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Bret T. Petersen, MD, FASGE

Associate Editor
Pancreatobiliary

b_petersen(1)

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

Time to Apply It Seriously – Washing and Drying Are the Achilles Heels in Reprocessing

Bret T. Petersen, MD, FASGE reviewing Barakat MT, et al. Gastrointest Endosc 2018 Aug 24.

Endoscope drying is required by all current reprocessing guidelines. The authors compared two durations of two common methods for achieving this end. Boroscope exam for residual fluid and delayed adenosine triphosphate (ATP) bioluminescence testing of rinsates were used to evaluate for fluid droplets and residual bioburden. Automated drying with a commercial machine and apparatus for 10 minutes yielded virtually no retained droplets and significantly lower ATP levels compared to shorter intervals or manual methods. Lastly, after 10 minutes of automated forced-air drying, vertical storage offered no benefit at 48 or 72 hours in contrast to its role in reducing droplets after drying for only 5 minutes or any interval with manual drying.

Comment:
Non-automated components of endoscope reprocessing have been recognized as major sources of variation and risk. The two processes most dependent on consistent performance of manual tasks are endoscope washing and drying. Forced-air drying is advised by all current guidelines. For drying, some centers rely on the terminal automated alcohol flush + air purge function in most high-level disinfection (HLD) machines, but this is demonstrably insufficient. Many surgically oriented central reprocessing departments employ manual targeting with an air gun, as is used for numerous other surgical devices without lumens (like your local car wash). This, too, is insufficient, as prolonged air flow directed to all channels is rarely achieved. The authors thoroughly demonstrate that prolonged (10 minutes) forced-air drying directed to all channels is required, confirming data from Alfa et al in the 1990s. While they used a commercial air dryer, others have achieved the same end with medical air passed through simple assemblies of filters and channel adapters available from the endoscope manufacturers. When so soundly demonstrated, such data warrant prompt adoption by all of our practices.
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):
Barakat MT, Huang RJ, Banerjee S. Comparison of automated and manual drying in the eliminating residual endoscope working channel fluid after reprocessing (with video). Gastrointest Endosc 2018 Aug 24 (Epub ahead of print) (https://doi.org/10.1016/j.gie.2018.08.033)