESULTS In in vitro experiments,a negative pressure of>0.06MPa was necessary for optimal visualization of the intestine,and this pressure did not cause gross or histological damage to the mucosa.For satisfactory examination of the small intestine in vivo,higher negative pressure(>1.00 MPa)was required.Despite this higher pressure,the small intestine did not show any gross or microscopic damage in the suctioned areas.The average time of examination in the living animals was 60±7.67 min.The animals did not experience any apparent ill effects from the procedure.CONCLUSION Small intestine endoscope was safely performed within a reasonable time period and enabled complete visualization of the intestine in most cases.

A 2.4GHz Low Power ASK Transmitter for Wireless Capsule Endoscope Applications

A 2.4GHz ASK transmitter suitable for a low power wireless capsule endoscope system is presented. A mixer-based frequency up-conversion transmitter architecture is employed to achieve a high data rate. A pseudodifferential stacked class-A power amplifier using the current reuse technique is proposed to save power. The transmitter mainly includes two parts： a 20MHz ASK modulator based on a constant amplitude phase lock loop （PLL） and a direct up-conversion RF circuit. This design, implemented in a TSMC 0.25μm CMOS process, achieves a - 23. 217dBm output power with a data rate of 1Mbps and dissipates 3.17mA of current with a single 2.5V power supply.

Endoscope-assisted goniosynechialysis combined with phacoemulsification and intraocular lens implantation to manage primary angle-closure glaucoma

AIM: To describe and evaluate a new ophthalmic endoscope surgical technique combined with phacoe-mulsification and intraocular lens (IOL) implantation to treat goniosynechialysis and manage primary angle-closure glaucoma (PACG). ·METHODS: Endoscope-assisted goniosynechialysis combined with phacoemulsification and IOL implantation was performed in 32 eyes of 29 patients with PACG. Regular follow-up was performed 1 week and 1 month, 3, and 6 months after surgery to assess complications, intraocular pressure (IOP), anterior chamber depth, visual acuity, and anterior chamber angle. ·RESULTS: Preoperative mean IOP was 24.88±7.22mmHg with pharmacological treatment, and was 13.70 ±4.02, 13.06 ±3.74, 14.29 ±4.70, and 14.33 ±5.01mmHg 1 week, 1 month, 3 months, and 6 months after surgery, respectively. The postoperative decrease in IOP was significant (P 【 0.05). The rate for all eyes with IOP of 21mmHg or less was 93.8% (30 eyes) at the final visit without ocular hypotensive agents. The average preoperative anterior chamber depth was 1.60 ±0.64mm, and this value significantly increased to 2.72±0.62, 2.76±0.70, 2.73±0.68, and 2.74 ±0.71mm at 1 week, 1 month, 3 months, and 6 months, respectively. Visual acuity was improved in 28 eyes (87.5% ) at 6 months postoperatively. The anterior chamber angle had increased in 25 eyes (78.1% ) at the final visit; it was adhesive 90°-180° in 6 eyes, 180°-270° in only 1 eye. Two eyes exhibited minimal hyphema in the early postoperative period, but it could gradually be absorbed. Fibrinous reaction was observed in five eyes and spontaneously disappeared within 7 days. No shallow anterior chamber, iridodialysis, choroidal deta-chment, or malignant glaucoma was found in any eyes.CONCLUSION:Endoscope-assisted goniosynechialysis combined with phacoemulsification and IOL implantation to manage PACG has several advantages, including optimized visualization, greater accuracy, and improved safety. Our results suggest that it has certain curative effects and clinical application value.

Early gastric cancer diagnostic ability of ultrathin endoscope loaded with laser light source

BACKGROUND Conventionally, the low luminous intensity, low image resolution, and difficulty in operation have been reported with the ultrathin endoscope. However, it has markedly advanced recently. The improvement of the diagnostic ability is expected.AIM To compare the early gastric cancer diagnostic ability of an ultrathin endoscope loaded with a laser light source and that of the conventional endoscope.METHODS The target subjects were 375 consecutive patients who underwent endoscopy at our hospital for post-endoscopic submucosal dissection follow-up of gastric cancer from January to August 2018. During endoscopy, the ultrathin endoscope was used in 140 patients(37.3%), and the conventional endoscope was used in235 patients(62.7%). Patient background was adjusted using the propensity score matching method, and gastric cancer detection ability was evaluated in the two groups.RESULTS The gastric cancer detection rate was 7.8% in the ultrathin endoscope group and7.0% in the conventional endoscope group, and the mean intragastric observation time was 4.1 ± 1.7 min in the ultrathin endoscope group and 4.1 ± 1.9 min in the conventional endoscope group, showing no significant differences between the groups. Moreover, the biopsy implementation rate was 31.8% in the ultrathin endoscope group and 41.1% in the conventional endoscope group, and the biopsy prediction rate was 17.9% and 13.2%, respectively, showing no significant differences between the groups.CONCLUSION The gastric cancer diagnostic ability of the ultrathin endoscope loaded with a laser light source was comparable to that of the conventional endoscope. The observation time was also comparable. Thus, endoscopy using the ultrathin endoscope loaded with the laser light source would be the first option in screening examinations of gastric cancer due to its low invasion.

High-level disinfection of gastrointestinal endoscope reprocessing

High level disinfection(HLD) of the gastrointestinal(GI)endoscope is not simply a slogan, but rather is a form of experimental monitoring-based medicine. By definition,GI endoscopy is a semicritical medical device. Hence,such medical devices require major quality assurance for disinfection. And because many of these items are temperature sensitive, low-temperature chemical methods, such as liquid chemical germicide, must be used rather than steam sterilization. In summarizing guidelines for infection prevention and control for GI endoscopy, there are three important steps that must be highlighted: manual washing, HLD with automated endoscope reprocessor, and drying. Strict adherence to current guidelines is required because compared to any other medical device, the GI endoscope is associated with more outbreaks linked to inadequate cleaning or disinfecting during HLD. Both experimental evaluation on the surveillance bacterial cultures and in-use clinical results have shown that, the monitoring of the stringent processes to prevent and control infection is an essential component of the broader strategy to ensure the delivery of safe endoscopy services, because endoscope reprocessing is a multistep procedure involving numerous factors that can interfere with its efficacy. Based on our years of experience in the surveillance of culture monitoring of endoscopic reprocessing, we aim in this study to carefully describe what details require attention in the GI endoscopy disinfection and to share our experience so that patients can be provided with high quality and safe medical practices. Quality management encompasses all aspects of pre- and postprocedural care including the efficiency of the endoscopy unit and reprocessing area, as well as the endoscopic procedure itself.

Development of a non-cable whole tectorial membrane micro-robot for an endoscope

A novel non-cable whole tectorial membrane micro-robot for an endoscope is developed. The micro-robot we have fabricated and tested can propel itself in the intestine tract of a pig in an autonomous manner by earthworm-like locomotion. The silicone of bellow shape is laid over the outer surface of the micro-robot to reduce the affection of the viscoelastic properties of the intestine. Wireless power transfer and communication systems are employed to realize the non-cable locomotion of the mi-cro-robot. The prototype of the micro-robot is 13.5 mm in diameter and 108 mm in length. The experimental results show that the towing force for the micro-robot is about 0.8 N, which is much smaller than the maximum driving force 2.55 N of the linear actuator. The supplying power of the wireless power transfer system fulfills the needs of the micro-robot system and the mi-cro-robot can creep reliably in the large intestine of a pig and other contact environments.

Endoscopic lithotripsy with peroral direct cholangioscopy using a conventional endoscope

Recently,peroral direct cholangioscopy(PDCS) using an ultra-slim endoscope has come into the spotlight.However,the working channel is too small to use various devices for lithotripsy.We report a case of endoscopic lithotripsy with PDCS using a conventional endoscope as a cholangioscope.Computed tomography scan on an 80-year-old female who was admitted with acute cholangitis showed two large stones in the bile duct.Endoscopic retrograde cholangiopancreatography was attempted first.However,mechanical lithotripsy failed because the stone was too large for the basket catheter.Finally,electric hydraulic lithotripsy with PDCS using a conventional endoscope was performed allowed the stones to be cleared completely.In conclusion,PDCS using a conventional endoscope can be an alternative solution for endoscopic lithotripsy for patients with large stones in the dilated bile duct.

Diagnosis and Treatment of Lacrimal Passage Obstruction by Lacrimal Endoscope

The diagnosis and treatment of the lacrimal passage obstruction with lacrimal endoscope was investigated and its subsidiary surgical procedures were evaluated. Ninety-three patients （109 eyes） with lacrimal passage obstruction, including presaccal canalicular obstruction （PSCO） and nasolacrimal duct obstruction （NLDO）, were examined under a lacrimal endoscope, and the obstruc- tions were treated with laser or micro-drill. All patients were followed up after the operation for 3--6 months. The difference between the laser and the micro-drill treatment was observed. During the period of follow-up, the curative rate was 82.57%. The healing rate in PSCO group and NLDO was 80.36% and 84.91% respectively （P〉0.05）. Alter treatment with the laser, the healing rate was 93.33% in the PSCO group and 66.67% in the NLDO group respectively （P〈0.05）. After treatment with the micro-drill, the healing rate in PSCO and NLDO groups was 65.39% and 94.28% respec- tively （P〈0.01）. The lacrimal passage obstruction can be observed and treated directly through the lacrimal endoscope. Choosing different surgical procedures in operation according to the locations of the obstruction is helpful to improve the effectiveness.

Diagnostic utility of small-caliber and conventional endoscopes for gastric cancer and analysis of endoscopic false-negative gastric cancers

AIM: To analyze the diagnostic utility of a small-caliber endoscope(SC-E) and clinicopathological features of false-negative gastric cancers(FN-GCs). METHODS: A total of 21638 esophagogastroduodenoscopy(EGD) gastric cancer(GC) screening examinations were analyzed. Secondary endoscopic examinations(n = 3352) were excluded because most secondary examinations tended to be included in the conventional endoscopy(C-E) group. Detection rates of GCs and FN-GCs were compared between SC-E and C-E groups. FN-GC was defined as GC performed with EGD within the past 3 years without GC detection. Macroscopic types, histopathological characteristics and locations of FN-GCs were compared with firstly foundgastric cancers(FF-GCs) in detail. RESULTS: SC-E cases(n = 6657) and C-E cases(n = 11644), a total of 18301 cases, were analyzed. GCs were detected in 16(0.24%) SC-E cases and 40 C-E(0.34%) cases(P = 0.23) and there were 4 FN-GCs(0.06%) in SC-E and 13(0.11%) in C-E(P = 0.27), with no significant difference. FN-GCs/GCs ratio between SC-E and C-E groups was not significantly different(P = 0.75). The comparison of endoscopic macroscopic types of FN-GCs tended to be a less advanced type(P = 0.02). Histopathologically, 70.6% of FN-GCs were differentiated and 29.4% undifferentiated type. On the other hand, 43.0% of FF-GCs were differentiated and 53.8% undifferentiated type, so FN-GCs tended to be more differentiated type(P = 0.048). CONCLUSION: The diagnostic utility of SC-E for the detection of GCs and FN-GCs was not inferior to that of C-E. Careful observation for superficially depressed type lesions in the upper lesser curvature region is needed to decrease FN-GCs.

COLOR CORRECTION FOR HIGH-DEFINITION ELECTRONIC ENDOSCOPE

The subtle color distinction is the important function of electronic endoscope imaging diagnosis.However,after image acquisition,transmission and display,color distortions of intracorporeal organs or tissues occur inevitably,which are adverse to analyze image features accurately or to diagnose early pathological changes.A real-time color correction algorithm based on fourneighborhood and polynomial regression in YUV color space is proposed.Based on polynomial regression the color correction matrix is calculated in YUV color space according to the dierences between standard values of color checker and measured values of that imaged by the endoscope.As the correction is only executed on U and V components in YUV color space,the defect that the color of corrected images in RGB color space will change along with luminance can be avoided,and then the stability of image color is improved.Owing to four-neighborhood processing,the signal-to-noise ratio of corrected images is enhanced and the processing speed of correction algorithm is accelerated.The average color dierence is reduced from 0.3944 to 0.2850 by application of the proposed algorithm in high-denition electronic endoscope.A total of 17 frames per second can be achieved at the resolution of 1280
800,and the color characteristics of the image after processing match that of human visual system.

Primary endoscopic stapedotomy using 3 mm nasal endoscope:Audiologic and clinical outcomes

Objective:To report the use of a 3 mm rigid nasal endoscope in primary endoscopic stapedotomy and clinical and audiological outcomes.Materials and methods:Thirty patients diagnosed with primary otosclerosis underwent endoscopic stapedotomy that was performed using a 3 mm nasal endoscope(Karl Storz).At 6 months follow-up,the patients were evaluated for intraoperative findings,postoperative hearing outcomes and complications.Results:Canaloplasty was performed in 2(6.66%)patients,and no curettage of the canal wall was required in 12(40%)patients.Transposition of the chorda tympani nerve was conducted in 11(36.66%)patients.The average duration of surgery was 36 min(range 31e65 min).The air-bone gap(ABG)was 35 dB(range 24e50 dB)preoperatively and 14.63 dB(range 9e20 dB)postoperatively(p?0.00).At 6 months follow-up,<20 dB ABG was achieved in 93.33%of the patients.No major intraoperative/postoperative complications were detected.Conclusion:A 3 mm rigid nasal endoscope can be effectively used in stapedotomy to obtain adequate audiological outcomes.It can be considered as a better alternative to the standard microscope or 4 mm endoscope in preserving the posterior canal wall and chorda tympani nerve while minimizing operative time without causing significant complications.

Swab culture monitoring of automated endoscope reprocessors after high-level disinfection

AIM:To conduct a bacterial culture study for monitoring decontamination of automated endoscope reprocessors(AERs) after high-level disinfection(HLD).METHODS:From February 2006 to January 2011,authors conducted randomized consecutive sampling each month for 7 AERs.Authors collected a total of 420 swab cultures,including 300 cultures from 5 gastroscope AERs,and 120 cultures from 2 colonoscope AERs.Swab cultures were obtained from the residual water from the AERs after a full reprocessing cycle.Samples were cultured to test for aerobic bacteria,anaerobic bacteria,and mycobacterium tuberculosis.RESULTS:The positive culture rate of the AERs was 2.0%(6/300) for gastroscope AERs and 0.8%(1/120) for colonoscope AERs.All the positive cultures,including 6 from gastroscope and 1 from colonoscope AERs,showed monofloral colonization.Of the gastroscopeAER samples,50%(3/6) were colonized by aerobic bacterial and 50%(3/6) by fungal contaminations.CONCLUSION:A full reprocessing cycle of an AER with HLD is adequate for disinfection of the machine.Swab culture is a useful method for monitoring AER decontamination after each reprocessing cycle.Fungal contamination of AERs after reprocessing should also be kept in mind.