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Bret T. Petersen, MD, FASGE

Associate Editor
Pancreatobiliary

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Biography

Bret T. Petersen, MD, FASGE is Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. His practice is focused in the Mayo Pancreas Clinic and the Advanced Endoscopy Group. His professional interests include pancreatic and biliary diseases, performance and outcomes of ERCP, and delivery of endoscopic services. At Mayo, Dr. Petersen is a past Director of Endoscopy and has served on multiple clinic and foundation committees. He has directed numerous American Society for Gastrointestinal Endoscopy (ASGE) and Mayo courses, particularly related to the performance of ERCP. He has received the Mayo Award for Excellence, GI Fellows Award for Outstanding Teacher, and Department of Medicine Laureate Award (GI), as well as the Master Endoscopist Award of the ASGE. Dr. Petersen is the incoming Secretary for (ASGE) and a past Chair of the Technology and Quality Assurance in Endoscopy committees.

Disclosures

Consultant 

Boston Scientific 

Advisory Board 

Ethicon/J & J

 

Summaries

Echoendoscope Cultures Reflect Persistent but Far Lower Risk Than Duodenoscopes

Bret T. Petersen, MD, FASGE reviewing Becq A, et al. Gastrointest Endosc 2019 Jan 14.

Endoscopes with elevator mechanisms are prone to risks of incomplete cleaning and disinfection. Duodenoscopes, in particular, have been linked to transmission of clinical infections. To assess whether echoendoscopes are also at risk of infectious transmission, the authors obtained cultures from the transducers, working channels, and elevators, when present, of 51 linear and 50 radial endoscopes the morning after standard reprocessing with single cycles of high-level disinfection. Bacterial growth of >0 and ≥10 colony-forming units (CFUs) was identified in 6% and 3% of endoscopes, respectively. No multidrug-resistant organisms (MDROs) were identified, and there was no difference between radial and linear instruments. The identified organisms were not further characterized. The rate of bacterial detection on the linear echoendoscopes with elevators was far lower than noted for duodenoscopes (p=0.02) in a similar study from the same institution.

Comment:
Bacterial contamination of reprocessed duodenoscopes and linear echoendoscopes has previously been shown. Many identified contaminants are environmental and presumably related to handling and storage. While this study did not differentiate pathogens from nonpathogens, the rate of persistent contamination of echoendoscopes was very low, although not zero. The absence of MDROs is likely more related to prevalence rates in the specific patient population and hospital. The identified contamination rates for echoendoscopes were significantly lower than demonstrated by the same institution in prior studies for duodenoscopes. This may reflect the greater exposure to highly purulent environments and forceful maneuvers employed during ERCP; however, concurrent sampling from both endoscope types would make the comparison more valid.
Note to readers:
At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Bret T. Petersen, MD, FASGE
Bio and Disclosures

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Citation(s):
Becq A, Snyder GM, Heroux R, et al. Prospective assessment of the effectiveness of standard high-level disinfection for echoendoscopes. Gastrointest Endosc 2019 Jan 14. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2018.12.024)