Faculty Bibliography

BACKGROUND AND AIMS/UNASSIGNED:Endoscopic retrograde cholangiopancreatography (ERCP) is a vital procedure for the management of hepatobiliary disease that requires fluoroscopy and results in radiation exposure to the interventional endoscopy team. Prevention of radiation-induced injury is crucial. Prompted by the pregnancy of our advanced endoscopist, who chose to continue performing ERCP throughout the pregnancy, we conducted a radiation safety and quality improvement initiative and evaluated the impact of this on mean fluoroscopy times and radiation dose exposure to the staff present in the procedure room. METHODS/UNASSIGNED:ERCPs performed between June 2018 and March 2020 were reviewed. ERCPs performed from June 2018 to June 2019 were categorized as "preinitiative" and those performed from July 2019 to March 2020 were categorized as "postinitiative." Interventions included purchase of a new fluoroscopy bed, new lead skirt for the bed and c-arm receiver, mindful fluoroscopy use by attending physician only, appropriate wear of dosimeter badges, and quality evaluation of personal protective equipment such as lead shielding. Data were collected on mean fluoroscopy time per procedure and each provider's monthly radiation dosage. RESULTS/UNASSIGNED:< .01). The fetal dosimeter badge worn at waist level of the pregnant provider under the lead shield detected less than the lowest detectable reading every month. CONCLUSIONS/UNASSIGNED:Quality improvement initiatives coupled with adequate personal protective equipment can result in significant improvement in the radiation exposure of advanced endoscopy staff during ERCP. Performing ERCP during pregnancy is a potentially feasible option if proper techniques and policy are implemented to protect the fetus.

INTRODUCTION/BACKGROUND:Single-use disposable duodenoscopes (SDD) have been developed to mitigate infectious risks related to reusable duodenoscopes. The aim of this study is to compare the safety and efficacy of the two available SDDs in the United States. METHODS:We conducted a comparative study of 2 SDD in consecutive ERCP procedures performed by expert endoscopists from 9 academic centers. Performance ratings, procedure details, and adverse events were collected. RESULTS:A total of 201 patients were included: 129 patients underwent ERCP with Exalt (mean age 63, Males- 66 (51%), 72 with aScope Duodeno (mean age 65, males=30 (42%). A majority of endoscopists had performed >2000 ERCPs in both groups (71% Exalt, 93% aScope Duodeno). Technical success was 92% in both groups (n=119 Exalt-group, n=66 aScope-Duodeno-group). The procedural complexity for the ERCP cases performed were: Grade 1: 35 cases (18%), Grade 2: 83 cases (41%), Grade 3: 65 cases (32%), and Grade 4: 18 cases (9%). Thirteen patients (10%) from the Exalt group and 16 patients (22%) from the aScope Duodeno group required conversion to a reusable duodenoscope. On a scale of 1 to 5, Exalt and aScope Duodeno, respectively, were rated: 2.31 versus 2.60 for location and visualization quality, 1.38 versus 1.57 for maneuverability based on papillary orientation, 1.48 versus 1.15 for suction/air control, and 2.31 versus 2.34 for elevator efficiency. None of the adverse events were related to the SDDs. CONCLUSIONS:The 2 SDDs were comparable. Further ongoing enhancements to these devices will improve maneuverability and clinical effectiveness.

Climate change is a global emergency. Increasing awareness has led to policy changes regarding global industry emissions. The healthcare industry carbon footprint is large and growing more and more. Gastroenterology, with its heavy reliance on industry, is a major contributor toward this growth. For a significant change toward reducing the field's carbon footprint, it would involve serious industry commitment. At present, there are no clear guidelines or regulations on controlling healthcare-related industry emissions and improving sustainability. This narrative review aims to provide practical suggestions at each step of the supply chain can lead to greater sustainability.

Pancreatic fluid collections often develop as a complication of acute pancreatitis but can be seen in a variety of conditions including chronic pancreatitis, trauma, malignancy or post-operatively. It is important to classify a pancreatic fluid collection in order to optimize treatment strategies and management. Most interventions are targeted towards the management of delayed complications of pancreatitis, including pancreatic pseudocysts and walled-off necrosis (WON), which often develop days to weeks after the initial episode of pancreatitis. Surgical, percutaneous, and endoscopic interventions are all possible methods for treatment of pancreatic fluid collections, however endoscopic drainage with endoscopic ultrasound has become first-line. Advances within endoscopic drainage strategies have also led to innovative changes in the specific stents used for treatment, with possible options including double pigtail plastic stents, fully covered self-expanding metal stents and lumen-apposing metal stents (LAMS).