22 esgena conference · combination makes the esgena conference to an exceptional educational...

22nd ESGENA

CONFERENCE 20-22 October 2018

In Conjunction with the

Hosted by

Austrian Society of Endoscopy Nurses and Associates (IVEPA)

1

CONTENT

Welcome of Welcome 2

Contact Addresses 2

General Information 3

- Useful Conference Information 3

- Useful Information about Vienna 7

- Floor Plans 8

- List of Exhibitors 13

ESGENA - Programme Overview 16

ESGENA – Detailed Programme 21

- ESGENA-Session on October 20, 2018 21

- ESGENA-Workshops on October 20, 2018 22

- ESGENA-Scientific Programme on October 21, 2018 25

- ESGE Learning Area 32

ESGENA Abstracts 35

- Oral Presentations 35

- Poster Presentations 51

Addresses of Speakers, Chairs and Tutors 62

ESGENA Conference Sponsors 65

ESGENA Annual News 66

Announcement for next ESGENA Conference 68

2

Word of Welcome Dear colleagues, On behalf of ESGENA and the Austrian Society of Endoscopy Nurses and Associates (IVEPA) it is our great pleasure to welcome you to the 22nd ESGENA Conference and the 26th United European Gastroenterology Week in Vienna. The relaxed atmosphere of the ESGENA conference is a wonderful opportunity to meet colleagues from different countries and to expand your professional network. The ESGENA conference includes state-of-the-art lectures, free papers & posters, lunch sessions, workshops with hands-on training and live transmissions. Last breaking news about new trends and developments as well as presentations about interesting projects and studies in Gastroenterology and Endoscopy ensure a truly global context. You also have full access to the UEG Week, this combination makes the ESGENA conference to an exceptional educational event.

Following past meetings in 2008, 2014 and 2016, this is the fourth time that the medical and nursing community of Gastroenterology and Endoscopy meet in Vienna. The city on the Danube is known not only for the Prater, the Hofburg and delicious pastries, but also for great experiences with and without adrenalin factor. Enjoy the extraordinary Austrian hospitality, combined with the multicultural atmosphere of an international meeting. We welcome you to the 22nd ESGENA Conference and 26th UEG Week in October 2018 in Vienna and wish you an interesting conference. Marjon de Pater, President of ESGENA Dagmar Zrzavy, President of IVEPA

Contact Addresses ESGENA Governing Board President Marjon de Pater Amsterdam, The Netherlands

Vice President Wendy Waagenes Copenhagen, Denmark

Secretary Irene Dunkley Huntingdon, United Kingdom

Treasurer Anita Jorgensen Oslo, Norway

Councillor Björn Fehrke Bern, Switzerland

Mario Gazic Bjelovar, Croatia

Enriqueta Hernandez Soto Barcelona, Spain

ESGENA Scientific Secretariat Ulrike Beilenhoff

Ferdinand-Sauerbruch-Weg 16 89075 Ulm Germany

Phone: +49 (0) 731 950 39 45 Fax : +49 (0) 731 950 39 58 Email: [email protected]

ESGENA Website www.esgena.org

mailto:[email protected]

http://www.esgena.org/

3

General Information Attendance Certificates will be sent out in the first week of November in electronic format. For special request, please contact [email protected] .

Cloakroom The cloakroom is located in Foyer F in back of Level 0 and can be used free of charge from Saturday, October 20 through Wednesday, October 24. Participants can also store their luggage there.. Coffee & Lunch Lunch and coffee are not included in the registration fee. UEG offers a certain amount of catering during the breaks on a first-come, first-served basis. Throughout the venue there will be water dispensers and catering kiosks to buy refreshments and snacks. ESGENA Catering - Saturday, October 20 (Foyer M)

Coffee Break 10:30 – 11:00 // 15:30 – 16:00 Lunch 13:00 – 14:00

- Sunday, October 21 (Foyer G) Coffee Break 10:30 – 11:00 // 16:30 – 17:00 Lunch 13:00 – 14:00

PGT Catering - Saturday, October 20 and Sunday, October 21

(Foyer A, B, C) Coffee Break 10:30 – 11:00 Lunch 13:00 – 14:00

UEG Week Catering (Mon–Wed) - Monday, October 22 and Tuesday, October 23

(Halls X2 – X5) Coffee Break 10:00 – 10:30 // 15:30 – 15:45 Lunch 12:00 – 14:00

- Wednesday, October 24 (Halls X2 – X5) Coffee Break 10:00 – 10:30 Lunch 12:00 – 14:00

Conference Language The official language of the ESGENA Conference is English. No simultaneous translation will be provided.

Emergency and First Aid In case of emergency please contact the staff at the registration counters in the Entrance Foyer. The attentive staff will be pleased to help. ESGENA Annual General Meeting ESGENA Annual General Meeting is held on Sunday, October 21, 2018 from 18:00-19:00 h in Room G. Access for ESGENA members only.

ESGENA Feedback form Your feedback is important to us ! Please use the ESGENA electronic evaluation form to give us your feedback and to suggest topics for the next ESGENA conference. Link: Here is the link https://www.surveymonkey.de/r/2018_Vienna Thank you very much for your support

ESGENA Hands-on-Training Hands-on-training on bio simulators is offered on Saturday and Sunday in the ESGE Learning Area in Room L-2 / L-3 See Workshops 5, 10-12 in the ESGENA detailed programme. Please note that there are only a limited number of tickets available in order to ensure small training groups at each station. Tickets for nurses are available at the entrance of the ESGE Learning Area- on a first-come-first-served basis.

ESGENA Lunch Sessions Two parallel lunch sessions on Sunday, October 21, 2018 combine state-of-the-art-lectures and hands-on-training. Lectures are given in room G and K from 12:30-13:40 while hands-on training is offered in the area in front of room G. ESGENA Membership Desks The ESGENA membership desk is located - On Saturday, October 20, 2018, in front of Room L-8 - On Sunday, October 21, 2018, in front of Room G ESGENA Participants at UEG Week ESGENA participants have full access to the UEG Week from Saturday to Monday, October 20-22, 2018 with their ESGENA name badges. Nurses who also attend the UEG Week on Tuesday and Wednesday have on contact the registration desk, either on Monday afternoon (after 15:00 h) or Tuesday morning, to get a special marking on their names badges (free of charge). It is not possible to get this marking earlier than Monday afternoon after 15:00 h !!! ESGENA Poster Sessions ESGENA posters are displayed in front of room G. Posters should be mounted on the assigned board on Sunday, October 21, 2018, between 9:00 h to 18.00 h. Poster authors receive material to fix the posters at the ESGENA membership desk. ESGENA has two poster sessions on Sunday, October 21, 2018: - From 10:30-11:00 h - From 13:30-15:00 h ESGENA Free Paper & Poster Award The winners of the best free papers and poster presentations will be announced - during the ESGENA Session 7 “Present & Future in GI

Endoscopy” - on Sunday from 17:00-19:00 h - in Room G. Presenting authors are requested to attend this session. Internet Centre and WiFi 2 Internet Centres with several terminals are located in Foyer E on Level 0 and in the Hands-on Area on Level 1. WiFi is available throughout the venue. UEGWifi by Pfizer - Password: uegweek18


https://www.surveymonkey.de/r/2018_Vienna

4

General Information Name Badges Participants are requested to wear their name badge at all times during the congress. In case the badge is being scanned at exhibition booths or during an Industry Sponsored Symposium the delegate gives his/her consent that his/her personal data, comprising full name, address (institute, company, department, address) and email address is being passed on to UEG sponsors/exhibitors listed on the website ueg.eu for the purpose of providing marketing and information material relating to the field of digestive health as well as information on scientific events. Photos, Filming and Recording of Scientific Sessions It is strictly forbidden to film, take photos or record any oral or poster presentation of UEG Week without the consent of the organiser (including smart phones, mobile devices, etc). Please note that numerous sessions will be recorded and published at ueg.eu/education/library immediately aVer the congress and will be available for all congress delegates. This archive will also include all abstracts, E-Posters and the Syllabus of the Postgraduate Teaching Programme. Programme Changes The organizers cannot assume liability for any changes to the programme, due to external or unforeseen circumstances.

Public Transport Ticket The congress badge serves as a public transportation ticket if it includes the logo of the public transportation company Wiener Linien alongside the validity date. ESGENA delegates may use the public transportation ticket free of charge from Saturday through to Monday, October 20–22. Vienna’s public transportation system includes bus, Straßenbahn (tram), U-Bahn (underground) and S-Bahn (express city train). However, transportation to/from the airport using the CAT train, or S-Bahn (rail city train) once the city boundaries are left, requires the purchase of a separate ticket. Please check the Metro Map of Vienna. Kindly note that the congress badge only serves as a public transportation ticket if shown in conjunction with a valid ID (passport) in case of ticket checks. How to get from the city centre to the venue The fastest way to get from the city centre to the ACV is the underground line U1 (red) with direction ‘Leopoldau’. Get off the U1 at ‘Kaisermühlen – VIC’ and take exit ‘Schüttaustrasse’ (Austria Center Vienna is also indicated). How to get to the airport Vienna International Airport – VIE is easily accessible from the ACV by public transportation and by taxi. The trip by taxi takes approx. 25 minutes, by public transportation approx. 50 minutes. The fastest way is the airport bus VAL 3 which takes you hourly and directly from/to Kaisermühlen – VIC in 40 min. One-way ticket EUR 8, return ticket EUR 13. Alternatively, you can take the underground line U1 (red) from the station ‘Kaisermühlen – VIC’ with direction ‘Reumannplatz’. Change at ‘Schwedenplatz’ and take the underground line U4 (green) with direction ‘Hütteldorf’. Get off the train at ‘Landstrasse – Wien Mitte’ and take the City Airport Train or the S-Bahn (S7). The City Airport Train operates every 30 minutes, S7 every hour.

Silent Room There is a room set apart for prayer. It is a quiet place, where delegates may withdraw to seek divine strength and guidance. The silent room is located in Room 0.81 on Level 0. Speakers Centre The Speakers Centre is located in Foyer E on Level 0. It is equipped with PCs where speakers can work on their slides. Speakers are asked to hand in their CD-ROM or USB stick, containing the PowerPoint Presentation (IBM format or compatible, no multisession) or video preferably one day before, but at the latest 3 hours prior to the presentation. The slides will be transferred to the central congress server and will be available afterwards on a special congress notebook in the session room. The use of personal notebooks is not allowed. Technical staff will be happy to assist. Opening Hours - Friday October 19 14:00 – 18:00 - Saturday October 20 07:30 – 18:00 - Sunday October 21 07:30 – 18:00 - Monday October 22 07:00 – 18:00 - Tuesday October 23 07:00 – 18:00 - Wednesday October 24 07:00 – 14:00 Taxi A taxi stand is located close to the ACV next to the underground station ‘Kaisermühlen – VIC’. Taxis can be called day and night at the telephone numbers: +43 1 401 00, +43 1 601 60 or +43 1 313 00 Technical Exhibition UEG Week is accompanied by a major technical exhibition taking place in Halls X2, X3, X4, X5 on Levels –2 and 0. This provides an excellent opportunity for physicians, pharmacists, pharmacy assistants, nurse practitioners, physician assistants to interact with the industry and familiarise themselves with the latest advances in technology and pharmacology. For further information and floor plans please see the list of exhibitors on next pages and following, in the UEG Week 2018 App as well as on the UEG website ueg.eu/week. Please note that according to the EU Directive 2001/83/ EC promotional material related to prescription-only medicines must be distributed or provided exclusively to healthcare professionals who are authorised to prescribe or dispense them. Opening Hours - Monday October 22 09:00 – 17:30 - Tuesday October 23 09:00 – 17:30 - Wednesday October 24 09:00 – 14:00 UEG Week 2017 App Get the UEG Week 2018 App for your smartphone and experience the congress at your fingertips! Send questions during sessions via the Q&A tool or quickly find your way through the most up-to-date congress schedule. Cast your vote in interactive sessions via the app. Have a look at floor plans and browse the exhibition and company profiles. The app is free of charge for iPhone/iPad and Android smartphone users. The UEG Week 2018 App is available at:Apple App Store and Google Play Please note, the ESGENA programme is available on the App.

5

General Information UEG Week Abstracts The abstracts of UEG Week Vienna 2018 will be available online in the Library on the UEG Education website. UEG Week Congress News and Website The UEG Week website, UEG Week App and our social media channels will provide an overview of sessions and data presented each day and “what not to miss” the following day along with hot topics and snapshots of the congress. For more information, visit the UEG Week website (ueg.eu/week). UEG Week Live streaming of Sessions Be part of UEG Week and view 50% of all sessions wherever you are! UEG will connect everyone to its annual meeting via live stream on the UEG Week Live website. Lean back and get updated on relevant GI and liver topics free of charge, and connect with the community via the UEG Week Social Wall. Simply sign in to myUEG. For more information, please visit live.ueg.eu. UEG Week Post Graduate Course Nurses are welcome to attend the UEG Week post graduate course on Saturday to Sunday at no extra charge.

UEG Week Core Programme Nurses are welcome to attend the medical lectures of the UEGW core programme at no extra charge. ESGENA participants have full access to the UEG Week from Saturday to Monday, October 20-22, 2018 with their ESGENA name badges. Nurses who also attend the UEG Week on Tuesday and Wednesday have on contact the registration desk, either on Monday afternoon (after 15:00 h) or Tuesday morning, to get a special marking on their names badges (free of charge). It is not possible to get this marking earlier than Monday afternoon after 15:00 h !!! UEG Week Programme Book The UEG Week programme book will be handed out at the congress material counter. Insurance / Liability UEG or ESGENA do not accept any liability for damages and/or losses of any kind which may be incurred by the congress participants, during either the official activities or official UEG networking events. Delegates attend the congress at their own risk. Participants are advised to take out insurance against loss, accidents or damage that could be incurred during the congress.

Color code for ESGENA Program

ESGENA Lectures

ESGENA Poster Exhibition

ESGENA Workshops ESGENA Lunch Session

Hands-on Training on Bio Simulators

ESGENA Free Paper & Poster Prize The ESGENA best free paper prize is sponsored by Pentax Europe. The presenting authors of accepted abstracts receive free registrations at the ESGENA Conference. Prizes to be won The best free papers and the best poster presentation win - free registrations at the ESGENA Spring School in April 2019 in Prague,

Czech. Repubic and - free registrations at the next ESGENA conference, in October 2019 in

Barcelona, Spain.

The winners of the best free papers and the best poster presentation will be announced - during the ESGENA Session 7 “Present & Future in GI Endoscopy” - on Sunday from 17:00-19:00 h - in Room G. Authors are requested to attend this session. For details how to submit an abstract for the next ESGENA conference 2018 in Vienna, please find the “Call for Abstract” included in this book and on the ESGENA Website www.esgena.org


7

Useful Information about Vienna Bank Most banks in Vienna are open from Monday to Friday from 8.00 am to 12.30 pm and from 1.30 pm to 3.00 pm, and until 5.30 pm on Thursdays. In the city centre (1st district), almost all banks are open over lunchtime Climate In October the average temperatures range from 7 to 14° C during the day in Vienna. Currency Payments will be accepted in EURO. At most banks as well as at exchange bureaus in the city currency can be exchanged. Credit cards are widely accepted. Electricity The voltage in Austria is 230 Volts, 50 Hertz. Sockets meet European regulations and use the two-round pin system.

Emergency numbers In case the worst should happen, here are the most important telephone numbers in Vienna. - European emergency and fire service: tel. 112 - Emergency doctor: tel. 141 - Ambulance / rescue: tel. 144 - Police: 133 - Vienna Med doctor's hotline for visitors (0-24): tel. +43-1-

513 95 95 - Evening and Sunday drugstores (0-24): tel. 1455 - Evening and weekend dental service (taped service): tel.

+43-1-512 20 78

Safety As in all major cities and congress venues, people should always keep an eye on their personal belongings. Please be aware of pickpocketing and bag-snatching and make sure to take off your name badge and congress bag when you go sightseeing in downtown Vienna. Wearing the name and bag identifies you as a tourist which might attract pickpockets. Sightseeing in Vienna There is much to see: From Gothic St. Stephen’s Cathedral to the Imperial Palace to the Art Nouveau splendor of the Secession, from the magnificent baroque palace Schönbrunn to the Museum of Fine Arts to modern architecture at the MuseumsQuartier. Record-breaking: In Vienna, there are over 27 castles and more than 150 palaces. A special registration desk for sightseeing is located in the registration area. Shopping hours Shops are usually open Mon - Fri from 9:00-18:30 h, Sat until 17:00 or 18:00 h. Some shopping centers are open until 20:00 or 21:00from Mon-Fri. Shopping is available on Sundays and holidays at the large railway stations, at the airport and in the museum shops. Telephone Country code: +43. Outgoing international code: 00. Time Zone The time zone in Austria is Central European Time (CET), which is Greenwich Mean Time (GMT) +1 hour in winter and +2 hours in summer.

8

Floor Plans

9

Floor Plans

10

Floor Plans

11

Floor Plans

12

Exhibition Plans

13

List of Exhibitors

Major Partners Booth No.

Major Partners Booth No.

ALFASIGMA S.p.A X2/14 MEDTRONIC X2/11

Celltrion Healthcare X5/10 Norgine X2/13

Gilead Sciences X5/32 PENTAX Europe GmbH X3/3

General Exhibitors Booth No. General Exhibitors Booth No.

3-D Matrix X5/18 GE Healthcare X5/6

3D Systems Simbionix X5/8 Genetic Analysis AS X3/11

Alton (Shanghai) Medical Instruments Co., Ltd X3/10 Hangzhou AGS MedTech Co., Ltd. X2/16

amg International GmbH X5/41 HITACHI Medical Systems / PENTAX Europe GmbH X3/3

ANKON Medical Technologies X5/5 IMMUNDIAGNOSTIK AG X5/16

Anrei Medical (Hangzhou) Co., Ltd. X4/21 INFAI GmbH X4/34

Apollo Endosurgery X3/12 Insitumed GmbH X2/9

Arc Medical Design X4/25 IntroMedic Co., Ltd. X2/30

BCM Co., Ltd X4/17 invendo medical GmbH X3/17

Beijing Huaco Healthcare Technologies Co., Ltd. X3/2e Jiangsu ATE Medical Technology Co., Ltd X5/26

BIOCODEX X2/23 Jiangsu Kangjin Medical Instrument Co., Ltd. X4/33

Biocrates Life Sciences AG X3/2a Jinshan Science & Technology X2/28

BioGaia X5/7 Karger Publishers X4/10

Biogen Intl. GmbH X3/5 KARL STORZ SE & CO. KG X4/16

Boston Scientific International X2/19 LA LETTRE DE L'HEPATO-GASTROENTEROLOGUE X5/35

BÜHLMANN Laboratories AG X5/36 Laborie X5/31

CALPRO AS X4/18 Leo Medical Co., Ltd. X5/23

Cantel X3/2 Leufen Medical GmbH X4/7

CapsoVision, Inc. X5/39 Life Partners Europe X5/42

CASEN RECORDATI S.L. X2/5 Lumendi X5/15

CBC Group X2/2 M.I. Tech Co., Ltd. X4/22

Celgene Corporation X4/4 Mauna Kea Technologies X4/32

Changzhou Dahua Group/Citec X5/47 Medify X5/14

Changzhou Jiuhong Instrument Co., Ltd X4/8 Medi-Globe GmbH/ Endo-Flex GmbH X2/25

Choyang Medical Industry Ltd. X4/23 MEDITALIA S.A.S. X5/40

Cook Medical X2/24 Mednova Medical X3/2d

Creo Medical Ltd. X3/14 medwork GmbH X3/8

Diversatek Healthcare X3/9 Micro-Tech Europe GmbH X2/26

Dr. Falk Pharma GmbH X2/18 Mirai Medical X4/24

Eli Lilly and Company X4/20 MSD (Merck & Company, Inc.) X2/20

ELLA-CS, s.r.o. X2/29 MTW-Endoskopie X2/32

EMED SP. Z O. O. SP. K. X3/16 Mylan GmbH X4/5

ENDALIS X4/28 NET New Electronic Technology GmbH X5/45

EndoAid Ltd. X5/28 NEXTBIOMEDICAL Co.,Ltd. X4/6

EndoClot Plus, Inc. X5/27 NIKKISO X2/8

Endoscopic Ultrasound Journal X4/13a NISO Biomed X5/33

Endoscopy / ESGE - Thieme X5/30 Noventure X3/20

Endoss X5/43 Ovesco Endoscopy AG X3/15

Endotics X5/38 Oxford University Press X4/13

Erbe Elektromedizin GmbH X2/15 Peter Pflugbeil GmbH X5/25

Eurospital X5/24 Probiotics International Ltd X4/27

Exalenz X5/12 R-Biopharm AG X2/3

Finemedix Co., Ltd X3/18 Reckitt Benckiser X4/29

Fischer ANalysen Instrumente GmbH X5/29 Richen Medical Science X2/1

15

List of Exhibitors

General Exhibitors Booth No. Members Village - Level 0

Booth No.

Robarts Clinical Trials X2/4 EAES MV0/7

Roche X2/12 EAGEN MV0/15

Rogaska Donat Mg X3/2c EASL MV0/1

S&G Biotech INC. X4/30 ECCO MV0/16

SAGE Publishing X4/9 EDS MV0/3

Sandoz International GmbH X2/22 EFISDS MV0/6 SHANGHAI ANQING MEDICAL INSTRUMENT CO., LTD X4/14 EHMSG MV0/12

Shangxian Minimal Invasive Inc. X5/13 EPC MV0/10 SHENZHEN ZHONGHE HEADWAY BIO-SCI & TECH CO., LTD X5/9 ESCP MV0/8

Shionogi Ltd. X5/22 ESDO MV0/4

Shire X5/1 ESGAR MV0/14

Shire X5/2 ESGE MV0/17

SMART Medical Systems Ltd. X3/1 ESNM MV0/5

SOFAR SPA X2/7 ESP MV0/2

SOLUSCOPE X3/19 ESPCG MV0/11

SonoScape Medical Corp. X3/4 ESPEN MV0/9

Standard Sci-Tech Inc. X2/31 ESPGHAN MV0/13

STEELCO SPA X5/21

SUMITOMO BAKELITE CO., LTD. X5/17

Association & Future Events Area - Level 1

Booth No.

Surgical Science X5/46 EGEUS - European Group for Endoscopic UltraSonography AFA1/14

Taewoong Medical X2/21 Egypt Gastro Hep Congress AFA1/13

The Standard Co., Ltd X4/15 Endo Live Roma 2019 AFA1/6

US Endoscopy X2/17 Euro-Eus 2019 AFA1/15

W. L. Gore & Associates X5/44 European Section and Board of Gastroenterology and Hepatology (ESBGH) AFA1/11

Wassenburg Medical B.V. X5/11 GEEW AFA1/7

Wego Group X3/2b International Foundation for Gastrointestinal Disorders AFA1/12

Wiley X4/12 Journal Gastrointestinal and Liver Diseases AFA1/16

WILSON INSTRUMENTS (SHA) CO., LTD X2/6 The Rome Foundation AFA1/4

Wisepress Medical Bookshop X4/11 Turkish Society of Gastroenterology AFA1/5

Zeon Medical Inc. X4/19 World Endoscopy Organization - WEO AFA1/10

World Gastroenterology Organisation - WGO AFA1/9

Patient Organisations - Level 1 Booth No.

Association of European Coeliac Societies (AOECS) AFA1/3

EuropaColon/Digestive Cancers Europe AFA1/2

European Federation of Crohn´s and Ulcerative Colitis Associations (EFCCA) AFA1/1

16

ESGENA Programme Overview

Saturday, October 20, 2018

Rooms Room E2 Room M

Lounge 7 Lounge 8 Room 1.61/1.62 ESGE Learning

Area

08:30-10:30

UEG Week

Postgraduate Training

Programme

11:00-13:00

UEG Week


Programme

11.30-13.00

ESGENA Opening Session

Quality makes the difference

13:00-14:00 Lunch

14:00-16:00

UEG Week


Programme

14:00-15:30

Special Bronchoscopy

Session I

14:00-15:30

Workshop 1

Electrosurgery in Endoscopy: How to make it

safe and effective?

Olympus

14:00-15:30

Workshop 2

The nurse’s

role in tissue resection and

infection prevention

Boston

14:00-15:30

Workshop 3

Health and Safety in

Endoscope Reprocessing

Dr Weigert

14:00-15:30

Workshop 4

Hands-on-training on

biosimulators:

15:30-16:00 Coffee

16:00-17:30

Special Bronchoscopy

Session II

16:00-17:30

Workshop 5

More than nice

to know – Damage

prevention & correct

endoscope handling

Olympus

16:00-17:30

Workshop 6

Electrosurgery – Prevention of complication

Erbe

16:00-17:30

Workshop 7

The influence

of endoscopes reprocessing on successful

infection prevention

Cantel

16:00-17:30

Workshop 8

Hands-on-training on

biosimulators

ESGENA Welcome Reception 20:00

Venue to be confirmed

17

ESGENA Programme Overview

Sunday, October 21,2018

Room G Room K Poster Area ESGE

Learning Area

09:00-10:30

Session 1

Abstract based

09:00-10:30

Session 2

Quality starts with building and

reconstruction

10:30 – 11:00

Coffee

10:30 – 11:00

Coffee

10:30 – 11:00

Poster Exhibition I

11:00-12:30

Session 3 Education

11:00-12:30

Session 4

Management - safety first

11:00-12:30

Workshop 9

Hands-on-training on Bio simulators

12:30-15:00

Lunch Session 1 GE Endoscopy

12:30-15:00

Lunch Session 2

Hygiene & Infection control

13:00-14:00

Lunch

13:00-14:00

Lunch

13:30-15:00

Poster Exhibition II

14:00-15:30

Workshop 10

Hands-on-training on bio simulators:

15:00-16:30

Session 5 Hygiene – points of

discussion

15:00-16:30

Session 6

IBD

16:30-17:00

Coffee

16:30-17:00

Coffee

17:00-18:00

Session 7

Present & Future in GI Endoscopy

18:00-19:00

ESGENA Annual

General Assembly

19

ESGENA delegates participate in UEG Week Please note: - With their ESGENA badge, ESGENA participants have full access to the UEG Week on Monday. - Nurses who also attend the UEG Week on Tuesday and Wednesday have on contact the registration desk, either on

Monday afternoon (after 15:00 h) or Tuesday morning, to get a special marking on their names badges (free of charge). It is not possible to get this marking earlier than Monday afternoon after 15:00 h !!!

Monday, October 22, 2018

UEG Week - Opening Session

Visit of Exhibition

Free Paper Sessions

Scientific Centre: Poster Exhibition / Poster Champ Sessions / Posters in the Spotlight

Symposia

Translational / Basic Science Pathway

Today's Science; Tomorrow's Medicine (TSTM)

Case-Based Discussions

ESGE Learning Area

Tuesday, October 23, 2018

Visit of Exhibition

Live Endoscopy

Free Paper Sessions

Scientific Centre: Poster Exhibition / Poster Champ Sessions / Posters in the Spotlight

Symposia

Translational / Basic Science Pathway

Today's Science; Tomorrow's Medicine (TSTM)

Case-Based Discussions

ESGE Learning Area

21

ESGENA Sessions Sat, 20 Oct 2018

11:30-13:00 Room E2

ESGENA Opening Session: Quality makes the difference

Chairs

Marjon de Pater, The Netherlands Wendy Waagenes, Denmark

11:30-11:45 Welcome Marjon de Pater (ESGENA President), The Netherlands

11:45-12:15 The value of nursing in Endoscopy and Gastroenterology Alison Leary, United Kingdom

L-1

12:15-12:35 Performance measures for endoscopy services: The ESGE Quality Improvement Initiative Roland Valori, United Kingdom

L-2

12:35-12:55 Delegation of tasks to unregistered staff - what - when - how - why Ulrike Beilenhoff, Germany

L-3

12:55-13:00 Discussions

14:00-15:30 Room M

Special Bronchoscopy Session I

Chairs Björn Fehrke, Switzerland

Michael Ortmann, Switzerland

14:00-14:20 Diagnostic and interventional broncoscopy- which options do we have? (From EBUS, EMN to cryo therapy, ELVR and stenting) Björn Fehrke, Switzerland

L-4

14:20-14:40 Endoscopic Lung Volume Reduction (ELVR) Christophe von Garnier, Switzerland

L-5

14:40-14:55 The introduction of capnography monitoring in endoscopy Elaine Egan, Ireland

L-6

14:55-15:10 Continuous tracking, control and safety of pulmonary patients through nursing documentation Ana Mustač, Croatia

L-7

15:10-15:30 Management of bronchial haemoptysis and desaturation - or how not to panic when it goes red! Michael Ortmann, Switzerland

L-8

16:00-17:30 Room M

Special Bronchoscopy Session II

This workshop is organised by ESGENA and OLYMPUS EUROPA SE & CO. KG

Chairs Björn Fehrke, Switzerland Michael Ortmann, Switzerland

16:20-17:30 The workshop will offer the opportunity to improve procedure skills in bronchoscopy with the help of dedicated hands-on training on bio simulators under the supervision of highly experienced tutors. Participants will be able to perform the following techniques in diagnostic and therapeutic procedures in bronchoscopy: - Bronchoalveolar lavage, cytology brushing, biopsy taking , TBNA for cytology and

histology sampling - Endoscopic Lung Volume Reduction(ELVR) - Management of bronchial bleeding Number of participants: limited to 40 persons

22

ESGENA Workshops Sat, 20 Oct 2018

14:00-15:30 Lounge 7

Workshop 1: Electrosurgery in Endoscopy: How to make it safe and effective?

This workshop is organised by OLYMPUS EUROPA SE & CO. KG

Chairs

Björn Rembacken, United Kingdom

Aims & Content

This workshop is all about creating confidence using HF in endoscopy. You will learn about different endoscopic cases and their specific procedures. In addition, there will be tips and tricks useful for the nurse’s daily work. During this workshop, we will offer the opportunity to improve your skills of choosing the right HF settings on your generator for the best outcome of the procedure. It includes a hands-on training to experience the differences of HF settings under supervision and support of highly experienced tutors After the theoretical part, an intensive hands-on will follow, where you may gain further knowledge about the effects of HF on tissue.

14:00-15:30 Lounge 8

Workshop 2: The nurse’s role in tissue resection and infection prevention

This workshop is organised by Boston Scientific

Chairs

Mark Ellrichmann, Germany

Aims & Content

This goal of this workshop is to highlight the nurses role during a tissue resection procedure from start to finish. You will learn about various tips and techniques for pre-procedure, during the procedure as well as post procedure to reduce risks to the patient. This workshop will : - Highlight the importance of teamwork during a tissue resection procedure while using single use

devices - Provide an update on infection risks in endoscopy units and tips on how to provide quality control

during cleaning and disinfection of reusable material - Offer hands-on experience with our new tissue resection devices as well as our infection prevention

line of products

14:00-15:30 Room 1.61/1.62

Workshop 3: Health and safety in endoscope reprocessing

This workshop is organised by Chemische Werke Dr. Weigert and ESGENA

Chairs

Thomas Brümmer, Germany Ulrike Beilenhoff, Germany

Aims & Content

Part 1: Process chemistry: overview - trends – active substances - Cleaning & disinfection processes The individual steps for a safe reprocessing of endoscopes are defined by national and international recommendations. Different active substances and processes have been established for manual and automated reprocessing of endoscopes This part of the workshop will answer the following questions: - What are the different active substances for manual and WD (washer disinfector) reprocessing?

- How good is the cleaning performance of different active substances and how is it tested?

- What impact do different process chemicals have on treatment processes? - What is better - aldehydes or peracetic acid in the endoscope preparation? Presentations: Different active substances in the cleaning and disinfection of flexible endoscopes, Daniela Schricker, Germany

23


14:00-15:30 Room 1.61/1.62

Workshop 3: Health and safety in endoscope reprocessing

This workshop is organised by Chemische Werke Dr. Weigert and ESGENA

Chairs

Thomas Brümmer, Germany Ulrike Beilenhoff, Germany

Aims & Content

Part 2: Health and safety hazards relevant for reprocessing medical devices cover the following areas - Biological and chemical hazards - Ergonomic and physical hazards - Risk of injuries - Psychological hazards National and international precaution standards are available for hand hygiene, staff attire, and personnel protective equipment (PEE) which need to be translated into Endoscopy and endoscope reprocessing. The aim of part 2 of this workshop is to enable participants to discuss their problems regarding - health and safety problems during endoscopic procedures and during reprocessing - compliance with current guidelines - appropriate personnel protective equipment (PPE) and protection measurers during reprocessing - traceability and outbreak management in an informal setting. Ask questions – we may have the answers

14:00-15:30 ESGE Learning Centre

Workshop 4: Hands-on training on bio simulators

This workshop is organised by ESGENA

Chairs

Eric Pflimlin, Switzerland

Aims & Content

Hands-on training on bio simulators (pig models) under the supervision of highly experienced tutors: Participants will have the opportunity to perform endoscopic techniques on the following topics: - OGD with Injection techniques, Ligation, Clipping, APC - Colonoscopy with Polypectomy, EMR and APC - ERCP with stone extraction and stenting As participation will be limited, registration will be treated on a first-come-first-served basis: Tickets will be available onsite only – at the entrance of the ESGE Learning Area.

16:00-17:30 Lounge 7

Workshop 5: More than nice to know – Damage prevention & Correct endoscope handling

This workshop is organised by OLYMPUS EUROPA SE & CO. KG

Chair

Ulrike Beilenhoff, Germany Holger Biering, Germany

Aims & Content

The spectrum of gastrointestinal endoscopic treatments has significantly expanded during recent years, also the number of endoscopic examination has increased. This is in conflict with economic factors for medical equipment, which will be used for frequently during longer periods. Consequently this leads situations with increased mechanical and chemical stress also to endoscopes. Within this triangle of forces, the need for a variety of checks and balances becomes obvious. This workshop is intended to: - give technical inside to endoscope material considerations and material stress aspects - visualise mechanical and hygiene risk factors - inform about practical aspects regarding damage prevention - allow workshop participants to touch and feel mechanical and stress aspects an endoscopes - get tips about suitable handling of endoscopes

24


16:00-17:30 Lounge8

Workshop 6: Electrosurgery – Prevention of complication

This workshop is organised by ERBE Elektromedizin GmbH

Chairs

Jens Bettin, Germany Marjon de Pater, The Netherlands

Aims & Content

Electrosurgery offers the possibility of pressure-free and precise cutting and at the same time control of bleeding during endoscopic resection techniques. With argon plasma coagulation tissue can be devitalized. The water-jet surgery provides additional options for resection. The aim of the workshop is:

- To update on principles of electrosurgery and relevant safety measures

- To demonstrate different settings for different applications like Polypectomy, EMR, ESD,

Papilloectomy, etc: in order to achieve max safety and to prevent adverse events and complications

16:00-17:30 Room 1.61/1.62

Workshop 7: The influence of endoscopes reprocessing on successful infection prevention - a risk assessment of the individual processing steps

This workshop is organised by CANTEL and BHT

Chairs

Alessandro Repici , Italy

Aims & Content

The aim of the workshop is to help you optimise and risk assess your endoscope reprocessing workflow. The workshop will focus on infection prevention, increasing efficiency, improving patient safety and reducing risk at the 4 key stages of an endoscopes journey: - Procedure , Paul J. Caesar, The Netherlands - Manual pre-cleaning, Frank Schiffer, Germany - Reprocessing in the AER, Alessandro Repici, Italy - Drying and Storage, Christian Fischer, Germany




Chairs

Eric Pflimlin, Switzerland

Aims & Content

Hands-on training on bio simulators (pig models) under the supervision of highly experienced tutors: Participants will have the opportunity to perform endoscopic techniques on the following topics: - OGD with Injection techniques, Ligation, Clipping, APC - Colonoscopy with Polypectomy, EMR and APC - ERCP with stone extraction and stenting As participation will be limited, registration will be treated on a first-come-first-served basis: Tickets will be available onsite only – at the entrance of the ESGE Learning Area.

25

ESGENA Sessions Sunday, 21 Oct 2018

09:00-10:30 Room G

ESGENA Session 1 : Abstract based

Chairs

Irene Dunkley, United Kingdom Siiri Maasen, Estonia Wendy Waagenes, Denmark Gerlinde Weilguny, Austria

09:00–09:15 National training programme for sedation in GI Endoscopy – 9 years experience Ulrike Beilenhoff, Germany

L-9

09:15-09:30 The 7-Month Journey from Endoscopy Nurse to Nurse Endoscopist Yulrich Louie dela Cruz, Irene Dunkley, United Kingdom

L-10

09:30-09:45 Process optimization in endoscopy by implementing a checklist for patient safety Silke Bichel, Germany

L-11

09:45-10:00 Access to nursing care for people with autism with special emphasis on preparation for endoscopic examination Katja Brozičević, Croatia

L-12

10:00-10:15 Analysis of the awareness of population about risk factors and methods of colorectal cancer prevention Nataliya Shandarovska,, Malta

L-13

10:15-10:30 Microbiological surveillance of the endoscopes: experience of Endoscopy Unit of the University Campus of Rome Benedetta Colombo, M.L. Candela, A. Minciullo, E. Portalino, G. Bencivenga, F. Antonelli, A. Conti, S. Angeletti, F.M. Di Matteo, Italy

L-14

09:00-10:30 Room K

ESGENA Session 2 : Quality starts with building and reconstruction

Chairs

Martina Fellinghauer, Austria Tatjana Gjergek, Slovenia

09:00-09:20 Restructuring of an Endoscopy Unit as an outcome of a work environment report Tine Karbo, Denmark

L15

09:20-09:40 Building a new hospital – using the chances for endoscopy Jan-Werner Poley, The Netherlands

L-16

09:40-10:00 Safety systems in endoscopy – How to prevent steeling of Endoscopes Ute Pfeifer, Germany

L-17

10:00-10:20 Transfer of reprocessing of the endoscopes from the endoscopy department to the department for central sterilization - everyday life Eric Pflimlin, Switzerland

L-18

10:20-10:30 Discussion

26


10:30-11:00 ESGENA Poster Area

Poster Exhibition I

Poster committee Fanny Durand, France

Enriqueta Hernandez-Soto, Spain Anita Jorgensen, Norway Theres Schober, Austria Jayne Tillett, UK

Education Nursing status in the Italian Digestive Endoscopy Units: A national survey by ANOTE-

ANIGEA. Alessandra Guarini, Elena Rossetti, Pierangelo Simonelli, Teresa Iannone, Daniela Carretto, Antonella Giaquinto, Giorgio Iori, Monia Valdinoc, Cinzia Rivara, Italy

P-1

Life in Germany - Integration in an Endoscopy unit Jorgert Kishta. Urte Stahlberg, Germany

P-2

Innovations in the Gastroenterology Nurses Training in Israel Yuri Guriel, Shirly Luz, Revital Barkan, Galia Niv, Rina Assulin, Israel

P-3

Mindfulness as a challenge in today's nursing Tina Kamenšek, Darja Thaler, Slovenia

P-4

11:00-12:30 Room G

ESGENA Session 3: Education

Chairs

Devika Ghosh, Ireland Denise Schäfer, Austria

11:00-11:20 Competency development and team work – the basis for patient safety Camilla Leidcker, Denmark

L-19

11:20-11:40

Mentorship and training to retain and sustain the endoscopy workforce Laura Dwyer, United Kingdom

L-20

11:40-12:00 Self-directed learning – how to implement in daily routine? Fanny Durand, France

L-21

12:00-12:20 ESGENA Statement: Quality indicators for patient care in Endoscpy Jadranka Brljak, Croatia

L-22

12:10-12:30 Discussion

11:00-12:30 Room K

SESSION 4: Management – safety first

Chairs

Mario Gazic, Croatia Joan Skovlund Christensen, Denmark

11:00-11:20 Risk management and quality control in Endoscopy – an analysis Patricia Burga, Italy

L-23

11:20-11:40 24 hours service in Endoscopy – Organisation, quality indicators and limitations Marjon de Pater, The Netherlands

L-24

11:40-12:00 Track and trace – Documentation and follow-up of endoscope reprocessing, repair and maintenance Mikael Mochet, France

L-25

12:00-12:20 ESGENA Statement: Sign-in, team-time out and sign-out – safety netting in Endoscopy Ulrike Beilenhoff, Germany

L-26

12:20-12:30 Discussions

28





Chairs

Michael Ortmann, Switzerland Eric Pflimlin, Switzerland

Aims & Content

Hands-on training on bio simulators (pig models) under the supervision of highly experienced tutors: Participants will have the opportunity to perform endoscopic techniques on the following topics:

• OGD with Injection techniques, Ligation, Clipping, APC

• Colonoscopy with Polypectomy, EMR and APC

• ERCP with stone extraction and stenting As participation will be limited, registration will be treated on a first-come-first-served basis: Tickets will be available onsite only – at the entrance of the ESGE Learning Area.

12:30-15:00 Room G

Lunch Session 1: Endoscopic techniques

Chairs Silvia Lahey, The Netherlands,

Wendy Waagenes, Denmark

12:30-12:40 A different approach to Hemostasis: When and how to use Hemospray (Cook Medical) Herdaye Aujla, United Kingdom

12:40-12:50 Advantages of the OTSC® System in the treatment of UGIB (Ovesco Endoscopy AG) Antonio Caputo, Germany

12:50-13:00 EUS: diagnostical and interventional options (M ic ro -Tec h Europe Gm bH) Elmar Botzet-Becker, Germany

13:00-13:10 The latest advancements in ERCP technology (OLYMPUS EUROPA SE & CO. KG ) Anja Schuster, Germany

13:10-13:20 Biliary tissue sampling update (US Endoscopy) John Koomen, USA

13:20-13:30 Boston Scientific’s perspective: infection prevention & safety in endoscopy David Keifer, USA

13:30-13:40 How to perform a successful ESD (Fujifilm Europe GmbH) Daniela Schröder, Germany

13:30-15:00 Hands-on training with the companies

12:30-15:00 Room K

Lunch Session 2: Hygiene & infection control

Chairs Björn Fehrke, Switzerland,

Tanja Sosic, Montenegro

12:30-12:40 Cleaning verification in the real world (Soluscope) Cécile Paya, France

12:40-12:50 Steelco enhanced solutions for "duodenoscope/echoendoscope" reprocessing & Gold Standard Layout" Monica Menin Ostani, Italy

12:50-13:00 Reprocessing of endoscope channels (KARL STORZ SE & Co. KG) Guido Merk, Germany

13:00-13:10 Smarter way of cleaning endoscopes (Pullthru) Rodolfo Pedro, United Kingdom

29


12:30-15:00 Room K

Lunch Session 2: Hygiene & infection control

13:10-13:20 All’s well that ends well: endoscope drying and storage deserve great care (CBC

Europe) Monica Cimbro

13:20-13:30 Reshaping the endoscope drying and storage (PLASMABIOTICS/PENTAX Medical)

Daniel Vinteler, France

13:30-13:40 Filt(hi)er Facts (UltraZonic) Nancy Steenbakkers, the Netherlands

13:40-15:00 Hands-on training with the companies



Poster round committee

Fanny Durand, France Enriqueta Hernandez-Soto, Spain Anita Jorgensen, Norway Theres Schober, Austria Jayne Tillett, UK

Sedation and Patient Care Right time for Propofol? A 4-years experience in an Italian center

Massimo Petrocco, Maria Pia Caldarella, Nicoletta Cicconetti, Gilda Napoletano, Paolo Panaccio, Maria Teresa Tartaglia, Maria Marino, Italy

P-5

Patient assessment: Checklist for endoscopic procedures Rafaela Bré, Carla Sousa, Hospital da Senhora da Oliveira – Guimarães, Portugal

P-6

Patients’ perspectives towards quality of a digestive endoscopy service: a qualitative approach Vânia Maria Braga, Marta Pinto, Sílvia Ferraz, Mário Dinis Ribeiro, Luís Filipe Azevedo, Portugal.

P-7

Hygiene Storage time of flexible endoscopes longer than 30 days is associated with an

increased contamination rate Yvonne Fietze, Switzerland

P-8

Technical report on the reprocessing of thermolabile endoscopes: An Italian experience Cinzia Rivara, Italy

P-9

Upper GI Tract Pain in upper gastrointestinal endoscopy. Is gastroscopy really painful?

Pedro Luis, del Mazo Tomé. Esther, González Nieto, María Concepción, Martínez Sexto, María Almudena, Pousada González, Ana María, Nieto Quesada, Alejandro, Toledo Soriano, Spain

P-10

Alternative usage of endoscopic band ligation Andrea Ácsné Tóth, Péter Lukovich, Péter László Lakatos, Magdolna Kardos, Andrea Arany, Krisztina Tari, Hungary

P-11

Nursing care for patients with bleeding gastric ulcerus Boris Kopić, Croatia

P-12

Colon capsule endoscopy: comparison of clinically relevant findings evaluation performed nurses versus physicians Pavla Hnatova, M. Setnickova, J. Folttiny, M. Voska, T. Grega, O. Ngo, B. Buckova, O. Majek, M. Zavoral, S. Suchanek, Czech. Republic

P-13

30




High concordance between trained nurse and gastroenterologist in evaluating

recordings of small bowel Video Capsule Endoscopy (VCE). Alessandra Guarini, Francesca De Marinis, Cesare Hassan, Angelo Zullo, Italy

P-14

Self-reported quality of life in patients with acute pancreatitis is impaired already on day of admission Sisse Rysgaard, Joy Stinne Timmner, Lise Lotte Gluud, Mikkel Werge, Amer Hadi, Palle Nordblad Schmidt, Srdan Novovic, Denmark

P-15

Lower GI Tract The colorectal cancer screening program in a tertiary-level hospital.

Alicia Hernández García, Marías del Cristo González Ramos, Mileidis San Juan Acosta, Silvia Morales González, Spain

P-16

Effects of patient education program on colonoscopy efficiency and patient satisfaction Ye Lim Song, Jeong-Sik Byeon, Ji Hye Kim, Mi Soon Kim, Dong-Hoon Yang, Sang Hyoung Park, Sung Wook Hwang, Eun Mi Song, South Korea

P-17

Evaluation bowel preparation in patients hospitalized Carolina M Clavera, L. Estepa, A. Navarrete, A Milà, A, Maynard, Spain

P-18

Compliance to different methods of preparation for bowel cleansing in pediatric colonoscopy Valentina Vulpe, Mirela Kubicz, Livia Dumitra, Laura Olariu, Oana Belei, Romania

P-19

Endoscopy nurse participation during screening colonoscopy increases the polyp detection rate Mihaela Caliţa, Liliana Preda, Tatiana Ivan, Adrian Săftoiu, Romania

P-20

The diagnostic sensitivity of sigmoidoscopy in bowel endometriosis Krisztina Tari, Péter Lukovich, Attila Bokor, Noémi Csibi, Réka Brubel, Andrea Ácsné Tóth, Hungary

P-21

The quality of endoscopy reporting in Patients with IBD Anne M. Liyanage, Vitthal Ramchandra Wadekar , Edie Myers, Israr UnNabi, Ireland

P-22




Chairs

Michael Ortmann, Switzerland Eric Pflimlin, Switzerland

Aims & Content

Hands-on training on bio simulators (pig models) under the supervision of highly experienced tutors: Participants will have the opportunity to perform endoscopic techniques on the following topics:

• OGD with Injection techniques, Ligation, Clipping, APC

• Colonoscopy with Polypectomy, EMR and APC As participation will be limited, registration will be treated on a first-come-first-served basis: Tickets will be available onsite only – at the entrance of the ESGE Learning Area.

31


15:00-16:30 Room G

Session 5: Hygiene – points of discussion

Chairs

Jadranka Brljak, Croatia; Jean Francois Rey, France

15:00-15:20 High prevalence of digestive bacteria in duodenoscopes – how does a national survey influence daily practice Margret Vos, The Netherlands

L-27

15:20-15:40 Endoscopy related infections – is sterilisation an answer? Michael Jung, Germany

L-28

15:40-16:00 Biofilm formation and prevention - a challenge with flexible endoscopes Lionel Pineau, France

L-29

16.00-16.15 ESGENA Curriculum on reprocessing of flexible endoscopes Ulrike Beilenhoff, Germany

L-30

16:15-16:30 Pentax-major sponsor presentation on hygiene & infection control NN

15:00-16:30 Room K

SESSION 6: Inflammatory Bowel Disease (IBD)

Chairs

Irene Dunkley, United Kingdom Ingrid Karström, Sweden

15:00-15:20 Monitoring of IBD patients – what is essential? Irene Dunkley, United Kingdom

L-31

15:20-15:40 IBD – Passport – a tool for information and communication in daily live and for travelling Key Greveson, United Kingdom

L-32

15:40-16:00 Iron-deficiency, anaemia and fatigue in IBD Palle Bager, Denmark

L-33

16:00-16:20 N-ECCO Continuing education – what can Endoscopy learn? Palle Bager, Denmark

L-34

16:20-16:30

Discussion

17:00-18:00 Room G

SESSION 7: Present & Future in GI Endoscopy

Chairs

Marjon de Pater, The Netherlands Denise Schäfer, Austria

17:00-17:20 Artificial intelligence in digestive endoscopy Jean-Francois Rey, France

L-35

17:20-17:40 New aspects of microbiome therapy Christoph Högenauer, Austria

L-36

17:40-17:55 Best Free Paper and Best Poster Awards The winner of the best free papers – oral presentation and the best poster presentations - will be announced. Presenting authors are requested to attend this session. PENTAX Medical supports the ESGENA Free Paper and Poster Award

17:55-18:00 Invitation to Barcelona 2019 Enriqueta Hernandez Soto, Spain

32

ESGE Learning Area

ESGE Lecture Theatre

In the ESGE Lecture Theatre highly qualified and well-known endoscopists have been invited to

present their views and experience with current endoscopic procedures and techniques. Their counterparts in discussion are equally well known, in several cases more senior specialists whose role it is to moderate the talk and perhaps critically question the case at hand. The number of participants is limited to 70 in order to ensure a small-forum atmosphere where active participation is possible. Special highlights in the Lecture Theatre include a mini symposium entitled “How do I ensure the quality of my endoscopy?” and an introduction of different research projects that are currently being conducted by the ESGE.

Saturday, October 20,2018 10:30 – 11:00

Endoscopy for GERD: what is there now and what is coming? Darina Kohoutova, Czech Republic; Helmut Messmann, Germany

12:30-13:00 Early colorectal neoplasia: when do I really need ESD? Michal Kaminski, Poland; Michael Bourke, Australia

15:15-15:45 EUS guided therapy of pancreatic lesions: a toy or a future? Istvan Hritz, Hungary; Pierre Deprez, Belgium

Sunday, October 21, 2018 10:30-11:00 How do I find early cancer in the stomach?

Miguel Areia, Portugal; Krish Ragunath, United Kingdom

11:30-12:00 POEM and reflux: what to do? Mohan Ramchandani, India; Marcel Tantau, Romania

14:00-14:30 Full thickness resection: how, when and to whom? Přemysl Falt, Czech Republic; Alexander Meining, Germany

15:30-16:00 Endoscopy in coeliac disease Alberto Murino, Italy: Edward Despott, United Kingdom

16:30-17:00 Pancreatic cysts: which guideline do I choose? Tomas Hucl, Czech Republic; Peter Vilmann, Denmark

Monday, October 22, 2018 10:30-11:00 Prevention of ERCP pancreatitis: what to do to whom?

Tomislav Bokun, Croatia; Stephen Pereira, United Kingdom

12:00-12.30 Early colorectal neoplasia: when do I need/not need histology and why? Maria Pellise, Spain; Rodrigo Jover, Spain

14:00-14:30 Diabetis mellitus: how do we treat it with endoscopy? Mostafa Ibrahim, Belgium; Jacques Deviere, Belgium

Tuesday, October 23, 2018 09:00-09:30 ERCP: when is time to go to EUS?

Ioannis Papanikolaou, Greece; Manuel Perez-Miranda, Spain

10:30-12:00 Latest ESGE guidelines Cesare Hassan, Italy - Endoscopic management, of acute necrotizing pancreatitis

Marianna Arvanitakis, Belgium - Small bowel endoscopy

Emanuele Rondonotti, Italy - EUS guided sampling

Marcin Polkowski, Poland - Endoscopy in PSC

Lars Aabakken, Norway - Endoscopic polypectomy and EMR

Monika Ferlitsch, Austria

33

ESGE Learning Area

Visit the ESGE Learning Area - Hands-on training on bio simulators

For all delegates of the UEG Week whose focus is on endoscopy the ESGE Learning Area is without a doubt the first and best place to meet and mingle. Again this year, accomplished doctors and nurses will volunteer their time and expertise to support the ESGE mission: to promote good endoscopy, to show the basics as well as the latest developments, to support training and to offer small-group teaching activities to everyone with a real interest in the how and why of current endoscopy. The ESGE Learning Area provides a unique and ideal platform for live encounter and interaction among aspiring endoscopists and renowned experts in the field. Please come and be a part of it! Hands-on Training Centre Test your skills and experience the latest technology. The 90-minute training sessions in the Hands-on Theatre offer unique access to state of the art endoscopic equipment and accessories. Participants will have the opportunity to look, learn, ask questions and perform techniques themselves under personal doctor and nurse tutoring. In cooperation with ESGENA, the aim of this activity is to increase the awareness of diagnostic and therapeutic techniques and to offer delegates the possibility of checking their skills. Basic and advanced training are offered. Registration: There is limited availability of tickets for the training sessions from Saturday to Monday. Please go the ESGE desk in the Learning Area and secure your ticket (starts Saturday 9.00 am). Participation will be on a first-come-first-served basis. Endoscopic training on Simbionix GI Simulators is available on a walk-in basis from Monday on and throughout the conference week, likewise the hands-on sessions on Tuesday and Wednesday can be attended without prior registration.

ESGE eLearning Stations

The ESGE eLearning Stations offer UEG Week delegates the opportunity to view the latest training material on video screens with headphone sound transmission. The ESGE teaching units presented at the Learning Area are otherwise only available to ESGE members via the ESGE website. If you are not already a member of ESGE, this is your chance to catch a glimpse of one of the many benefits ESGE provides when you join. The ESGE teaching units are complemented by select video submissions from ASGE and JGES. Any time you are in the Learning Area take a seat, grab a headphone and tune in to the topic of your interest.

35

ESGENA Abstracts Oral Presentations

L- 1 The value of nursing in Endoscopy and Gastroenterology Alison Leary, United Kingdom Introduction: The national standards for IBD care defined the numbers of nurse specialists required as 1.5 FTE per 2 50 000 population. The aim was to publish a new, robust, validated national standard and caseload. Methods: A concensus workshop of 15 IBD nurse specialists from across the UK met to check assumptions regarding workload and activity of this group. A 24-item questionnaire, exploring demographic data, caseload, workload and experience was developed. This was was distributed through the RCN IBD Nursing Network. Data was modelled using descriptive statistics and pattern recognition. Results: 164 responses were received (55% response rate). 76% were from England. Responses were received from all four countries of the U.K. Most respondents covered a single (60%) or two (25%) hospital sites. 38% of respondents had less than 3 years experience working with IBD patients. 62% having four years plus experience. 32% had over ten years’ experience. 90% of the responding CNS were working solely in IBD. 82% reported spending 80% to 100% of their time on IBD. 51% worked with adult and transition patients. 72% of respondents worked full time. 84% of respondents regularly carried out unpaid overtime. The amount of unpaid overtime carried out equalled 17.6 FTE per week. Most common title was ‘Clinical Nurse Specialist’. Grade 7 most common grade for respondents (65%). 61% received either no admin support or support for clinic letters only. The number of unfilled posts was estimated to be equivalent to 24.5 FTE. No respondents reported frozen posts. 43% of respondents had a prescribing qualification. 82% reported participation in CPD/education within the last 12 months. 63% of respondents had a higher caseload than the recommended level. Caseloads as high as 2000 patients plus were reported. Respondents generally had a positive experience of working in an MDT. Conclusions This study recommends a caseload of 2.5 Full Time Equivalent (FTE) IBD specialist nurse per 2 50 000 population (a static caseload of 500 per FTE). The original recommended caseload for IBD specialist nurses is 666 patients (or 1.5 FTE per 2 50 000 population) per FTE nurse. This does not allow for proactive management, advancing practice, cover arrangements and is not optimal for care. There is a shortfall in the UK. 63% have much higher caseloads than the original recommended standard.

L- 2 Performance measures for endoscopy services: The ESGE Quality Improvement Initiative Roland Valori, United Kingdom Historically, the focus on improving the quality and safety of endoscopy has been on the performance of individual endoscopists. There has been less emphasis on the environment within which endoscopists work. An endoscopy is part of the patients’ diagnostic or therapeutic journey. What happens before and after the procedure impacts on his or her experience and safety. An endoscopist performs the procedure, but he or she is dependent on a team to perform the procedure well and safely. Thus, the quality and safety of endoscopy depends

on the environment within which endoscopists work (including the facilities and equipment), and the staff who work in that environment. In recognition of the importance of the environment within which endoscopists work, and whom they work with, the ESGE Quality Improvement Committee has created Performance Measures for endoscopy services to support the process of quality improvement. This presentation will explain and explore the ESGE Endoscopy Services Performance Measures and discuss how they might be used to improve the quality and safety of endoscopy, and the experience of the patient.

L- 3 Delegation of tasks to unregistered staff - what - when - how - why Ulrike Beilenhoff, Germany Qualification and competencies of registered nurses are clearly defined by European law. But the role, tasks and responsibilities of specialised nurses are not clearly defined in many European countries. Therefore, ESNO, ESGENA and national societies developed statements of staffing level, training, competencies and delegation (1-5). Independent from the setting where the endoscopy procedure is performed, the safety of the patients must be paramount. Each patient has the right to be treated by competent and trained staff. Consequently, endoscopy departments need to have sufficient numbers of adequately trained staff to meet the safety needs of both, patients and health care workers (1,4,5). In many European countries, the lack of specialised nurses and physicians leads to long waiting lists with prolonged diagnosis and therapy. On the other hand, more and more complex tasks and responsibilities have to be covered by medical and nursing staff in Endoscopy. Can delegation be a solution? If so, which framework conditions have to be taken into account? Due to shortage of staff and increased work load, delegation is a necessary management tool in endoscopy. Delegation is a complex process in professional practice which require

• a detailed understanding of legal and professional frameworks

• profound clinical judgement

• final accountability for patient and staff safety

• good team work with healthy interpersonal relationships

• supervision and continuing education Legal situation: Legal and professional regulations vary from country to country. But in all health care systems, the delegating person is responsible for ensuring or controlling that the performing person is capable to do the job. The performing person has the duty to check if she/he is able to take over the tasks. She/he also has the duty to reject tasks which exceed her knowledge and skills (obligation to remonstrate). Both the delegating person and the performing person need to know which activities can legally be delegated under the national regulations. Many tasks cannot legally be delegated to other qualified staff because they exceed the scope of practice of these job roles. Many tasks require

36


specialist knowledge and skills which require an additional training or recognised courses. Clinical judgement and patient safety: Endoscopy departments have multidisciplinary teams. In addition to registered nurses and endoscopists, a great variety of staff work in Endoscopy such as

• Ancillary staff (e.g. nursing aids, technicians),

• Staff for cleaning and decontamination (e.g. staff from Central Sterile Supply Department (CSSD) or Health Care Support Worker (HCSW),

• Administrative staff (e.g. medical secretaries, receptionists).

Other specialities also work in Endoscopy providing specialised services (e.g. staff from Anaesthesiology, Radiology, Pathology, Surgery, etc). In Endoscopy delegation takes place from physicians to nurses and from nurses to other qualified staff. Examples for delegation to nurses are informed consent, iv injection, technical tasks (e.g. stent release, PEG insertion, feeding tubes), sedation, patient monitoring, discharge. Some tasks require additional education and training (e.g. NAPS). Mainly in Beveridge countries, medical tasks have been substituted to specially trained nurses like clinical nurse specialist, ANP or nurse endoscopists. Examples for delegation from nurses to other qualified staff are patient transport, patient preparation, service support, cleaning and administrative work. Professional nursing assessment and judgment remains to nurses. The level of delegation depends on the patients health status, the complexity and risks of the planned procedure, the endoscopy environment and the staff competencies (4,5). Supportive work can be delegated. Some tasks like endoscope reprocessing require additional courses and training. Conclusion: Delegation is not just a hand-off. It is an important leadership skill that directly affects patients` safety in Endoscopy. We have to realize that we don’t have the capacity to do everything on our own. Successful delegation can improve efficiency, safety and outcome quality. If someone or a group feel rushed or overworked, delegation can be an option to keep our patients safe and comfortable instead of doing something in a hurry. Delegation can release from workload and can give resources for advanced roles. Delegation has to be planned and agreed by hospital management in order to fulfil all legal requirements. Ad-hoc delegation should be avoided. Transparent job descriptions and structured training plans ensure that patient and staff safety will be reached. References: 1. U. Beilenhoff et al. ESGENA Statement: European Job Profile

for Endoscopy Nurses. Endoscopy 2004;36:1025–30. 2. European Society of Gastroenterology and Endoscopy Nurses

and Associates (ESGENA). ESGENA Core Curriculum for Endoscopy Nursing. 2008. www.esgena.org

3. European Specialist Nurse Organisation (ESNO). Competences of the Clinical Nurse specialist (CNS): Common plinth of competences for the Common Training Framework of each specialty. 2016. www.esno.org

4. Beilenhoff U. et al. Personelle Anforderungen für die Betreuung von Patienten in der Endoskopie – DEGEA-Positionspapier. Endo-Praxis 2017; 33: 135–142

5. Dunkley I, et al. UK consensus on non-medical staffing required to deliver safe, quality-assured care for adult patients undergoing gastrointestinal endoscopy. Dunkley I, et al. Frontline Gastroenterology 2018;0:1–11. doi:10.1136/flgastro-2017-100950

L- 4 Diagnostic and interventional broncoscopy- which options do we have? (From EBUS, EMN to cryo therapy, ELVR and stenting) Björn Fehrke, Switzerland Interventional bronchoscopy is a large field with different diagnostic and therapeutic indications. First reports date back to as early as 300 b.c. with the descriptions of the cannulation of the trachea by Hippocrates. The real hour of birth of modern interventional bronchoscopy was the introduction of rigid bronchoscopy by Gusatv Kilian in 1897. Since then, rigid as well as flexible bronchoscopy have rapidly evolved, especially in the last decades and facilitate important diagnostic and therapeutic intervention in the lower airways and the lungs. Interventions can be performed via flexible or rigid bronchoscopy or as a combination of both and a multitude of different interventional tools are available. Over the last decades, the diagnostic yield of diagnostic procedures such transbronchial forceps biopsies, brushings and catheter aspirations was improved by the introduction of modern navigation tools. These include fluoroscopy, as a basic tool, and more advanced procedures such as ultrasound guided and electromagnetic navigation as well as virtual bronchoscopy. All of these facilitated an increase in diagnostic yield, especially in small peripheral pulmonary lesions. Central airway stenosis is a common indication for therapeutic interventional bronchoscopy. Recanalization with or without the introduction of an airway stent is one of the main domains of interventional bronchoscopy. Various “hot” techniques such as electro cautery, laser and argon plasma coagulation and “cold” interventions such as cryotherapy and cryoextraction are applied. Hemoptysis is another indication for diagnostics and intervention via bronchoscopy. Foreign body aspiration can be an emergency, especially in children, and may require rigid or flexible bronchoscopy to retrieve the object. A new field in interventional bronchoscopy is the treatment of severe emphysema by implanting valves and coils. This lecture aims to provide the audience with an overview of the different interventional techniques available.

L- 5 Endoscopic Lung Volume Reduction (ELVR) Christoph von Garnier, Switzerland In patients with severe chronic obstructive pulmonary disease (COPD) and lung emphysema that are still symptomatic despite optimal medical treatment, endoscopic lung volume reduction (ELVR) may constitute a therapeutic option. ELVR requires appropriate patient selection through assessment of lung function, exercise performance and chest CT imaging. We perform ELVR under general anesthesia and employ two device types – valves and coils. Prior to insertion of valves, we measure collateral ventilation, whereas this procedure is not required when coils are inserted. To monitor possible adverse events such as tension pneumothorax and hemoptysis, we perform post-interventional surveillance in the ICU for 24 hours with prophylactic treatment of COPD exacerbations.


http://www.esno.org/

37


L- 6 Capnography monitoring in endoscopy Elaine Egan, Ireland Introduction: Capnography monitoring is internationally recommended as a standard of care for patients who are administered moderate to deep sedation for endoscopy procedures. Objective: To reduce the gap between what evidence-based research supports and what is done in clinical practice. The feasibility of integrating capnography monitoring in endoscopy was investigated. Research Methods: Multiple searches of the databases provided a gold standard literature selection required to develop a portfolio of evidence. It includes literature reviews, a business plan, an education plan and correspondences with hospital stakeholders, Irish Society of Endoscopy Nurses and ESGENA committee members. The aim of the correspondences was to identify if any endoscopy units were using capnography monitoring in endoscopy in Ireland or within Europe. Learning Outcomes: Education sessions were given to endoscopy staff on capnography monitoring. Care plans, policies procedures and protocols were updated. An audit programme was introduced to evaluate the full implementation of education and training, the appropriateness of interventions, the procedural benefit and the service impact. Conclusion: The results of ongoing audits have highlighted capnography monitoring improves patient safety and leads to early recognition of respiratory depression prior to development of hypoxaemia. Early detection of respiratory depression provides the opportunity to perform timely corrective action, thus likely reducing the need to disrupt the procedure. We have demonstrated that it is possible to integrate capnography monitoring at a low cost and we encourage other hospitals to adapt this safety and quality improvement initiative. Relevance to Nursing Practice: Recommendations from evidence-based research supports nurses to develop their skills and extend their practice. Endoscopy nurses feel empowered using capnography monitoring in endoscopy, which enhances the delivery of a high-quality patient centred service. References: 1. ASA (2018) Practice Guidelines for Moderate Procedural

Sedation and Analgesia. Anaesthesiology 123 (3) 437-479 https://static1.squarespace.com/static/54d14bfce4b02b4744e70d6d/t/5a8708ad24a6943b16cb9ea2/15 18799460707/ASA+Practice+Guidelines+Moderate+Procedural+Sedation_2018.pdf

2. AAGBI. (2016) The Association of Anaesthetists of Great Britain & Ireland. Recommendations for standards of monitoring during anaesthesia & recovery. www.aagbi.org

3. Beitz A., Riphaus A,. Meining A,. Kronshage T,. Geist C,. et al. (2012) Capnography monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy. The American Journal of Gastroenterology 107, 1205-1212.

4. Jopling MW & Qui J. (2017) Capnography sensor use is associated with reduction of adverse outcomes during gastrointestinal endoscopic procedures with sedation administration. BMC Anesthesiology. www.https://dx.doi.org/10.1186%2Fs12871-017-0453-9

5. Lin Y., Fang Y., Huang S., Wang T., Kuo C., Wu H., Kuo H., Lo Y. (2017) Capnography monitoring the hypoventilation during the induction of bronchoscopic sedation: A randomized controlled trial. Scientific Reports 7, 8685 https://www.nature.com/articles/s41598-017-09082-8

6. Qadeer M., Lopez AR., Dumot JA., Vargo JJ. (2011) Hypoxemia during moderate sedation for gastrointestinal

endoscopy causes and associations. www.ncbi.nlm.nih.gov/pubmed/213204242

7. ESA. (2017) Evidence Based Guidelines on Adult Procedural Sedation and Analgesia. http://www.eba-uems.eu/resources/Budapest/Guidelines-Budapest/ESA-PROC-SED-2016-FINAL-DRAFT.pdf

8. Saunders R., Struys M., Pollock RF., Mestek., Lightdale JR.(2017) Patient safety during procedural sedation using capnography monitoring: a systematic review and meta – analysis https://www.ncbi.nlm.nih.gov/pubmed/28667196

L- 7 Continuous tracking, control and safety of pulmonary patients through nursing documentation Ana Mustak, Aleksandra Trupković, Slava Šepec, Jadranka Brljak, Croatia Introduction: Nursing documentation is a collection of data used for quality control (QC) of planned and implemented health care. It is an integral segment of the medical records. Continuous recording of condition of the patient forms of nursing documentation we provide quality health care, nursing research, provides the basis for the education of nurses and further development in nursing. Rehospitalization of chronic lung patients have access to the previous course of health care, we plan to present the course of health care and treatment, and we plan to continue health care and treatment. Nurses must permanently record all planned and implemented procedures for 24 hours. Aims: The aim is to represent the importance of keeping records in nursing. Systematic implementation of all phases of the process of health care, offered safety in patient care through continuous tracking, recording, planning, implementation and evaluation of health care. Nurses enable professional development of individual consultations, expert meetings, conferences, courses that are conducted on the basis of the annual plan. Objectives: Nursing documentation contains mandatory forms, depending on the condition of the patient are carried out additional forms for tracking pressure ulcers, forms tracking of pain, a forms of tracking fluid, a report on the incident. Every three months evaluate the forms of health care as indicators of the quality of health care. Depending on the needs of health care, patients are categorized into four categories depending on the required assistance to meet basic human needs and depending on the diagnostic and therapeutic procedures in patients conducted. Categorizing patients provides a quick insight into the severity of the condition the patient and therefore points to the need for health care needed by, respectively number nurses is required to provide adequate health care. Electronic nursing documentation enables communication between team members and other departments. Re-hospitalization of patients we can see earlier planned, implemented and evaluated interventions health care. To enable the access to previous physical and psychological condition of the patient, ability to communicate, vital signs, compare the current situation before diagnostic and therapeutic procedures. There needs to be in the same patient at the same time solves the acute and chronic problem in all stages process of nursing care. Health care is individualized and focused on the patient and provides the individual approach in gratification of based human needs. Health care plans are made targets that form the basis of evaluation. Focusing on patients means attainment of the goal. Nursing documentation can be used for researches and can

38


contribute significant results for improved quality of nursing care and nursing practice. Learning/Outcomes: Record keeping of continuous monitoring, implementation, documentation and evaluation of nursing work creates a good basis for communication and contributes to a better understanding of the patient's condition and results of health care. We conduct measures to improve nursing practice, we make standard operating procedures (SOP) and work instructions. Monitoring the indicators of the quality of health care, evaluation of keeping of nursing documentation. We organize courses of keeping nursing documentation. Health care plan are precondition of well-organized health care which can significantly affect of the overall success of treatment. Conclusions: Implementation of record keeping provides evaluate of the patient's condition, establishment of the problem, assessment course of the monitoring and make conclusions on the progress of health care for each patient. Nursing documentation creates good professional communication that substantially influences the success overall treatment. References 1. www.hkms.hr/.../1316431501_827_mala_sestrinske_dijagnoze

_kopletn. 2. www.nanda.org/nanda-international-nursing-

diagno...NANDA International Nursing Diagnoses: Definitions and Classification 2015-2017

3. issuu.com/kvaliteta.net/docs/rezic, S. Režić, Hrvatska konferencija o kvaliteti, svibanj 2015; str 211-215

L- 8 Management of bronchial haemoptysis and desaturation - or how not to panic when it goes red! Michael K. Ortmann, Switzerland Significant iatrogenic bleeding during flexible bronchoscopy is fortunately rare and usually self-limiting. Life-threatening bleeding, however, can occur, especially after conventional or cryoprobe-assisted transbronchial biopsy. The aim of this review is to provide the practising pulmonologist with a concise overview of the incidence, severity and risk factors for bleeding, to provide sensible advice on prophylactic measures and to suggest a plan of action in the case of significant bleeding. Bronchoscopy units should have a standardised approach and plan of action in the case of life-threatening haemorrhage. Wedging the bronchoscope in the bleeding segment, turning the patient in an anti-Trendelenburg position and onto the side in order for the bleeding lung to be in the dependent position, installing vasoconstrictors and using a tamponade balloon early are the recommended first-line strategies. Involving a resuscitation team should be considered early in the case of massive bleeding, desaturation and haemodynamic instability. In conclusion, significant iatrogenic bleeding during FB is rare and usually self-limiting. Life-threatening bleeding may occur, especially after conventional or cryoprobe-assisted TBLB. Bronchoscopy units should have a standardised approach and plan of action in case of life-threatening haemorrhage, including the involvement of a resuscitation team. Wedging the bronchoscope in the bleeding segment, instillations of vasoconstrictors and the early use of a tamponade balloon are the recommended first-line strategies.

L- 9 National training programme for sedation in GI Endoscopy – 9 years experience Ulrike Beilenhoff, Germany Introduction: In Germany approx. 90 % of endoscopic procedures are performed under sedation. For over 15 years, aside from the traditional medication with Benzodiazepines - often in combination with an opioid, the short-acting hypnotic Propofol has increasingly been used in Germany. National guidelines give precise recommendations for the structure and process quality for safe sedation which also includes the qualifications for medical and nursing staff (1). Irrespective of the type of sedation used in GI Endoscopy, the same structure and process quality are required to ensure same level of safety for all patients undergoing endoscopic procedures. German regulations allow the delegation of sedation to qualified nurses under certain conditions and underlines the necessity of suitably trained and competent staff. Specific knowledge and skills on risk assessment, sedation, recovery and resuscitation are necessary not just for physicians, but also for supporting nurses (1). Method: A national training programme was developed by the national societies of Gastroenterologists and Endoscopy Nurses which combines basic training with periodic refresher courses (2,3). The two curricula are aimed at experienced nurses working in endoscopy to expand their knowledge and skills in risk assessment, patient monitoring, different sedation regimes, recovery, airway management and resuscitation: The basic course is a 3 days course with 16 hours theory and 8 hours practice (2). The theoretical part includes legal aspects, pharmacology, structural and personnel requirements, peri-endoscopy care, sedation management, prevention and management of adverse events and complications. Knowledge is assessed by written exam. The practical training on human patient simulators includes basic live support (BLS), advanced cardiac life support (ACLS) and training on different sedation concepts. An intensive reflection of practice in small groups ensures effective reflection of previous practice, improvements and reinforcement of experience. After the course an internship of 3 days supports the practical implementation. Further training and assessment of competencies in the own department are recommended before delegation of sedation can take place. The basic course is recommended for all endoscopy nurses. The refresher course is a one-day course. 4 hours of theory updates background knowledge and supports students to reflect / improve their daily practice (3). 4 hours with practical training on human patient simulators updates practical skills on emergency management. The refresher course is recommended every 2 to 3 years in addition to the yearly BLS / ACLS. The course data between February 2009 and May 2018 were evaluated. A survey was performed among members of the national society for endoscopy nurses. Endoscopy departments were asked to send one answer per unit only. The survey asked to identify improvements as well as weaknesses in the translation of national policies. Results: Between February 2009 and Oktober 2018, 1353 basic courses with more than 18.800 students and 495 refresher courses with more than 7425 students were performed in 76 different institutes or hospitals all over Germany. All courses received the official recognition of the German endoscopy societies. 1,5% courses that applied did not receive the official recognition.

39


253 endoscopy units answered the survey (preliminary results from September 2, 2018). The following improvements were identified: number of staff increased in 53,94% of departments in 55% of departments 100% of nurses followed basic and refresher courses, in 24% of units 75% of staff have the required qualification, in 20% of units less than 50% of staff have the required qualification 70% of departments already used refresher courses A risk assessment was established - with ASA classification in 79,34% units, with checklists in 79,75% unit 82% of departments performed Propofol mono sedation 85,08 % of units had dedicated recovery areas with staff A structured discharge was standard in 85% of departments The following limitations were identified which need further evaluation 37,20 % of unit did not establish a team-time-out Due to staff shortage only 40% of units had a dedicated person for sedation during ALL procedures, other departments provided a sedating person for advanced procedures only. Some procedures were performed without sedation. Conclusion: The national training programme of basic and refresher courses is well established. First evaluations showed improvements in the participants departments. Nurses are aware of their knowledge, skills and limitations. Areas for further improvements could be identified Learning outcomes: Participants should be Aware of the nurses advanced roles and limitations in sedation in GE Endoscopy Aware of different options how to organize a national courses to train nurses in sedation and emergency management References: 1. Riphaus A et al. Update S3-Leitlinie „Sedierung in der

gastrointestinalen, Z Gastroenterol 2015; 53: 802–842 2. Beilenhoff U, Engelke M, Kern-Wächter E, et al. Curriculum

Sedierung- und Notfallmanagement in der Endoskopie. Endopraxis 2009; 1; 32-35 / Update 2018. Endo-Praxis 2018; 34: 89–93

3. Beilenhoff U, Engelke M, Kern-Wächter E, et al. Curriculum für den Refresherkurs. Endo-Praxis 2010; 26: 185-186 / Update 2018. Endo-Praxis 2018; 34: 154–156

L- 10 The 7-Month Journey from Endoscopy Nurse to Nurse Endoscopist Yulrich Louie dela Cruz; Irene Dunkley, Rizwan Kassam, North West Anglia NHS Foundation Trust, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, United Kingdom Introduction: Nurse endoscopists have been an integral part of endoscopy services in the UK for over 20 years accounting for over 20% of all endoscopy procedures. In 2016, Health Education England (HEE) and the Joint Advisory Group for GI Endoscopy (JAG) launched a pilot programme for fast track training of non-medical endoscopists to meet the demand for endoscopy services in England. This is a reflective account of a nurse trainee endoscopist’s personal experience of this training programme. Aim: To describe the challenges of HEE fast track training and the support mechanisms crucial to successfully completing the programme requirements. Methods: This reflective account describes the challenges and successes of participation in the HEE pilot programme for fast track training of non-medical endoscopists.

Trainees were required to undertake the following programme elements: in-house clinical/practical skills training; completion of training and academic portfolios; blended learning including eight taught days and e-learning modules; JAG-accredited basic skills course; and clinical supervision and mentorship. Results: A total of 244 gastroscopy procedures and 24 formative and summative Direct Observation of Procedural Skills (DOPS) recorded on the JAG Endoscopy Training System (JETS) e-Portfolio from October 2017 to May 2018 were reviewed. Of these 244 procedures, 228 were performed to completion without physical assistance from trainers. DOPS submitted by trainers showed increasing independence in technical (e.g. visualisation, scope handling, lesion recognition, reporting) and non-technical skills (situation awareness, communication, teamwork). No serious complications or adverse events were reported in this period. Discussion: The in-house training was achieved with a dedicated endoscopy trainer and training lists; the trainee being physically assisted initially to eventually only needing to be observed while performing gastroscopy. The JAG basic skills course provided opportunity to fine-tune scope-handling skills and peri-endoscopy management. DOPS feedback forms were recorded at intervals on the JETS e-Portfolio and were completed to track trainee’s acquisition of the technical and non-technical endoscopist skills and assess competence for independent practice. The training and academic portfolios provided a skills framework and facilitated identification of learning needs and achievements through reflective practice using the Driscoll and Kolb models. Taught days equipped trainees with knowledge to support advanced GI practice and clinical-decision-making like pharmacology, anatomy and pathophysiology, and treatment algorithms. Mentorship from an advanced nurse practitioner, which involved regular face-to-face meetings, were crucial for successful role transition. Ad-hoc debriefing sessions with trainer and/or mentor provided the trainee with emotional support and coaching after particularly challenging training episodes. Further local support included access to additional lists supporting technical and lesion recognition skills. The accelerated nature of the programme presented unique challenges. For example, it required high self-directedness to complete multiple course elements in less time. Contingency planning was also vital to ensure deadlines were met despite shortfalls from procedure cancelations, bank holidays, or planned trainer/trainee time-off from work. Conclusion and relevance to nursing practice: Two lessons can be culled from this reflective account. Firstly, commitment to active learning, time management, and a high degree of self-motivation are required to gain the necessary competencies and confidence within the accelerated programme timeframe. Secondly, transitioning from nurse to a specialist role to perform diagnostic gastroscopy is achievable if support mechanisms from employing hospital, clinical supervisor, nurse mentor, colleagues, fellow students and tutors are in place for the trainee to develop clinically, technically and academically to safely perform diagnostic gastroscopy. References - https://hee.nhs.uk/our-work/endoscopy Accessed 18/05/2018 - https://hee.nhs.uk/sites/default/files/documents/Non-

Medical%20Endoscopists%20%28NMEs%29%20Competence%20Assessment%20Portfolio_0_0.pdf Accessed 18/05/2018

- https://www.jets.nhs.uk/ePortfolio.aspx Accessed 18/05/2018 - https://skillsforlearning.leedsbeckett.ac.uk/preview/content/mo

dels/02.shtml Accessed 18/05/2018

40


L- 11 Process optimization in endoscopy by implementing a checklist for patient safety Silke Bichel, Germany Introduction and Background: The project was carried out as a final project of continuing education concerning "management of a nursing unit". The focus is on improving processes and avoiding mistakes as well as interruptions of the work process. A checklist was designed which enables the endoscopy team to check specific parameters with regard to the safety of patients within the scope of endoscopic procedures, and counteract deviations if necessary. Despite well-structured processes and competent employees, repeated interruptions of the work processes occur due to extrinsic and intrinsic factors. In view of high-quality patient care, the objective of optimized patient safety is approached in the project group in a way that enables smooth integration into existing structures and processes. The idea of this project originated within the endoscopy team due to an adverse event, which would have led to a complication, had it not been recognized in time. The adverse event happened due to high workload of an otherwise very dependable employee and despite principally well-structured procedures1. Lessons learned from the WHO initiative "Safe surgery saves lives" of 2009 show that interdisciplinary employment of safety checklists during invasive procedure can decisively improve patient security. A worldwide study of Haynes A. et al. confirms that safety checklists according to the criteria of the WHO initiative can significantly reduce morbidity and mortality2. The experiences and study results led to rapid implementation in the processes by the surgical professional societies. The medical and nursing professional associations in Germany (DGVS and DEGEA) have adopted "patient safety by checklists and team time out" into the SK2 guideline for quality requirements in gastro-intestinal endoscopy3. Objectives Project work includes goals following the SMART method:

- Specific: Reduction of foreseeable and avoidable complications by test criteria

- Measurable: Measurable improvements of patient safety by reduction of interruptions od work processes

- Attractive: Increase of employee satisfaction by more transparent work routines as well as improved communication

- Realistic: Comprehensible documentation of already established measures in the context of patient preparation in endoscopy

- Time sequence: A period of ten weeks has been set and a kick-off event with the affected interfacing units

Research methods: After defining the subject of the project and approval of the continuing education institute and management, a project group of two experienced members of the endoscopy team was assembled. To ensure uniform level of knowledge heading into the project, I presented background information available on team time out, the relevance of patient safety in all procedures, as well as the availability of safety checklists in endoscopy to the project group. As a basis for successful project management, a project pyramid consisting of budget, schedule and requirements and task allocation was devised. The communication plan guarantees the flow of information about the results with the defined interfacing units. The project structure plan set the development of a checklist for patient safety in endoscopy as the primary goal, together with respective instructions for

implementation into the procedures. Sub-tasks were the determination of the number of steps, the definition of evaluation criteria and the enumeration of possible interruption of work processes. These were worked on in the project group and presented to the interfacing units during the kick-off meeting. Further milestones were given by two temporally defined test phases. The introduction of the checklist in phase one only for members of the project group over two weeks, and phase two with the entire endoscopy team involved over three weeks. Both phases were concluded with feedback and an evaluation. The test phases were successfully completed, so that after approval by management, the checklist for patient safety in endoscopy was introduced into routine procedure. The resulting documentation was added to the manual of quality of the endoscopy team. Results: During the test phase, the safety checklist was applied in 278 endoscopic procedures. In 2.16% of cases (6 patients), where patients were anxious, action stage 2 (team time out) was only executed after sedation of the patient. In 1.1% of cases (3 patients), the supervising nurse of the station was consulted to ensure correct identification of the patient, since the identification bracelet of disoriented patients was missing. In 12.95% of cases (36), the endoscopic procedures was not conducted after sign-in, since the patients were not fasted, deviating from preparatory standard. In 1.44% of cases (3), the endoscopic procedure was cancelled or postponed because anticoagulant therapies were not interrupted in time. ASA classification was not performed during patient education about sedation in 8.99% (25) of cases, leading to delay of treatment procedure. Summary and discussion: During the project phase, the department-specific checklist for patient safety in endoscopy was developed and integrated into operating procedure. During process optimization, the focus was on improving patient safety, communication structures as well as motivation and satisfaction of employees. A further foal was comprehensible documentation of safety-relevant parameters while avoiding additional expenditure of time. In the first action stage, considerable mistakes with possible safety-relevant consequences could be observed. Due to documentation and the deduction of further steps, employees were enabled to act in a safe and uniform manner. Patients predominantly perceive the method as improving safety and confidence in the endoscopy team. The expenditure of time stayed within reasonable bounds, with 1-3 minutes. The required discipline was rated positively especially when faced with high workload, where interruptions of work processes are most likely. This emphasizes the aspect of safety of the checklist. The endoscopy nurse team rated action stage 2 (team time out) and the related uniform information transfer regarding the endoscopic procedures as very advantageous. Interfacing units highlighted the improved communication structure. Conclusion: From the point of view of the project group and the interfacing units, the project "process optimization in endoscopy by implementation of the checklist for patient safety" was completed with success, and the employment of the checklist in endoscopy was evaluated as sensible. Management confirmed the success of the project. The employment of the checklist for patient safety in endoscopy will be integrated into standard operating procedure for all endoscopic procedures. Learning outcomes and relevance to nursing practice: Using a safety checklist directs focus on safety-relevant aspects of patient care. The employment ensures

41


transparent documentation of structured processes. Communication structures are improved, which supports self-reliant action of employees and improves patient safety during situations. References: 1. https://www.nejm.org/doi/pdf/10.1056/NEJMsa0810119, (05.10.17) 2.http://apps.who.int/iris/bitstream/handle/10665/44186/9789241598590_eng.pdf?sequence=1&isAllowed=y, (05.10.17) 3. https://www.dgvs.de/wp-content/uploads/2016/11/S2k-Leitlinie_Qualitaetsanforderungen_in_der_gastrointestinalen_Endoskopie__Langversion_.pdf, Kap. 3.4, E41-E43, Patientensicherheit durch Checklisten und Team Time Out (05.10.17)

L- 12 Access to nursing care for people with autism with special emphasis on preparation for endoscopic examination Brozičević Katja, Croatia Introduction: Autistic disorder is a pervasive developmental disorder that occurs in childhood and lasts for a lifetime. The basic features are deviations in social interaction, communication, stereotypes and bizarre behavior. Performing health care for people with autism requires educated staff. Because of their ignorance, nurses are sometimes unable to understand this problem, resulting in improper access and inappropriate interventions. Care requires individual approach. Since work with people with autism is not often the area of our work, it always represents a challenge. Methods: The first step of the nurse is that in first contact with the parents establish a quality relationship. It must be given enough time and try to collect as much information as possible about how the person communicates, habits, everyday routines, sensitivity and possible aggressive behaviors. People with autism have their own routine, and any change cause discomfort. According to the way a person communicates, a nurse can adapt their communication using a thumbnail if a person is communicating nonverbal. If there is a possibility of verbal communication, the nurse should use clear and simple sentences in explaining the procedures. If a person is prone to aggressive forms of behavior, parental suggestion must be accept in correcting these behavior. If the person is sensitive to stimuli, we must provide the environment without noise, people, light and equipment. Results: It is recommended that the terms of procedures be in the morning when there is no crowd in the ambulance. It is important to avoid waiting. If waiting is inevitable, the person should be placed in a quiet room. Parents should be familiar with the details of the endoscopic examination: preparation, duration and examination complexity. Since endoscopic examinations are unpleasant and can last long, we do them in general anesthesia. Discussion: Before performing any activites, the person must be explained what will be done. Physical contact is achieved slowly. The nurse should receive verbal or non-verbal feedback. Parents' presence is something that must always be enabled. For successfull work nurses must have the will, desire, and understanding. Conclusion: In performing health care for people with autism, health care professionals need to be creative, possess basic disease knowledge, and be prepared to adapt their work and conditions to people with autism. Collaboration with parents is an important precondition of a positive outcomes of health care.

Learning outcomes: Explain the specificity of preparing and performing endoscopic examinations in people with autism. This area of work requires basic knowledge of the problem, correct approach, patience and adaptation to work. References: 1. Margaret C. Souders, Denise DePaul, Kathleen G. Freeman,

Susan E. Levy. Caring for Children and Adolescents With Autism Who Require Challenging Procedures. Pediatr Nurs. 2002;28 2. Adriane A. Jolly, MSN, RN, CPN, AE-C, PCNS-BC. Top Ten Tips a Nurse Should Know Before Caring for a Hospitalized Child With Autism Spectrum Disorder. Pediatr Nurs. 2015;41 (1):11-16

L- 13 Analysis of the awareness of population about risk factors and methods of colorectal cancer prevention Nataliya Shandarovska,, Ukraine Objectives. Globally, colorectal cancer (CRC) ranks the third place among all cancers for the incidence rate, and in Ukraine - occupies a second rank position [1, 2]. This disease can be effectively prevented by detecting precancerous conditions and cured when diagnosed at the early stages. The effect from preventive measures can be achieved by informing the public about the risks of CRC, promoting healthy lifestyles and educate on the possibility of preventing CRC through a regular screenings [3]. The aim of the study is to determine the level of awareness of Ukrainian citizens about risk factors, causes, main signs and symptoms, prevalence of malignancies in the large intestine and rectum and ways of its prevention. Material and Methods We conducted a survey about colorectal cancer interviewing ordinary people over the age of fifty who already belong to the risk group (through age). The questionnaire included questions related to awareness about CRC itself and its symptoms, main risk factors, clinical manifestations, and screening programs and their adherence to them. Results To conduct the survey, we distributed 100 questionnaires to ordinary people over the age of 50. It should be noted that only 58 (58%) people filled out and returned the questionnaires and agreed to talk about the CRC. Almost all participants (56 (97%)) have heard about colorectal cancer. Most often, 40(68%) respondents got information from the media,10 (17%) indicated relatives or friends and 9 (15%) – from medical institutions. However, the majority of respondents would like to receive such information from a family doctor (39 (69%)), from doctor specialised in oncology - (2 (3.5%)), or nurse (1 (1.7%)). 42 (72%) persons know the correct localization of CRP, however only 12 (21%) respondents know that the disease most often develops in the age group older than 50, the rest believe that at a younger age. Only 9 (16%) of the respondents recognized the genetic factors as a risk factor for this disease, 19 (33%) did not agree with it, and half of them -28 (50%) could not give the answer.Awareness of the risk factors, which are related to nutrition, is quite high. The majority of respondents referred here to obesity (39 (69%)), alcohol use (35 (62%)), consumption of red meat (34 (60%)). Only 4 (8%) respondents understand that the disease can be asymptomatic, while the remaining 26 (46%) believe that it is impossible and the same number - do not know. It is shows that the majority of the population is poorly informed about the "saliency" of this disease. 27 (48%) participants know that CRC can begin with intestinal

42


polyp, and 28 (50%) believe that timely removal of a polyp can prevent the development of cancer. The obtained results indicate that two thirds of the respondents (35 (63%)) believe that there are methods for early detection of CRC, and 21 (37%) - that such methods don’t exist.

Among those who responded “Yes” to this question, 30 people (86%) selected an ultrasound examination as diagnostic measure. Only 5 (14%) participants indicated the most effective examination - colonoscopy. None of the respondents indicated the faecal occult blood test, which is

an affordable and effective method to detect malignancy of the colon and rectum and their precancerous conditions. Conclusions. 1. Ukrainian citizens aren’t well aware about this disease, and especially with modern methods of early detection and prevention. 2. The source of information about CRC, as a rule, was the media, but they would like to receive more information from health professionals, in particular, a family doctor. 3. The people we interviewed do not have information on the risk factors for the development of colorectal cancer, since they do not consider age, genetic predisposition and smoking as such. But they agree that the unbalanced diet, obesity, alcohol, red meat may be its causes. 4. The respondents interviewed by us were little informed about the "quiet", asymptomatic course of the disease, and only half assume the possibility of its development from benign polyp and the possibility of preventing the disease by removing of those polyps. 5. Despite the current development of information technology, there is a significant lack of information on colorectal cancer, methods of early detection and prevention, which adversely affects people's awareness about the danger of this disease. Therefore, it is encourages the search for effective methods to increase the level of awareness of the population about CRC. The nurse plays important role in this task References. 1. Cancer in Ukraine, 2015 – 2016. Захворюваність, смертність, показники діяльності онкологічної служби / Бюлетень національного канцер-реестру України № 18 // за ред. О. О. Колеснік. - КИЇВ - 2017 2. Howlader N, Noone AM, Krapcho M, editors. , etal. , eds.SEER CancerStatisticsReview, 1975–2012.Bethesda, MD: NationalCancerInstitute; 2015.http://seer.cancer.gov/csr/1975_2012/. AccessedJune 10, 2016. 3. Centersfor Disease Control and Prevention. National vital statistics system. https://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm. Accessed December 22, 2016 4. http://gco.iarc.fr

L- 14 Microbiological surveillance of the endoscopes: experience of Endoscopy Unit of the University Campus Bio Medico of Rome. B. Colombo, M.L. Candela, A. Minciullo, E. Portalino, G. Bencivenga, F. Antonelli, A. Conti, S. Angeletti, F.M. Di Matteo, University Campus Bio Medico of Rome , Itlaly Background: Recently an outbreak of multi drugs resistant (MDR) organisms in endoscopy has been reported. Altough no evident breaches in reprocessing procedures were identified, the problems appears to be more relevant in side-viewing endoscopes. Crevices in ruined channels of over-used instruments and complexity of design at the elevator region of the duodenoscopes facilitates the formation of bacterial biofilm that may impair the disinfection, even if reprocessing protocols are correctly applied. Aim: The aim of this study was to evaluate the effectiveness of endoscope disinfection process in our

Endoscopy Unit, with special regards on side-viewing endoscopes. Methods: From September 2016 to December 2017, all the 45 endoscopes of the Endoscopy Unit were submitted to microbiological surveillance; 8 of them were side-viewing endoscope. Side-viewing endoscopes were sampled monthly while all remaining endoscopes were submitted to microbiological control twice a year. The sampling solution was Tampon DNP + 0,5% thiosulfate (Thermoscientific) with a flush-to-flush technique in all channels. The samples were carried out during the endoscope storage, at least after 12 hours from disinfection in an endoscope washer-disinfector (EWD). For the side-viewing instruments, a buffer was also used for the recess behind the elevator. In case of positivity, the endoscope was stopped until a negative microbiological sample was obtained. Results: 85% of the endoscope were found to be negative at microbiological sampling. 37.5% of the side-viewing endoscopes underwent the replacement of channels or dismissal. In particular, most frequently used instruments (over 200 cases a year and in activities for more than 10 years) presented major problems. Even an 4,4% of NON-critical endoscopes (2 gastroscopes) have been dismissed or have channels replaced. The percentage of endoscopes negative for microbiological sampling has gone from 85% to 100% today. In January 2017 we had a complete renovation of the reprocessing system (washing module, EWD, storage cabinets and traceability). In January 2018 all endoscopes where replaced. A schedule of preventive maintenance for all instrument by the manufacturer was also introduced. Summary and discussion: Basing on this results, it was necessary to implement the following strategies: 1) Retraining of staff in reprocessing procedure, 2) introduction of disposable brushes and valves, 3) correct monitoring of the drying of endoscopes, 4) replacement of internal channels of endoscopes 5) update of the entire reprocessing system and traceability. Conclusion: According to our experience, we suggest the replacement of endoscope channel after three consecutive positive microbiological samples. A strict adherence to the cleaning and disinfecting protocol, the use of disposable material, EWD and storage cabinet complying with the current standards (EN ISO 15883 and EN ISO 16442), do not guarantee the complete disinfection of the endoscope, especially for instruments with a higher frequency of use. Learning Outcomes+Relevance Nursing Practice Alongside the technological renewal, standardised retraining of personnel and constant microbiological sampling should be used as a measure of quality of the entire process of endoscope reprocessing. References 1. Kovaleva J, Peters FT, van der Mei HC, Degener JE.

Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev. 2013 Apr;26(2):231-54.

2. Claire Aumeran, E. Thibert, F. A. Chapelle, C. Hennequin, O. Lesens, et al. Assessment on experimental bacterial biofilms and in clinical practice of the efficacy of sampling solutions for microbiological testing of endoscopes. Journal of Clinical Microbiology, American Society for Microbiology, 2012, 50 (3), pp.938-42.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kovaleva%20J%5BAuthor%5D&cauthor=true&cauthor_uid=23554415

https://www.ncbi.nlm.nih.gov/pubmed/?term=Peters%20FT%5BAuthor%5D&cauthor=true&cauthor_uid=23554415

https://www.ncbi.nlm.nih.gov/pubmed/?term=van%20der%20Mei%20HC%5BAuthor%5D&cauthor=true&cauthor_uid=23554415

https://www.ncbi.nlm.nih.gov/pubmed/?term=Degener%20JE%5BAuthor%5D&cauthor=true&cauthor_uid=23554415

https://www.ncbi.nlm.nih.gov/pubmed/23554415

43


3. Ulrike Beilenhoff et all. Prevention of multidrug-resistant infections from contaminated duodenoscopes: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA). Endoscopy 2017; 49(11): 1098-1106

4. Lee DH, Kim DB, Kim HY, Baek HS, Kwon SY, Lee MH, Park JC Increasing potential risks of contamination from repetitive use of endoscope. Am J Infect Control. 2015 May 1;43(5)

5. Rapporto tecnico UNI/TR 11662: Ricondizionamento dei dispositivi medici. Guida al ricondizionamento degli endoscopi termolabili (Dicembre 2016)

L- 15 Restructuring of an Endoscopy Unit as an outcome of a work environment report Tine Karbo, Denmark Introduction: High quality and professionalism are contributing to the endoscopic nurses feeling of pride and motivation in their field. In recent years, Denmark have merged small units into larger sections. At the same time, the complexity and development of what can be done endoscopically has increased. This has been one of the reasons for the need to reconstruct and think of the organization in a new way. Endoscopy services need to be carried out by multidisciplinary and specialized teams. Endoscopy teams/nurses are like other social systems. There are official and unofficial rules, roles, behaviors and attitudes. It is important that every member of the team feels that their suggestions and ideas are heard and taken seriously. Methods: We used questionnaires and staff meetings, to conclude which areas we should prioritize. The nurses themselves were put into working groups, so they could have influence and help determine the actions. It was clear after a few months, what the nurses wanted: Structured training of new nurses. Structured teaching and development of experienced nurses. - Description and alignment of patient visits - Time to study and develop skills - Better communication and cooperation both mono-

and interdisciplinary - Specialized teams - Responsibility from management and employees Results: We got resources to hire a clinically specialized nurse who can initiate and develop guidelines. She is at the front of the development of clinical practice and unit research We now have a mentor team of dedicated nurses, who one-on-one are partners with the new nurses in the first few months. New staff who join the department get schedules for training and follow-up by mentors and leader. We have regular teaching sessions once a week for all nurses and many participates in external courses. We have a daily coordinator, who ensures that patients get to the correct examinations/treatments and staff with the right competences. The coordinator manages our resources, so everyone helps each other to get through the examination list of the day. We are working with “short-time nursing” and talk a lot about the role of the nurses assisting and performing endoscopic procedures As leader, I have prioritized that nurses get time out of the surgery rooms, so that they can write procedure descriptions and have professional discussions. Several are now responsible for specialized areas and they also get time to do this. We have meetings every morning, where we make an overview of today's program. Short information is also given here. Nurses have become more active at these meetings. In addition, there is generally a much better dialogue, which is also felt in staff meetings.

There is a lot of praise from the doctor and secretary groups. They like being in the endoscopy unit and working with the nurses. All nurses are in speciality teams and they also have meetings. They make descriptions and can make decisions in cooperation with management. We have a good working environment. The nurses are acting professionally and have a high degree of accountability. The nurses are aware of this and respect each other's competences. References: 1.Yukl, G. (2013):” Leadership in organizations- Global edition.” New York. Pearson Education, Prestice hall. (page 17-38,188-243, 272-300, 328-346) 2.Drath, W., McCauley C., Paulus C., Van Velsor, O´Connor., McGuire, J. (2008): Direction, alignment, commitment: Toward a more integrative ontology of leadership 3. Benner PE. From novice to expert: excellence and power in clinical nursing practice. Menlo Park, CA: Addison

L- 16

Building a new hospital – using the chances for endoscopy Jan-Werner Poley, The Netherlands Not aubmitted

L- 17 Safety systems in endoscopy – How to prevent steeling of Endoscopes Ute Pfeifer, Germany Objectives: Since 2014, there have been thefts of endoscopes, processors and monitors in several German clinics and gastroenterological practices, resulting in losses of several million euros. In order to reduce the risk in the future and to avoid the risk of treatment failures or bottlenecks, a nationwide safety survey was conducted in endoscopy departments. In addition, the survey was also extended to several European countries. Method: From July to August 2018, an 11-items- questionnaire was online delivered in Germany and some European countries. SurveyMonkey software was used to create the questionnaire. The questionnaire included multiple choice questions with the additional possibility of free text information and the request to fill in the questionnaire only once per endoscopy department. Various e-mail distributors of educational institutes and societies as DGVS, DEGEA and ESGENA were used to send the link and the QR-code (n = 2807). Results: 451 completed questionnaires were collected from Germany. Overall, 50.1% of all endoscopy is on the ground floor (29,8% 1st floor, 20,0% higher than 1st floor). The majority (64.7%) of the endoscopies have two entrances from the corridor or are connected to other care areas (15,6%) (f.e. intensive care unit). In 68 cases a theft in the endoscopy department was perpetrated in Germany. The loss in Germany was estimated at between 40,000-100,000 EURO per burglary. In 27 cases (40,3%) the insurer paid for the loss or refunded only the current fair value (n = 18, 26.8%). In 47% of the cases, patient care could be continued with loan equipment in the affected facilities. In total, in 128 (36,9%) facilities cleaning personnel have access to endoscopy outside normal working hours and 41,6% (n = 173) of departments use ordinary keys for closure (closed-circuit television camera (CCTV) 14,9%, audible alarm 17,1%, key cards 20,9%).

https://www.ncbi.nlm.nih.gov/pubmed/?term=Lee%20DH%5BAuthor%5D&cauthor=true&cauthor_uid=25726130

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kim%20DB%5BAuthor%5D&cauthor=true&cauthor_uid=25726130

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kim%20HY%5BAuthor%5D&cauthor=true&cauthor_uid=25726130

https://www.ncbi.nlm.nih.gov/pubmed/?term=Baek%20HS%5BAuthor%5D&cauthor=true&cauthor_uid=25726130

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kwon%20SY%5BAuthor%5D&cauthor=true&cauthor_uid=25726130

https://www.ncbi.nlm.nih.gov/pubmed/?term=Lee%20MH%5BAuthor%5D&cauthor=true&cauthor_uid=25726130

https://www.ncbi.nlm.nih.gov/pubmed/?term=Park%20JC%5BAuthor%5D&cauthor=true&cauthor_uid=25726130

https://www.ncbi.nlm.nih.gov/pubmed/?term=Park%20JC%5BAuthor%5D&cauthor=true&cauthor_uid=25726130


44


The main entrance as wel as the examination rooms will be closed in 46,8% (n = 206). In 25% (n = 110) of the cases the corridor area of the endoscopy is also an escape route, so that only the intervention rooms can be closed. 63 questionnaires came from abroad. In Israel, Italy, Portugal and Hungary there was also a burglary with theft. The endoscopy departments were located on the first floor or higher and have one or more entrances. The loss is stated per case between 80,000-100,000 EURO. Only in one case did the insurer take over the loss. In all 5 cases surveillance cameras, audible signals and keycards were used. Conclusion: In 514 questionnaires in 73 cases there was a burglary in endoscopy with theft (68 in Germany, 5 in other European countries). The loss was estimated at 40,000-100,000 EURO per break-in. In about 40% of the cases, the insurer came up for the damage. Outside the service period, beside nurses and physicians often cleaning staff and technicians have access to the examination rooms of the endoscopy departments. In the majority of cases, conventional keys are used to close the doors. If the corridor of the endoscopy is also an escape route only the intervention rooms are closed (25% in Germany; 12,9% in european countries). References: 1. www.dgvs.de (10.08.2018) 2. https://www.volksfreund.de/region/diebstahl-von-endoskopen-

aus-kliniken-die-angeklagten-schweigen-weiter_aid-22305407 (03.05.2018)

3. https://www.swr.de/swraktuell/rp/kliniken-verschaerfen-sicherheitsvorkehrungen-wieder-endoskopiegeraete-geklaut/-/id=1682/did=20091948/nid=1682/11g4acy/index.html (30.07.2018)

4. https://www.aerzteblatt.de/nachrichten/76478/Diebstahl-endoskopischer-Geraete-weitete-sich-aus (10.08.2018)

L- 18 Transfer of reprocessing of the endoscopes from the endoscopy department to the department for central sterilization - everyday life Eric Pflimlin and Michael Ortmann, Switzerland Endoscopes are not only used in GI Endoscopy, but also in Bronchoscopy, Urology, Neurology, ENT, Cardiology, Surgery, Anaesthesiology and Intensive Care units. That means that each of these single units need to provide a purpose designed reprocessing room with specially trained staff. Current situation: At the University Hospital Basel, Switzerland, a large number of departments use flexible endoscopes. The reprocessing protocols vary from department to department with different washer disinfectors and different process chemicals in use. It is difficult to keep the staff updated. After purchasing new equipment, difficulties often arise due to organisational problems and lack of experience. New Reprocessing area The University Hospital Basel built a centralised reprocessing area within the Central Sterile Supply Department (CSSD) where all hospital endoscopes will be reprocessed. The aims of this project was - To unify the reprocessing of flexible endoscopes by

providing high hygiene standards - To build an efficient unit with a high capacity that will

be ready to meet future needs and a high workload - To centralise expertise and know-how for the

reprocessing of crucial equipment

- To ease the workload of endoscopy departments as well as to reduce exposure to chemicals, contaminated equipment and noise

- To optimise and reduce running costs by investing in centralised services and establishing efficient reprocessing pathways

Responsibilities: A multidisciplinary working group was established with representatives from hospital management, technical experts, architects, hygiene experts and the managers of the main endoscopy units. It is of utmost importance to involve experts from endoscopy because they have a deep knowledge of and experience in endoscope reprocessing. Key features of the new department: Transport System: The hospital has an automated transport system using containers on an internal rail system. In order to avoid any contamination of the transport system, special containers were developed which fit into the transport containers. The transport system needs a maximum of 7 minutes for endoscope transportation, depending on the distance to the CSSD. Service time: The CSSD offers the service for endoscope reprocessing 18 hours a day, seven days a week. The entire reprocessing cycle will take place in the CSSD. Conclusion: The relocation of the complete reprocessing cycle in the CSSD represents an interesting alternative to conventional reprocessing in endoscopy departments. It is cost-effective and efficient, eases the workload of endoscopy units and ensures safe reprocessing with high hygiene standards, performed by experts in this field.

L- 19 Competency development and team work – the basis for patient safety Camilla E. Leidcker , Denmark The term "competence" is defined as "to be able to." That is, to possess the knowledge, skills and attitudes that make it possible for you as an employee or human being to act appropriately, ie. behave in the given context - either in working contexts or in other life-related situations. Development is about increasing this ability over time. (1) The development of competence can be planned to facilitate that the nursing staff in the department over time develop their professional level in a continuous process, thereby gaining new knowledge and insight into achieving the right skills for performing care and treatment for complex patients. This is achieved through participation in the competence process, as well as by bringing own qualifications and experiences into play with others. (2). Framed team work and competence cards are methods used in this competence development. The implementation of competence cards is done in cooperative with mentors, and acts as a natural part in the revision of the existing endoscopy procedures manuals and teaching plans. Competence courses are prepared for the individual nurse inspired by Patricia Benner's development ladder. (3) This means that nursing staff at the level corresponding to Novice are included in the competence course individually, staff at the level corresponding to competent are planned to be part of the competence course in clinical partner pairs, and that staff at level equivalent to expert initiate or participates in scientific projects in the endoscopy ward. The competence cards are built upon separate main topics and are divided into knowledge, skills and competencies, based on the areas of competence given by the bologna qualification

45


framework. In addition, there is included a tool for assessing non-technical skills. (4). Non-technical skills are social and cognitive skills used in conjunction with technical skills in pre, procedure-oriented and post-operative endoscopy nursing. Endoscopy teams are often temporary, changeable and loosely formed. Communication and teamwork (examples of social and interpersonal skills) and situational awareness and decision making (examples of cognitive skills), are key non-technical skills and are central to high quality safe teams, and therefor worth focusing on in the competency development. (5). By increasing focus on competency development and teamwork, it caters to the staff's desire to develop professionally, increase quality, promote well-being and ensure the patients safety and the best possible care and treatment. References: 1. Danelund, J., Jørgensen C. 2002 Kompetencebroen – strategisk reflekterende kompetenceudvikling systemteoretisk og diskursteoretisk perspektiv Danmarks forvaltningshøjskole, 2. udgave. 2. Mentorskab i sygeplejen i Gastroenheden AHH 2016 https://intranet.regionh.dk/ahh/afdelinger/gastroenheden/om-afdelingen/Documents/Mentorskab beskrivelse 310516.docx 3. Benner, Patricia. From novice to expert. Addison-Wesley Publishing Company, Menlo Park. California 1984 4. Kompetenceudvikling af sygeplejen i Gastroenheden, Klinisk sygeplejespecialist Lena Veye, AHH. 5. Matharoo M et. al. Endoscopic non-technical skills team training: the next step in quality assurance of endocopic training, WJG 2014;20 (40): 17507-17515

L- 20 Mentorship and training to retain and sustain the endoscopy workforce Laura Dwyer, United Kingdom Not aubmitted

L- 21 Self-directed learning: How to implement continuing training in daily routine? Fanny Durand, France Introduction: We says that the world change, of course the system and the actors change, how to accompany these evolutions in endoscopy. Aims/Objectives: Economy context change in France, in Europe, the teams must combine the knowledge how to do, how to be, more and more quickly. The system become more complex when activities such as endoscopy are concerned, because nurse studies doesn’t prepare for endoscopy activities. Generally, nurses accompany and train the new professional in endoscopy unit on variable lengths. Endoscopy activities are more and more complex, the materials change, the disinfection process are in constant evolution, guidelines must be known and applied, it need time for new nurse in endoscopy and for the team. French society for endoscopy nurses ( GIFE) for physicians (SFED) organize congresses, publishes recommendations for doing acts safety.To answer to the security of actions care , GIFE by the web ,communicate by forum, try to help nurses and give different information. The system is it adapted really? Methods: A research is indispensable to understand the actors. Nurses are different by experiences, but also by generations. Managers must take into consideration the

new generations of nurses and adapt accompaniment for these different generations. The language is different between generation, the life vision, not to take into account the different generations of risk seeing teams exhausted by frequent destabilizing mobilities. The team is a group of actor’s different manager must create harmony between them. It need new tutorial system, by computers, nurses need to access easily to the web to find information during the work, do training by simulators : “never a first time on a patient without training “ French recommendation. Nurses must follow specific program in university, example endoscopy university program, education in disinfection with national society, to improve that nurses are valid for working in endoscopy unit. Findings: The forums, congresses, are important for endoscopy nurses, GIFE association give all the presentations in free access for endoscopy nurses, to help them, and federate these professionals. With university program, all the students, and graduates continue to interact continuously witch each other founded discuss group web. They can exchange video they make, information of their life work and also their private life. Conclusions: This work will prepare managers, and nurses , to understand and to adapt new training models. It answers to pedagogy activities for new generations. References: Bibliography :HEALTHCARE TEXT for become nurse 2012-256 , 27 June 2012 The next generation of project management: how to develop technical and leadership expertise July 15-17, 2019

L- 22 ESGENA Statement: Quality indicators for patient care in Endoscpy Jadranka Brljak , Croatia

Introduction: Since the 1960s quality assurance has become an integral part of medicine and nursing. The International Council of Nursing (ICN) and national nursing associations underline the nurse’s role in delivering high standard of care based on quality assurance programmes. Quality assurance is the responsibility of the whole team. Quality can be evaluated if minimum standards are defined and clear measurable criteria are identified for structure, process and outcome quality. Measurable outcomes enable the identification of deficiencies and facilitate improvements. Quality criteria for endoscopy nursing cover pre, intra and post procedure care. However, a complete separation between clinical medical and nursing outcome criteria is often difficult in Endoscopy, as the clinical interventions are a combination of both medical and nursing actions. Method: The ESGENA Education Working Group (EEWG) developed quality criteria for patient care in Endoscopy, covering structure, process and outcome quality. The group consists 25 members, representing the ESGENA group members. Results: Structure quality for patient care in Endoscopy covers rooms, equipment and staff necessary to provide professional patient care in the pre, intra and post endoscopy phases. Quality criteria are defined for patient contact areas like registration, waiting area, assessment & preparation rooms, endoscopy rooms, recovery areas and consultation rooms as well as for supporting services areas like reprocessing room, storage, disposal and administration areas.

46


Process quality covers all steps of the patient´s clinical pathway in Endoscopy 1. Admission 2. Assessment & Consenting 3. Preparation & Pre-procedure care 4. Intra procedure care 5. Assistance 6. Recovery 7. Discharge All parts are consistently structured with - General recommendations - The time frame - Description of patient care - Responsible staff - Necessary knowledge and skills Outcome quality are defined for each single step of the patient´s clinical pathway in Endoscopy Conclusion: The service needs to be patient focused and able to demonstrate the level of quality of care provided. This document is intended to help endoscopy departments to improve patient care in endoscopy by defining clear quality criteria for pre-, intra- and postendoscopy patient care. The document provides also arguments for qualified personnel. References - Donabedian A. Evaluating the quality of medical care. Milbank

Mem Fund Q 1966; 44: 166-206 - ESGENA Statement: European Job Profile for Endoscopy

Nurses. Endoscopy 2004;36:1025–30. - European Society of Gastroenterology and Endoscopy Nurses


- SGNA. Minimum Registered Nurse Staffing for Patient Care in the Gastroenterology Setting update 2016, www.sgna.org

- Dunkley I, et al. UK consensus on non-medical staffing required to deliver safe, quality-assured care for adult patients undergoing gastrointestinal endoscopy. Frontline Gastroenterology 2018;0:1–11. doi:10.1136/flgastro-2017-100950

L- 23 Adverse Events in Endoscopy Patricia Burga, Italy Introduction: As defined by Kohn, IOM 1999. an adverse event is an injury resulting from a medical intervention, or in other words, it is not due to the underlying condition of the patient. While all adverse events result from medical management, not all are preventable (i.e., not all are attributable to errors). Method: The possibility of an adverse event in an endoscopic setting has been analyzed through the review of bibliographic literature. In this analysis of adverse events, various definitions were taken into account, in addition to the different types of adverse events caused by organizational management, communication, and endoscopic procedures both diagnostic and therapeutic. Conclusion: Always according to Kohn : Human beings, in all lines of work, make errors. Errors can be prevented by designing systems that make it hard for people to do the wrong thing and easy for people to do the right thing. In health care, building a safer system means designing processes of care to ensure that patients are safe from accidental injury. When agreement has been reached to pursue a course of medical treatment, patients should have the assurance that it will proceed correctly and safely so they have the best chance possible of achieving the desired outcome. Risk can not be eliminated. Digestive endoscopy is one of

the many clinical specializations in which even the scientific societies have developed many initiatives for risk management through retraining, research and surveys both on national and international levels, development of guidelines both clinical and for the reprocessing of the endoscopic equipment. Scientific literature points out the risk factors for the patient from complications during the different endoscopic procedures. Co-morbidity and age are important factors, which must be taken into consideration before performing an endoscopic procedure. Adverse events may occur at any phase of the endoscopic procedure: before, during and after. Key Words: Adverse event, Digestive endoscopy, Complication, Incident reporting

L- 24 24 hours service in Endoscopy – Organisation, quality indicators and limitations Marjon de Pater, The Netherlands Introduction: Most of us are frequently engaged on-call the emergency service of the endoscopy unit. The 24 hours accessibility of an experienced endoscopy team is installed in many hospitals and is vitally important for the rapid and effective treatment of gastrointestinal bleeding, clearance of foreign bodies and food bolus impactions. However only a minority require an immediate endoscopic therapy. Aims/Objectives: Many cases in endoscopy could safely be postponed and performed electively or as an out-patient. My talk will highlight the guidelines and scores for the initial assessment of GI patient in the emergency room. This approach will may provide assistance for an appropriate time of endoscopy and triage of patients. Method - Describing the indications for an emergency

endoscopy following the guidelines - For bleeding/perforation and GI foreign body& food

bolus - Various scoring systems - How to organize in daily practice - Training program Conclusions: A responsible risk stratification should improve patient care without enforcement of dispensable invasive procedures or inadequate waste of personal resources References - The role of endoscopy in the management of acute

non-variceal upper GI bleeding, ASGE Guideline 2012. Gastrointestinal Endosc. 2012:75:1132-1138

- Blatchford O, Murray WR, Blatchford M, A risk score to predict need for treatment for upper gastroinstestinal haemorrhage. Lancet 2000:365: 1318-1321

- AMC protocol - Guideline NVMDL - Up to date: Airway foreign bodies in children - ESGE guideline 2016: Removal of foreign bodies in

the upper gastrointestinal tract in adults


47


L- 25 Track and trace : Documentation and follow-up of endoscope reprocessing, repair and maintenance Mikael Mochet, France Endoscopy still be in progression and there is more and more acts in endoscopy department. Thats also mean we need more and more materials and specially endoscopes. Today there is a lot of different endoscope and each have his own particularity. Furthermore operator solicited them a lot because time of procedure always increase, they need utilisation of bending for a long time during Endoscopic Submucosal Dissection for example. At the same time, we still have to be focus on controlling the microbiological risk. For this there is lot of different step like multistep cleaning and desinfection process, storage localisation. So endoscopy department really need to have a good follow-up: « track and trace » endoscope. Objective: Evaluate the best way to follow endoscope in real time and have the documentation and follow-up of to all step. Method: If we want to answer this objective we have to considerate that there is two way to track and trace endoscopes, the written follow-up or software. Today there still have a big part of endoscopy department whose using paper support with a big work of archiving. But now software begin install in different unit. Result : Current recommandation encourage computer software development. Thanks to that you can have any information in very short time and you minimize error sources. Conclusion : Endoscopy department should invest in computer tracability and specially the biggest department. These organization facilitate management and allow to have more safety.

L- 26

ESGENA Statement: Sign- in, time-out, sign-out safety netting in Endoscopy Ulrike Beilenhoff, Germany Introduction: Adverse events and complications are common in all fields of medical treatment and often preventable. An international, systematic review showed that adverse events may occur in 1 in 10 hospitalized patients (1). Possible causes of errors and mistakes are (2): - Structural deficiencies (inadequate equipment, lack of

staff, insufficient qualified staff) - Lack of communication and coordination - Work intensification and stress - Errors in the implementation of knowledge. In 2008 the World Health Organisation published its initiative “Safe surgery safe lifes” (3). A 19-item surgical checklist was developed to improve team communication and to identify patient´s risks. The efficiency of this checklist was evaluated in a worldwide study (in 8 hospitals on 4 continents, in rich and poor countries) (4). Failures, errors, complications (like surgical infections, pneumonia) and mortality were significantly reduced by using this checklist. This led to the worldwide implementation of surgical checklists. In the last 10 years checklists have increasingly been implemented in Endoscopy (5-8). The ESGENA Education Working Group developed an official statement.

Safety Briefing: Based on national and international guidelines, many endoscopy units established a safety briefing in the morning (before the endoscopy list starts) to ensure that all equipment and staff is available for the list of planned patients and to discuss the strategy for complex procedures (8). Sign-in, Team time out and sign-out should be performed for each individual patient. Sign-in should be performed when the patient arrives in the endoscopy department. The sign-in is a standardized risk assessment that identifies the patient's individual risks concerning the planned intervention and sedation. The following parameters have to be checked (5-8): - Identification of the patient (name, date of birth, Pat-ID) - Completeness of the patient's record including signed

informed consent, laboratory parameters and findings - Correct preparation of the patient - Risk assessment concerning sedation and the planned

procedure including ASA classification, comorbidity, cardio-respiratory problems, allergies, infections, anticoagulants, glaucoma and other items which are relevant for the respective procedure

Team-time-out (TTO) should be performed just prior to the endoscopic procedure to verify that the right patient is appropriately prepared in the correct room with the correct equipment is ready for use and that the team is aware of the individual risks of the respective patient. The following parameters have to be checked (5-8): - Introduction of team members with their function

during this procedure - Identification of the patient (name, date of birth, Pat-ID) - Planned procedure with indication, aim and planned

strategy - Correct function of all necessary equipment - Planned sedation - Relevant comorbidities and risks of the patient (e.g.

cardio-respiratory problems, allergies, anticoagulants) The TTO can be led by any team member. All team members must be present and must stop all other tasks. Surveys should that a TTO need a mean of 2 minutes if it is performed with a structured checklist (9). Sign-out is performed directly after finishing the procedure before the patient leaves the procedure room. All team members must be present and must stop all other tasks. The following items should be confirmed: - End of the procedure with result - Any equipment problems? - Completeness of the documentation including status of

patient and instructions for aftercare - All Specimens labelled Noise and interruptions should be avoided during the sign-in, TTO and sign-out. The use of standardised Endoscopy specific checklists ensure objectively reproducible processes, safe time and contribute to patient safety. Implementation phase A multidisciplinary working group should be established to develop department specific checklists based on national or WHO recommendations. The entire endoscopy team has to be informed about the background, aims, objectives and implementation procedure. The checklist should be tested and improved during an implementation phase of some weeks before the final document will be approved as an official document. The checklists can be designed in paper format or included in electronic endoscopy documentation systems. Summary & Conclusion: Checklists in Endoscopy are helpful tools to assess patient´s risks, to intensify team communication and to prevent failures. Sign-in, TTO and sign-out can easily be implemented in Endoscopy units.

48


References: 1. de Vries EN, Ramrattan MA, Smorenburg SM, et al. The

incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care 2008;17: 216–23.

2. Cullinane M. Scoping our practice: The 2004 Report of the National Confidential Enquiry into Patient Outcome and Death. National Confidential Enquiry into Perioperative Deaths, London, 2004.

3. World Health Organisation. Safe surgery saves lifes. www.who.int/patientsafety/safesurgery/en/

4. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360:491–9

5. AGA, ACG, ASGE. Gastroenterology Safe Surgery Checklist for Ambulatory Surgical Centers. http://gi.org/wp-content/uploads/2012/03/TriSocietyASCChecklist.pdf

6. Matharoo M, Thomas-Gibson S, Haycock A et al. Implementation of an endoscopy safety checklist. Frontline Gastro. 2014; 0, 1–6, doi:10.1136/flgastro-2013-100393

7. Denzer, U. et al. S2k guideline: quality requirements for gastrointestinal endoscopy, Z Gastroenterol 2015; 53: E1–E227

8. NHS National Safety Standards for Invasive Procedures (NatSSIPs) Endoscopy, published in September 2015. https://www.england.nhs.uk/wp-content/uploads/2015/09/natssips-safety-standards.pdf

L- 27 High prevalence of digestive bacteria in duodenoscopes – how does a national survey influence daily practice Margreet C Vos, The Netherlands. Increasing numbers of outbreaks caused by contaminated duodenoscopes used for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures have been reported, some with fatal outcomes. We conducted a nationwide cross-sectional study to determine the prevalence of bacterial contamination of reprocessed duodenoscopes in The Netherlands. All 73 Dutch ERCP centers were invited to sample ≥2 duodenoscopes using centrally distributed kits according to uniform sampling methods. Contamination was defined as 1)any microorganism with ≥20 colony forming units(CFU)/20mL (AM20) and 2)presence of microorganisms with gastrointestinal or oral origin, independent of CFU count (MGO). Sixty-seven out of 73 centers (92%) sampled 745 sites of 155 duodenoscopes. Thirty-three (22%) duodenoscopes from 26 (39%) centers were contaminated (AM20). On 23 (15%) duodenoscopes MGO were detected, including Enterobacter cloacae, Escherichia coli, Klebsiella pneumonia and yeasts. For both definitions, contamination was not duodenoscope type dependent (P values: 0·20 and higher). Due to this finding we developed a new guideline on methods and frequency of culturing endoscopes. We developed a program of repeating cultures depending on the outcome of the culture results. With this, the frequency of cultures and the prevention measures taken depends on the results of the measurements. However, no results of working with the guideline are available yet. Keywords endoscopic retrograde cholangiopancreatography; reprocessing; disinfection; contamination

L- 28 Endoscopy related infections – is sterilisation an answer? Michael Jung, Mainz Thermolabile flexible endoscopes are classified as semi-critical devices and were consequently reprocessed with manual cleaning, disinfection by automatic washer-disinfector and thorough drying before storage. Numerous infectious series by contaminated duodenoscopes with multi-drug resistant organisms in the last five years have raised questions, if standard protocols for disinfection are sufficient enough or if sterilisation modalities should be considered. There are 3 main reasons for possible failure of high level disinfection of endoscopes: the complex design of the instruments with small narrow lumina and branch channels, difficult to clean and disinfect, in particular the area around the Albaran elevator in duodenoscopes. The contamination of fluids and accessories (cleaning brushes, adaptors, water bottles etc.) and the risk of developing biofilms. And finally human factors with untrained personnel and the risk of errors during the procedure Several attempts to optimize reprocessing of flexible endoscopes, either with doubled cycles in washer-disinfectors (Rex, Endoscopy 2017) or ethylene oxide gas sterilisation (Narytzky GIE 2016) did not lead to complete elimination of microorganisms but to increased costs and time loss. As heat sterilisation would damage and destroy flexible endoscopes, only low temperature sterilisation can be regarded as a possible alternative. Ethylene oxide gas sterilisation has not proven to be superior to disinfection in this regard. The European view so far is based on intensifying and optimizing the current process of reprocessing with validation and regular re-qualification of washer-disinfectors, a regular microbiological surveillance and the focus to personnel training and qualification. ESGE-ESGENA guidelines (Endoscopy 2018 in press) on reprocessing may serve as a basis for the European view.

L- 29

Biofilm formation and prevention - a challenge with flexible endoscopes Lionel Pineau, France Not submitted

L- 30

ESGENA European Curriculum for endoscope reprocessing Ulrike Beilenhoff, Germany; Jadranka Brljak, Croatia; Christiane Neumann, UK Principles: Flexible endoscopes are reusable, complex medical devices with numerous lumens and narrow channels. Due to their thermo labile construction and complex design, endoscope should only be reprocessed by specially trained and competent staff. This applies both to routine as well as emergency endoscopy.All endoscopes and reusable endoscopic accessories in endoscopy should be reprocessed with a uniform, standardized reprocessing procedure following every

http://www.who.int/patientsafety/safesurgery/en/

49


endoscopic procedure (universal precautions). Sufficient number of trained, dedicated, competent staff and sufficient time are prerequisites for correct reprocessing of endoscopes and endoscopic accessories. A formal officially recognized training is recommended, followed by competency assessment. Aims: ESGENA developed a European Curriculum for endoscope reprocessing in order - to set standard for education of nurses and other

health care workers who are responsible for endoscope reprocessing

- To support national nursing societies, official bodies and course organisers to establish educational structures for staff reprocessing flexible endoscopes and endoscopic equipment

- To establish equivalence of training and consequently support free movement within the EU

Target group: This curriculum is aimed to train health care workers - working in Endoscopy department and Central

Sterilization Service Departments (CSSD) - involved in the reprocessing of flexible endoscopes

and its components Course Content: The course consists of different modules. The suggested number of hours results in a 3 days course for health care workers. - Module 1: Basics of hygiene, epidemiology and

microbiology - Module 2: Occupational health and safety - Module 3: Structural requirements for Endoscope

Reprocessing units - Module 4: Design, construction and use of endoscopes

and its components and Accessories - Module 5: Standardised and validated reprocessing of

flexible endoscopes and its accessories - Module 6: Validation and routine testing of

standardised reprocessing cycles for flexible endoscopes and its accessories

A formal assessment is recommended.Regular practice and updated training are essential to maintain competency. Initial training, regular updates and regular competency assessment should be documented for endoscopy and reprocessing staff. Regular audits should be performed in order to assess compliance with guidelines and to identify any lack of competence or inconsistent attitudes at an early stage. References: - ESGENA Statement: European Job Profile for Endoscopy

Nurses. Endoscopy 2004;36:1025–30. - European Society of Gastroenterology and Endoscopy Nurses


- Beilenhoff U, Neumann CS, Rey JF, et al. ESGE-ESGENA guideline: Cleaning and disinfection in gastrointestinal endoscopy. Update 2008. Endoscopy 2008; 40: 939-957, Update 2018 in press

- VEDAS - Vocational Education Disinfection and Sterilisation”

(October 2011 - November 2013). www.evedas.com

L- 31 Monitoring of IBD patients – what issential? How do we assess disease state and patient well being in inflammatory Bowel disease? Irene Dunkley, United Kingdom Introduction: Patients with Inflammatory bowel disease are monitored from the time their diagnosis is made. This

life long condition can vary in its severity from occasional interference with daily living to being a continuous burden for patients causing suffering, hardships and loss of social interactions. Healthcare professionals supporting patients and their families with a diagnosis of inflammatory Bowel Disease aim to enable a supporting therapeutic relationship that allows patients to decide on the recommendations offered to them with the aim of helping them lead a ‘normal’ and active life. The interactions patients have with healthcare professionals will determine how engaging they are with care decisions and treatment recommendations. Nurses provide one of the key relationships with patients, they are seen as more accessible and having more time to give information, psychological support to patients and their families. Inflammatory Bowel disease is complex, healthcare teams need tools to help them make the right recommendations for patient care decisions to be made in a timely manner to prevent disease progression. Aim: This presentation will aim to provide: - An overview of Inflammatory Bowel disease. - Drugs used to treat IBD and the monitoring

requirements. - Types of monitoring and their influence on treatment

decisions. - The role of Endoscopy in the management of IBD. - The role of IBD nurses in supporting patients. - Influences on patient engagement in treatment. References https://www.ecco-ibd.eu/publications/ecco-guidelines-science.html https://www.nice.org.uk/guidance/cg152/ifp/chapter/monitoring Clinical usefulness of therapeutic drug monitoring of thiopurines in patients with inadequately controlled inflammatory bowel disease Melissa L. Haines MB, BS, FRACP Yousef Ajlouni MD, JB (Medicine), JB (Gastroenterology) Peter M. Irving MA, MD, MRCP Miles P. Sparrow MB, BS, FRACP

L- 32 IBD – Passport – a tool for information and communication in daily live and for travelling Key Greveson, United Kingdom Inflammatory bowel disease (IBD) and foreign travel is associated with an increased risk of travel-related morbidity caused through exacerbations of IBD, acquisition of infectious diseases endemic to the destination and availability of healthcare and medicines whilst abroad. This presentation will outline research undertaken to examine the patient’s experience of travel with IBD, including pre-travel preparation and will present the development of IBD Passport online travel resource for IBD.

L- 33 Iron-deficiency, anaemia and fatigue in IBD Palle Bager, Denmark This presentation will take you through three common conditions for patients with inflammatory bowel disease (IBD): iron deficiency, anaemia and fatigue. The prevalence of iron deficiency in IBD is approximately 35% and for anaemia the prevalence is close to 20%. Fatigue is present in approximately 40% of patients with IBD in remission and much higher if IBD flare is present. The presentation will focus on each condition and the


https://onlinelibrary.wiley.com/action/doSearch?ContribAuthorStored=Haines%2C+Melissa+L

https://onlinelibrary.wiley.com/action/doSearch?ContribAuthorStored=Ajlouni%2C+Yousef

https://onlinelibrary.wiley.com/action/doSearch?ContribAuthorStored=Ajlouni%2C+Yousef

https://onlinelibrary.wiley.com/action/doSearch?ContribAuthorStored=Irving%2C+Peter+M

https://onlinelibrary.wiley.com/action/doSearch?ContribAuthorStored=Sparrow%2C+Miles+P

50


possible relationship between them. Furthermore, reflections on treatment will be presented. The presenter holds a position as clinical nurse specialist and achieved a PhD degree in 2014 based on research within the present topic.

L- 34 N-ECCO Continuing education – what can Endoscopy learn? Palle Bager, Denmark This presentation will focus on how the European Crohn's and Colitis Organisation (ECCO) have created their education activities. Special attention will be on the education of inflammatory bowel disease (IBD) nurses organised by Nurses-ECCO (N-ECCO) and how this activity is integrated with the rest of ECCO. The presenter holds a position as clinical nurse specialist and has been committee member of N-ECCO between 2014-2018, the last year as committee chair.As a teaser you can visit the ECCO homepage at: https://www.ecco-ibd.eu/

L- 35 Artificial intelligence in digestive endoscopy Jean Francois Rey, France Intelligence artificial (AI) concept has been elaborated during Dartmouth conference in 1956 by McCarthy and colleagues.it is an expert system with two levels: human like intelligence then a new form of intelligence (super human expert). These systems require knowledge and input with the overall results in competition computer versus human champion on chess (1997), shogi (2014) go (2016). the main difference between computer versus human brain: human get tired.

In healthcare AI is involved in classification and recognition, advise and search task, complex task planning or interference and prediction. In digestive AI is used for assist or execution assist with endoscopy three main fields: guidance, diagnosis and treatment. Insertion of colonoscope is a decision assist procedure were the computer is able to look for colon lumen but also detect dangerous looping in order to avoid perforation. This is already achieved on colonoscope prototype. Detection function guide practitioner during examination allowing to enhance area with abnormalities. For classification, the computer has to be fed with thousands of pictures in order to obtain a learning machine the classification is obtain with the trained model. various model has been already publishing on Barrett or stomach. The most impressive study has been published Y. Mori from S, Kudo group using AI with endocystoscopy on polyp classification with impressive accuracy and specificity.AI allows also to guest outcome after ESD on superficial carcinoma on lateral spreading tumour. S.Kudo show the benefit of AI in prediction of lymphanode metastasis. Finally, AI is using in digestive endoscopy during interventional procedure in order to achieve delination on superficial gastric cancer or underline the risk of large vessel during ESD procedures. The benefit of AI is promising in digestive endoscopy as it will level average quality endoscopy not only for experts but to all endoscopist

L- 35 New aspects of microbiome therapy Christoph Högenauer, Austria Not submitted

51

ESGENA Abstracts Poster Presentations

P-1 Organizative aspects in italian digestive endoscopy units: A national survey by ANOTE-ANIGEA Alessandra Guarini1, Elena Rossetti2, Pierangelo Simonelli3, Teresa Iannone4

, Daniela Carretto5, Antonella Giaquinto6, Giorgio Iori7, Monia Valdinoci8, Cinzia Rivara9 1Nuovo Regina Margherita Hospital, Rome; 2IRCCS Humanitas, Milan; 3 ‘Spedali Civili’ Hospital, Brescia;4 ‘Polistena’ Hospital;5 ‘Cardinal Massaia’ Hospital, Asti; 6‘Tor Vergata’ University Hospital, Rome; 7 ‘Santa Maria Nuova’ Hospital, Reggio Emilia; 8 ‘Careggi’ University Hospital, Florence; 9 ‘Ciriè’ Hospital, Turin, Italy Introduction Novel technologies, techniques and devices are continuously introduced in Digestive Endoscopy Units. Therefore, an adequate organization is required, including apposite structures, technologies, and presence of dedicated nurses. ANOTE-ANIGEA performed a Nation-wide survey to assess all these aspects in the Italian Endoscopy Units. Materials and Methods A specific questionnaire was prepared with different items regarding structures, organization and nursing activities in the Endoscopy Units. The questionnaire was distributed to ANOTE-ANIGEA associates working in different Hospitals distributed through Italy. Data were statistically analysed by using Chi-square test or Fisher’s test, as appropriate. Results Overall, questionnaires from 176 different Endoscopy Units were evaluated (Figure 1). Data found that a recovery room and a distinct dirty-clean area were lacking in 15% and 45% of centres. In 19% of centres, the reusable devices were reprocessed with high level disinfection rather than sterilization, as well as the reprocessing traceability was lacking in 23% of centres. There was a median of 6 (range: 1-30) nurses in different centres. The number of nurses working in each Endoscopic room was provided in Figure 2. In as many as 56% of centres, only the nurses perform reprocessing, other trained staff being lacking. Of note, significant differences emerged when comparing data from Northern, Central, and Southern centres (Figures 3-5). Conclusions This survey found concerns on reprocessing of reusable devices (high level disinfection rather than sterilization) in several centres. A distinct dirty-clean area is lacking in half Endoscopy Units. Lacking of dedicated staff for reprocessing other than nurses lead to inappropriate use of resources in half of centres. Significant differences emerged among Northern, Central and Southern Italy. References 1. ANOTE-ANIGEA (2011). Linee Guida. Pulizia e disinfezione

in Endoscopia. Update 2011. 1-51

2. UNI Technical Report 11662 (2016). Ricondizionamento dei

dispositivi medici – Guida al ricondizionamento degli

endoscopi termolabili. 1-51.

3. Bazzoli F, Buscarini E, Cannizzaro R, et al. (2011) Libro

bianco della Gastroenterologia italiana.

4. Beilenhoff U, Neumann CS, Rey JF et al. (2008) ESGE-

ESGENA guideline: cleaning and disinfecion in gastrointestinal

endoscopy. Update 2008. Endoscopy 40:939-57.

5. Caletti G, Chilovi F, De Boni M, et al. (2003) Il libro bianco

dell’Endoscopista. Centri di endoscopia e soluzioni adottate. 5-

21.

6. Caruso R, Pittella F, Ghizzardi G, et al (2016). Che cosa

ostacola l’implementazione di competenze specialistiche per

l’infermiere? La prospettiva degli infermieri clinici: uno studio

esplorativo e descrittivo. L’infermiere 53:e22-e28.

7. Guarini A (2010). Il reprocessing in Endoscopia Digestiva:

l’ottimizzazione delle risorse è possibile. Infermiere Oggi 2:22-

7P-2

P-2 My experience of integrating into an endoscopy unit in Germany coming from Albania Jorgert Kishta und Urte Stahlberg, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany Background: The project started as a pilot project for nurses who wanted to work in Germany. First, an intensive language course until the level B2 was mandatory. Second, passing the professional exam allowing the work in Germany was necessary. The main aim was to learn and adapt new methods and standards developed recently in the field of diagnostic and therapeutic endoscopy. Differences between a German endoscopy unit to home country: There are two examination rooms at the hospital in Albania, one for gastroscopy and the other for colonoscopy, and the sterilization room for the endoscopes and instruments. During the endoscopic procedures two nurses and one doctor were present in the examination room. Sedation for gastroscopy was performed with midazolam and fentanyl and for colonoscopy, propofol was used. In cases of therapeutic interventions such as sclerotherapy, APC, polypectomy, PEG, oesophageal band ligation and ERCP, anaesthesiologists routinely performed the sedation. Regarding the endoscopic examinations in the Charité, there is a difference in the number and diversity compared to the situation in Albania. In the Charité, propofol is used for outpatients. For inpatients and longer or more therapeutic interventions, a combination of midazolam and propofol is recommended. Sedation in Germany is mostly administered by the assistant personal after special training. Lack of personal experience existed in ERCP, PTC, EUS or innovative new techniques like FTRD, cholangioscopy with lithotripsy or RFA. For these examinations intensive training and support from the colleagues was necessary. Personal deficiencies in Language and Experience Implementing new standards was challenging for different interventions such as ERCP, PTC or EUS and other therapeutic examinations. Several practice sessions occurred and for intensifying special techniques, hands-on-training courses are planned in the future. A good collaboration and the support from colleagues are important and very efficient. Overcame the deficiencies: Integration in a German endoscopy unit is a process that requires time and commitment. Beside several difficulties and problems in the beginning, the barrier of language was the main challenge of all. During initial training, the support of the colleagues is very helpful. In the first two weeks, basic observation of the whole unit was recommended. One week was scheduled for each examination room (gastroscopy, colonoscopy, EUS, recovery room) and two weeks for the ERCP-room. Conclusion; The project for emigration to Germany was successful despite difficulties in language and adaption of professional abilities. The experience for five years in an endoscopy unit in Albania significantly facilitated the integration. However, integration is a continual process that needs further education and specific training.

52


Learning outcome: Integration is an intensive experience which needs time and energy but brings a lot of joy after this new start of life. A good teamwork facilitates inclusion. Integration to be continued …!

P-3 Innovations in the Gastroenterology Nurses Training in Israel Yuri Guriel, Rambam Health Care Campus, Haifa, Israel; Shirly Luz, Nursing Division, Ministry of Health, Jerusalem, Israel: Revital Barkan, Rabin Medical Center, Petah Tikva, Israel; Galia Niv, Nursing Division, Clalit Medical Services, Israel; Rina Assulin –Ophir, Rambam Health Care Campus, Haifa, Israel Nursing training in Israel for registered nurse begins with bachelor’s degree in nursing extending for four years. After graduation, nurses can choose a specific field of specialization and a career path. Training in advanced fields is carried out as part of post basic courses. The purpose of the training program is to address the changing challenges of the health care system as well as to provide solutions for the future demands of hospitals and the community clinics training requirements. Studies in post basic courses provide theoretical knowledge to learners, as well as practical experience in the relevant clinical field and simulations of representative clinical situations and patient-care scenarios. The curriculum is determined by the Nursing Administration in the Ministry of Health and is updated once a year with the help of experts from the clinical field and is based on evidence-based nursing studies. Currently, training programs take place in 21 fields, such as intensive care, emergency medicine, oncology, geriatrics, etc This year, for the first time, a post basic course training program for gastroenterology nursing will be launched. As part of this training, nurses will undergo extensive education program and clinical training. The educational framework includes topics such as physiology of the digestive system, advanced endoscopy, Inflammatory Bowel Disease, gastrointestinal diseases, nutrition, sedation, infection prevention and legal aspects of nursing work and other related subjects. In addition, nurses will undergo workshops designed to help them improve their skills for coping and for emotionally supporting patients and their families suffering from chronic illnesses. The duration of theoretical studies is about 450 academic hours. Furthermore, nurses will also undergo a clinical training lasting between 130 and 200 hours depending on their experience in the gastroenterology field. After graduation of the course and after preforming a simulation-based exam the graduate nurse will get credential and a wide scope of practice that will enable her to provide specific services and treatments such as independent sedation supplementation, referral to imaging and laboratory tests, change of steroid dose for IBD patients, gastrostomy maintenance treatment, IBD patient preparation for biological treatment and other related activities.

P-4 Mindfulness as a challenge in today's nursing Tina Kamenšek1, Darja Thaler2,1 Department of Nursing, Faculty of Health Sciences, University of Ljubljana, Slovenia, 2 Department of Nursing, Faculty of Health Sciences, University of Ljubljana, Slovenia Introduction: Mindfulness is a holistic approach to person, that improves the function of human in all aspects. It is important to be aware of mindfulness being the central pathway during nursing, which puts in the forefront mutual relations and holistic treatment of patients and evidence-based medicine. In Slovenia, not only the relation to the fellowman, but also the understanding of its needs during the illness, is very deteriorated. Due to the weakening of the culture of relationships among healthcare workers, this also reflects in relation to the patient. All this affects the quality of the care and the patient's satisfaction during treatment. Aim: The aim of this contribution is to draw attention to the problem of relationships in nursing. We also want to encourage and educate healthcare professionals about the importance of using empathy and sympathy during work with their patient. Methods: There was a descriptive method of work, used with a review of professional and scientific literature, published in English between 2008 and 2018. The keywords, used for searching, were »mindfulness, nursing, health workers and patients«. The articles were selected according to the keywords, and the relevance of the research, where patient and healthcare workers were involved, in order to examine the impact of mindfulness. We examined selected articles with a qualitative analysis. Findings / Results: The studies, that were included in the review, indicated the positive effect of mindfulness on the relations among nurses and patients, and consequently better treatment outcomes were shown. The main reason for that is in bigger listening, an increased sense of empathy, and less judgmental attitude of nurses towards the patients. Examples of good practice describe training of mindfulness, that reduces the stress of nurses and patients, it improves communication, that by inference causes better satisfaction of involved one, and higher quality of health care. Summary and Discussion: Mindfulness enables people to become more aware of their body sensations and the way they think and feel. It has the potential to produce benefits in the prevention and treatment of physical and mental illnesses. Trained nurses can safely offer mindfulness as a choice for patients to assist them in healthcare process and to self manage their disease. One of the successful forms of training is supervision. Research in Slovenia revealed that nurses consider supervision useful and they want to integrate it into their work. That is why supervision has been included as obligated study subject for registered nurse and midwife in Slovenia. Conclusion: The fact is, that the attitude towards the human was, is, and always will be topical and necessary. Over time, its form changes, but it should not disappear. Introduction of mindfulness into education and practice can contribute to the development of the presence in the present from a purely theoretical point of view on the human holistic aspect. Learning Outcomes & Relevance to Nursing Practice: Supervision enables and offers a possible solution to improve and enforce mindfulness in clinical practice.

53


P-5

Right time for Propofol? A 4-years experience in an Italian center Massimo Petrocco, Maria Pia Caldarella, Nicoletta Cicconetti, Gilda Napoletano, Paolo Panaccio, Maria Teresa Tartaglia, and Maria Marino. Unit of Surgical Digestive Endoscopy; “G.Bernabeo” Hospital of Ortona (Chieti) – Italy Introduction: Propofol-induced deep sedation in endoscopy improves procedure's quality (caecal intubation, adenoma detection rate) and eases patient discomfort and anxiety [1]. The Italian Digestive Endoscopic Society (SIED) released a document with recommendations for using Propofol by a trained endoscopy team [2]. In our study endoscopy nurses followed a safe path, drawing up nursing documentations and achieving advanced competences in management of patients in deep sedation, in cardiovascular and respiratory monitoring and in management of complications (training courses as Basic and Advanced Life support: BLS-ALS/ACLS). Aim: Complications rating of the Propofol-induced deep sedation made by non anesthesiologist (NAPS) to demonstrate safety and feasibility of deep sedation administrated by a trained endoscopy team through improving of competences. Method: Retrospective observational study. Between February 2014 and February 2018, 8412 patients (females 4724, males 3688 mean age 62 +/- 6) had colonoscopy with NAPS, for patients with a ASA (American Society of Anesthesiologists classification) 1 and 2. Each patient compiled a satisfaction questionnaire (measuring anxiety and comfort before and after the procedure) and nurses redacted a nursing documentation to record clinical history, risk factors, allergies, pharmacological therapy and vital signs during the procedure and the awakening ( oxygen saturation, heart rate and blood pressure). A crash cart to manage the complications has been set; endoscopy team performed trainings through BLS and ALS/ACLS courses. A dedicated person was used for propofol administration, with available anesthesiologist (on the same floor of the endoscopy unit) and emergency team (MET). Results: In all recruited patients there were no significant heart rate alterations.About 12% developed hypoxaemia (SpO2 <90%) and about 10% required oxygen supplementation. Hypoxaemia (SpO2 <85%) was observed in about 2% of cases, but the use of supraglottic airway devices or tracheal intubation were not necessary. Hypotension was observed in 5% (sBP <90mmHg) with spontaneous resolution. More than 99% of colonoscopies were completed reaching the caecal fund ..Furthermore we recorded a significant decreasing of anxiety and discomfort of patients after the procedure. Discussion: Hypoxaemia was the most common adverse event encountered with propofol sedation during endoscopic procedures and it was easily managed by endoscopy team. The absence of several complications and the low rate of moderate complications (2%) avoided resuscitation procedures and/or anesthesiologist and emergency team intervention. Limitations. The study included only NAPS, without recording anesthesiologist–administrated propofol (AAP) which would be useful to make a comparison between complication ratings. Furthermore the study didn't observe complications of midazolam or petidine-induced sedation (sometimes considered safer then propofol because of reversibility), although we observed 2 severe complications with sedoanalgesia and “conscious sedation”.

Conclusions: Sedation with Propofol, administered by a trained endoscopy team has a good safety profile when administered in ASA 1-2 patients and it guarantees an excellent level of confort for patients with an improvement of the quality of procedures. Furthermore endoscopy nurses can improve their profile getting advanced competences in management of patients and complications in deep sedation. References: [1] ASGE Standards of Practice Committee, Early DS, Lightdale JR, Vargo JJ 2nd, Acosta RD, Chandrasekhara V, Chathadi KV, Evans JA, Fisher DA, Fonkalsrud L, Hwang JH, Khashab MA, Muthusamy VR, Pasha SF, Saltzman JR, Shergill AK, Cash BD, DeWitt JM. Guideline for sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2018 Feb;87(2):327-337 [2] Giorn Ital End Dig 2014;37:223-227 La sedazione in endoscopia digestiva; Rita Conigliaro, Lorella Fanti, Matteo Gazzi

P-6 Patient assessment: Checklist for endoscopic procedures Rafaela Bré, Carla Sousa, Hospital da Senhora da Oliveira – Guimarães, Portugal Introduction: There is an increasing emphasis on the patient safety culture. In a digestive endoscopy unit (DEU) the common mistakes are often inconsequential and as such are not valued. Our ability to perform therapeutic procedures has increased exponentially, both in number and in specificity, which has an impact on the associated inherent risks and complications. However, minor errors can lead to significant adverse events. In 2012, the National Department of Health's Patient Safety Agency updated the list of serious but preventable patient safety incidents, and integrated incidents that are directly related to DEUs: overdose of benzodiazepine during conscious sedation; failure to monitor and respond to oxygen saturations during a sedation procedure; incorrect patient identification; wrong endoscopic procedure; and positioning of the nasogastric tube. In Portugal, the Ministry of Health has developed the National Plan for Patient Safety 2015-2020, which aims to achieve 9 strategic objectives, four of which directly related to the patient evaluation in a DEU: to increase communication security; correct procedure identification; ensuring the unambiguous identification of patients; and prevent the occurrence of falls. Current evidence suggests that the implementation of the pre-examination checklist can help prevent errors in a DEU. Aims: The purpose of this research was to improve the ability to elaborate and implement the checklist for endoscopic procedures. Methods: We reviewed the literature in databases: PubMed, EBSCO host web and other data sources. Results: The current evidence tells us that the checklist should include the following items: correct patient identification; correct procedure identification; confirmation of signed informed consent; allergies; relevant clinical pathology; current medication; examination, if necessary; and recording of vital signs. The model of the checklist must be developed and consensus obtained by all members of the team that will use it. Education of the multidisciplinary team, should be carried out through in-service training actions. Strong leadership is needed within the nursing and medical team to establish a change in practice. A period of time should be stipulated for the training and implementation of the checklist. An exclusive person must fill out the checklist.

https://www.ncbi.nlm.nih.gov/pubmed/?term=ASGE%20Standards%20of%20Practice%20Committee%5BCorporate%20Author%5D

https://www.ncbi.nlm.nih.gov/pubmed/?term=Early%20DS%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Lightdale%20JR%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Lightdale%20JR%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Vargo%20JJ%202nd%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Acosta%20RD%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Chandrasekhara%20V%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Chathadi%20KV%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Chathadi%20KV%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Evans%20JA%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Fisher%20DA%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Fonkalsrud%20L%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Hwang%20JH%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Khashab%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Khashab%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Muthusamy%20VR%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Pasha%20SF%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Saltzman%20JR%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Shergill%20AK%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Cash%20BD%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=Cash%20BD%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

https://www.ncbi.nlm.nih.gov/pubmed/?term=DeWitt%20JM%5BAuthor%5D&cauthor=true&cauthor_uid=29306520

54


Discussion: The checklist is a simple and inexpensive tool, is feasible and significantly increases the perception of team communication and teamwork. The checklist is dynamic, needs constant improvement, and does not work if it is not properly filled and engaged with all the team. Conclusion: Improving patient safety is a team responsibility and a collective process, which aims to ensure the highest possible safety of patients, avoiding unnecessary incidents. Learning outcomes: The preparation and implementation of the checklist should be adequate to the DEU reality. The checklist should be concise and easy to fill out. The whole multidisciplinary team must be involved.

P-7

Patients’ Perspectives Towards Quality of a Digestive Endoscopy Service: A Qualitative Approach Vânia Maria Braga, MSc (1); Marta Pinto, PhD (2)(3); Sílvia Ferraz, MSc (1); Mário Dinis Ribeiro, MD, PhD (1)(3); Luís Filipe Azevedo, MD, PhD (3) 1) Gastroenterology Department, Portuguese Institute of Oncology, Porto; 2) Department of Psychology of Addictive Behaviours, Faculty of Psychology and Education Science, University of Porto; 3) Center for Health Technology and Services Research (CINTESIS) & Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto. Portugal. Background: Quality of endoscopy is of paramount relevance. Published studies mostly focus on clinical outcomes, but there has been increased concern on evaluating services from patients’ perspectives. A recent review identified several approaches to determine these, but the focus was the overall satisfaction and only a few instruments were truly based on patients’ experiences. Objective: We hypothesized that by understanding the expectations of patients, the quality of endoscopy services would be improved. We aimed to identify elements of quality most important to patients in their perspective, to offer information to healthcare providers on how to improve the quality of delivered care. Methods: Qualitative research study using in-depth, semi-structured, face-to-face interviews performed by a single interviewer involving 16 patients and 10 healthcare providers, and content analysis. Participants were selected by theoretical sample and sample size was achieved by saturation. The inclusion criteria were patients submitted to upper or lower gastrointestinal endoscopy in a single hospital, including diagnostic or therapeutic procedures, and healthcare providers working at the same endoscopy unit. The exclusion criteria were refusal or inability to answer to questions. Ethical approval was obtained. Results and Discussion: Patients seemed to rely on the healthcare providers aspects related to technical quality of the procedure. Also, they reported receiving care as expected and demonstrated a positive image of the staff and the service. In addition, they showed a great feeling of gratitude and attachment to the institution. In general, patients expected to be well cared for, not feel pain and be properly informed. In fact, they mentioned that communication skills and the option and waiting time for a procedure under sedation are aspects to be improved. On the other hand, healthcare providers stated that they must be holders of current scientific knowledge and technical skills and that the most important issue for the patient should be to perform the procedure safely. The staff

members considered that the service has good professionals and equipment, but the facilities could be improved and the relational aspect with the patient should be optimized. This study was performed in a single centre and there are potential biases related to the researcher previous conceptions. Nevertheless, these results indicate that patients have an uncritical attitude, not positioning themselves on quality issues and this is an important issue that healthcare providers must consider. It seems that both patients and providers agree that the technical parameters must be hold by health providers and are in general good, but that communication can be improved; and it seems that pain is an issue that is more relevant for patients whereas safety is for providers. Conclusion and relevance to nursing practice: Access to a pain free endoscopic procedure and adequate communication seem to be dimensions to be improved and relevant in the quality of health care from a patients’ perspective. Nurses must be involved in all these processes towards an improvement and to a patient-centeredness care obtained. References • Brown, S. et al. (2015). Patient-derived measures of GI

endoscopy: a meta-narrative review of the literature. Gastrointest Endosc, 81(5), 1130-1140.e1131-1139.

• Cohen, J., & Pike, I. M. (2015). Defining and measuring quality in endoscopy. Am J Gastroenterol, 110(1), 46-47.

• Rees CJ. et al. (2016) European Society of Gastrointestinal Endoscopy - Establishing the key unanswered research questions within gastrointestinal endoscopy. Endoscopy, 48(10):884-891.

• Rutter, M.D. et al. (2016). The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures. Endoscopy, 48(1), 81-89.

P-8 Storage Time of Flexible Endoscopes Longer than 30 Days is Associated with an Increased Contamination Rate Yvonne Fietze, Universitätsspital Bern. Switzerland Background: Recommendations of professional societies on storage times for flexible endoscopes vary considerably between twelve hours to two months, or even no recommendation at all. Underlying high quality clinical data are scarce. We aimed at identifying a time point that could trigger reprocessing. Materials/methods: Single centre surveillance study between march 2014 and april 2017. We prospectively analysed routine microbiological samples from flexible endoscopes where the date of last disinfection processing was available. Co-variables were information on the sampled channel, on the endoscope setup, centralised versus localised processing, use in an endoscopy center, and storage condition. Detection of ≥10 CFUs/ml flush medium were defined as the contamination cut-off. Generalized linear and additive models (GAM) were used to describe effects predicting endoscope contamination. Results: 1,024 flush samples from 106 flexible endoscopes were included. The co-variables were normally distributed for the different storage times (0-7; 8-30; >30 days). The contamination rate for a storage time >30 days was 6% and significantly higher compared with 0-7 days (1.2%; OR 5.3; 95% CI, 1.2-17.9, p=0.014). This rise in contamination rate at about 30 days was confirmed in a GAM (p=0.045, Figure 1). None of the co-variables were associated with contamination.

55


Conclusions: Storage times over 30 days were the only parameter predicting increased endoscope contamination. Contamination rate was not influenced by storage condition and centralised processing. Our data suggest, that endoscopes should be reprocessed prior to clinical use if storage is >30 days. Keywords: endoscopes, microbiologic sampling, storage

P-9 Technical report on the reprocessing of thermolabile endoscopes: an Italian experience Cinzia Rivara, Italy Introduction: Guidelines from Scientific National and International Associations are today available and overlook the reprocessing of flexible endoscopes. However, a technical standard is missing, which should define the overall characteristics of the reprocessing process (operational phase and related tests, controls and qualifications; competencies and responsibilities; environment; traceability; validation). Objective: Define a Technical Document for the reprocessing of thermolabile endoscopes in order to address not only the operational process activity but also the organizational and management process. Method: Set up of a multidisciplinary working group (technical board UNI/CT 044/SC 12/GL 03 “Sterilization Processes”), formed by professionals involved at different levels (nurses, physicians, association and industry representatives), in the reprocessing process for thermolabile endoscopes. The group met regularly on monthly basis. For the definition of the document scope a thorough analysis of international scientific literature and guidelines was performed. Referral to existing Technical Standards for specific processes was also included. Results: After 18 months, in December 2016 the working group drew up a document entitled “Medical Devices Reprocessing – Guide to the reprocessing of thermolabile endoscopes”. Following the performed analysis, the experts decided to define a Technical Report rather than a Standard; therefore, the document adopted a more descriptive nature and showed, in a single document, advanced methodologies for the design, development, control and evaluation of the efficacy of the single stages and entire reprocessing procedure for thermolabile endoscopes. This was achieved also considering the objectives to reduce microbial charge for a safe use of the aforementioned devices. Conclusions: The Technical Document, that integrates National Guidelines recommendations, represents for Italy a growth opportunity for professionals within this sector; it brings to the reader the state-of-the-art information on the reprocessing of thermolabile endoscopic instrumentation and brings over talking points for the improvement and achievement of high quality and safety standards within endoscopic procedures. Only through the implementation of a scientific methodology, we can derive standards and recommendations in line with safety and quality objectives. Discussion among professionals represents an added value in defining a document of great significance References: 1. ANOTE-ANIGEA. Linee Guida Pulizia e Disinfezione in Endoscopia. Update 2011 2. ESGE-ESGENA guideline: cleaning and disinfection in GI endoscopy. Update 2008. Endoscopy 2008;40:939-957 3. UNI EN 285; 556-1; 868; 13060; 14698-1; 15883; 17664; UNI EN ISO 11140-1; 11607-1; 11607-2; 14644-1; 15882; 17665-1; UNI CEN/ISO TS 17665-2

P-10

PAIN IN UPPER GASTROINTESTINAL ENDOSCOPY. IS GASTROSCOPY REALLY PAINFUL?. Pedro Luis, del Mazo Tomé1,2/ Esther, González Nieto1/ María Concepción, Martínez Sexto1/ María Almudena, Pousada González1,2,3/ Ana María, Nieto Quesada1/ Alejandro, Toledo Soriano1,2 / (1) Hospital Universitario Central de Asturias (HUCA), (2) Instituto de Investigación Sanitaria del Principado de Asturias and (3) Universidad de Oviedo / Oviedo (Spain) Introduction: Gastroscopy is not as aggressive a procedure as surgery might be, however, it is an invasive technique. Frequently, patients suffer discomfort and even pain of changeable intensity. Objective: Evaluate number of patients who suffer pain and/or discomfort in upper gastrointestinal (GI) endoscopy and quantify it. Method: Observational, quantitative, prospective and non-randomised study carried out at HUCA from May to September 2017. Subjects under study: Representative sample was obtained from the 6500 gastroscopies performed at HUCA endoscopy unit in 2016. Applying the finite population correction factor, a total of 382 subjects were obtained as a representative sample, with 95% of confidence level and adjusted to 5% of losses. Inclusion criteria: Going to perform an upper GI endoscopy during the period of study. Being over 18 years. Accept voluntary participation in the study by signing informed consent. Materials: A hetero-applied questionnaire that included sociodemographic and clinical variables was applied. A numerical scale of 0 to 10 to assess pain and discomfort was used, with 0 being no pain and 10 being unbearable pain. For the data analysis, Statistical Package for the Social Sciences (SPSS) was used. Results: This study involved 382 subjects, of whom 175 were men (45.8%) and 207 women (54.2%). Participants’ mean age was 54.02 years, range of 19 to 89 years old and standard deviation of 14.96. Sedation used: None 1 (0.3%), topical 11 (2.9%), conscious 113 (29.6%) and both 257 (67.3%). Experienced perceptions: Nothing (23%), discomfort (70%), pain (5%) and both (2%). Experienced pain was greater in men than in women (Welch's t-test, p-value = 0.049). Relation between presence of experienced pain and previous digestive pathology: Existence of previous digestive pathology is related to pain presence (Pearson's chi-square test, p-value = 0.038). Relation between value of experienced pain and complications during the test: Patients who had complications during the test had more pain (Wilcoxon signed-rank test, p-value = 0). None statistical relation was found with pain for other variables. Discussion: Existing bibliography is about the tolerance of the test, not specifically about the pain. As limitations, the use of sedation might influence the perception of pain, although none statistically significant differences have been found regarding the type or the amount of sedation. Conclusion: Only 7% of patients notice pain during gastroscopy, accompanied by discomfort (2%) or not (5%). Variables that influence in this pain are male sex, previous digestive pathology and appearance of complications during the test. Learning outcomes and relevance to nursing practice: Despite not being an especially painful test, patients do report discomfort, so we should try to perform nursing interventions in order to improve patient's perceptions. In this way, by reducing discomfort during the test, we would improve the satisfaction with it.

56


eferences: 1.-Abraham NS, Fallone CA, Mayrand S, Huang J,

Wieczorek P, Barkun AN. Sedation versus no sedation in the performance of diagnostic upper gastrointestinal endoscopy: a canadian randomized controlled cost-outcome study. Am J Gastroenterol. 2004; 99(9):1692-9. 2.-Tierney M, Bevan R, Rees CJ, Treble TM. What do patients want from their endoscopy experience? The importance of measuring and understanding patient attitudes to their care. Frontline Gastroenterology. 2016; 7:197-8.

P-11 Alternative usage of endoscopic band ligation Andrea Ácsné Tóth RN BSc 1, 2, Péter Lukovich dr MD 3,2, Péter László Lakatos, MD 5,4, Magdolna Kardos MD 6, Andrea Arany MD 7, Krisztina Tari RN BSc MSc 8,2 1, Joined Saint Istvan and Saint Laszlo Hospital, Endoscopy, Budapest, Hungary; 2, Semmelweis University, 1st Department of Surgery, Budapest, Hungary; 3, Saint John Hospital, Department of Surgery, Budapest, Hungary; 4, Semmelweis University, 1st Department of Internal Medicine, Budapest, Hungary; 5, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec; 6, Semmelweis University, 2st Department of Pathology, Budapest, Hungary; 7, Joined Saint Istvan and Saint Laszlo Hospital, Radiology, Budapest, Hungary; 8, Semmelweis University, Emergency Department Endoscopy Unit, Budapest, Hungary Introduction: First application of rubber band ligation for the treatment of internal hemorrhoids was performed by Blaisdell in 1958. The method has became widely used after 1963, since Barron improved the device; This method is safe to apply and easy to use. Case report: In a 19 years old female patient with known Crohn's disease, localized to the colon, a polypoid lesion was found duringroutine colonoscopy. The lesion appeared to be vascularized, purple in color and could be localized 25 cm above the anal sphincter. MSCT examination was performed which confirmed it to be highly vascularized. Regarding the high risk for severe bleeding, resection was performed with surgical assistance. At first, two rubber rings was placed around to neck of the polypoid lesion. Thereafter 1 ml of epinephrine was injected into the neck of the lesion above the rubber rings which was followed by polypectomy with a standard hook. No complications were present throughout the observation period. Histological examination of the polypoid lesion confirmed it to be cavernous hemangioma. Conclusion: Cavernous hemangioma is a benign, rarely found disorder, usually localized in the distal part of the gastro-intestinal system. Based on previous and present finding there might be a connection between inflammatory bowel disease and the development of cavernous hemangioma. In literature have been described the use of the rubber band for submucosal resection and also have been used in the closure of iatrogenic gastric perforation. Application of rubber rings in endoscopic resection of cavernous hemangioma in a novel technique which can be easily implemented and seem to be sufficiently secure in cases, when there is high risk for major bleeding. Learning Outcomes: In many times endoscopic assistants have to apply the routine endoscopic techniques

to use in a new situations. Therefore we need to be creative and open minded for new methods. References: - Allred HW, Spencer R. Haemangiomas of the colon, rectum,

and anus. Mayo Clin Proc 1974;49:739-41 - Sang Heon Lee, Seun Ja Park, [...], and Bo Mi Kim

Endoscopoic Resection for Rectal Carcinoid Tumors: Comparision of Polypectomy and Endoscopic Submucosal Resection With Band Ligation Clin Endosc. 2012;45:89-94.

- Ishii N, Setoyama T, Deshpande GA, Omata F, Matsuda M, Suzuki S, Uemura M, Iizuka Y, Fukuda K,Suzuki K, Fujita Y. Endoscopic band ligation for colonic diverticular hemorrhage. Gastrointest Endosc. 2012;75:382-7

P-12

Nursing care for patients with bleeding gastric ulcerus Boris Kopić, Croatia Introduction and overview of research: In this final work shows the need for nursing care patients through the process of health care with a case, and the categorization of the patient suffering from bleeding ulcers in the stomach. Bleeding ulcerus can be very dangerous for patient because it can cause death if patient lose a lot of blood. It is very important to recognize that kind of diagnosis and nurses´ role is very important in health care Objective: The aims of the research as part of the final work are the patient's nursing care. The aim was also to show the incidence of bleeding ulcers by age, gender, and appearances by season. My goal was to show the performance of endoscopic surgery and treatment in the rehabilitation of bleeding and categorization of patients according to the needs for health care. Patients and methods: In the final paper analyzes the available data from 110 patients with bleeding ulcers in the stomach for a period of two years (2011. and 2012.). Results: The results showed that the bleeding ulcer occurs more frequently in the male population in aged between 45 and 65 years of age. It is also evident that the largest number of patients classified in the fourth category. Conclusion: As the results of my research showed that despite the quality management of nursing documentation, and thereby classifying patients into categories, still nothing has changed in the improvement of working conditions and increase the number of staff, can finally conclude that our profession, unfortunately, insufficiently appreciated by those on whom is to allow us to easier working conditions, and thus improve the overall health care. Key words: stomach ulcer, gastroscopy, the process of health care, patient categorization or patiensts with bleeding gastric ulcerus. References: 1. Bajek, S. Bobinac, D., Jerković, R., „et al“ , Sustavna anatomija čovjeka, Sveučilište u Rijeci, 2007. 2. Fučkar, G. Proces zdravstvene njege. Zagreb: Medicinski

fakultet Sveučilišta u Zagrebu. 1992.

http://www.ncbi.nlm.nih.gov/pubmed?term=Ishii%20N%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Setoyama%20T%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Deshpande%20GA%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Omata%20F%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Matsuda%20M%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Matsuda%20M%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Suzuki%20S%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Uemura%20M%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Iizuka%20Y%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Fukuda%20K%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Suzuki%20K%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Fujita%20Y%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed?term=Fujita%20Y%5BAuthor%5D&cauthor=true&cauthor_uid=21944311

http://www.ncbi.nlm.nih.gov/pubmed/21944311

57


P-13

Colon capsule endoscopy: comparison of clinically relevant findings evaluation performed nurses versus physicians P. Hnatova1, M. Setnickova1, J. Folttiny1, M. Voska1, T. Grega1, O. Ngo2, B. Buckova2, O. Majek2, M. Zavoral1, S. Suchanek1 1 Department of Internal Medicine, First Faculty of Medicine, Charles University, Military University Hospital, Prague 2 Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic 3 Second Department of Internal Medicine - Gastroenterology, Faculty of Medicine in Hradec Kralove, Charles University, University Hospital, Hradec Kralove 4 Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine in Prague, Czech Republic Introduction: The second generation of colon capsule endoscopy (CCE2) is a novel non-invasive method which has the potential as the colorectal cancer screening test. Interpretation of the complete video recording is time-consuming and can last up to 2 hours. The specialized nurses can reduce physician workload and rationalize resource utilization. Aims and methods: The multicenter prospective study has been running in three tertiary endoscopic centers. The aim is to evaluate the accuracy of capsule colonoscopy clinically significant lesions analysis between a trained endoscopy nurses and a physician. CCE2 videos have been viewed independently by 2 nurses and 3 physicians, all blinded to the results of optical colonoscopy (OC). The total number of 230 individuals are planned to be involved. Preliminary results are presented. Results: Since April 2016, there were 111 individuals enrolled and data of 54 persons have been analyzed. Sensitivity of all polyp detection by CCE2 was higher in physicians (97 % vs. 81 %, p=0,0143). However, detection of significant polyps (≥10 mm) was better in nurses reading (83 % vs. 75 %), although the results were not statistical significant (p=0,654). The nurses found 10 of 12 (83%) significant lesions detected by colonoscopy, and the gastroenterologists found 9 of 12 (75%) significant lesions seen by the colonoscopy . Conclusion: The study preliminary results show that capsule colonoscopy evaluation by endoscopy nurses is comparable to experienced gastroenterologists. Therefore, reading or pre-reading of CCE2 videos (i.e. to identify or select areas of pathology for further medical review by physicians) might be effective in daily clinical practice. Key words: colon capsule endoscopy; optical colonoscopy; accuracy; sensitivity This project has been supported by the Czech Ministry of Health Grant No. 16-29614A

P-14

High concordance between trained nurse and gastroenterologist in evaluating recordings of small bowel Video Capsule Endoscopy (VCE). Alessandra Guarini, Francesca De Marinis, Cesare Hassan, Angelo Zullo. Gastroenterology and Digestive Endoscopy, ‘Nuovo Regina Margherita’ Hospital, Rome, Italy

Background & Aims: The video capsule endoscopy (VCE) is an accurate and validated tool to investigate the entire small bowel. According to current European guideline, VCE is recommended for investigating patients with obscure gastrointestinal bleeding (OGIB), suspected Crohn’s disease, suspected small-bowel tumours, and inherited polyposis syndromes [1]. Unfortunately, VCE recordings interpretation by gastroenterologist is time-consuming. There are some evidences suggesting that the pre-reading of VCE recordings by an expert nurse is accurate, allowing reducing the time of evaluation without losing relevant lesions [2]. We assessed the concordance between expert nurses and gastroenterologists in detecting lesions on VCE examinations. Methods: This was a prospective study enrolling consecutive patients who underwent VCE in clinical practice. Two specifically trained nurses and 2 expert gastroenterologists participated in the study. At VCE pre-reading, the nurses selected any abnormalities, that were saved as ‘thumbnails’, and classified lesions (vascular, ulcerative, polyp, tumoral masses, and unclassified). Then, the gastroenterologist evaluated and interpreted the pre-selected lesions (quick view) and, successively, reviewed the entire video to searching for potential missed lesions. Time for VCE evaluation was recorded. The PillCam Small Bowel (Medtronic, Milan, Italy) was used. Results: A total of 95 VCE procedures performed on consecutive patients (M/F: 47/48; mean age: 63 ± 12 years, range: 27-86 years) were evaluated. Overall, the nurses detected at least one lesion in 54 (56.8%) patients. As shown in Table 1, there was a total agreement between nurses and physicians in detecting lesions in the small bowel. Indeed, the second look of the entire VCE recording by the physician failed to find other relevant mucosal abnormalities. The overall (median; range) reading time was 58 (45-79) minutes for nurse, 10 (8-16) and 49 (33-69) minutes for the quick and entire medical view by the gastroenterologist, respectively. Therefore, the pre-reading procedure by nurse allowed a time reduction of medical evaluation from 49 (33-69) to only 10 (8-16) minutes (Difference: -79.6%). No case of VCE retention was observed. Conclusions: Data suggest that trained nurse is able to accurately identify and select the relevant lesions in thumbnails, that may be faster reviewed by the gastroenterologist for a final diagnosis. This would significantly reduce the cost of VCE procedure. Therefore, specific training program on VCE for nurse, expert on gastrointestinal endoscopy, could be advantageously implemented. References 1. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule

endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: ESGE Clinical Guideline. Endoscopy 2015;47:352-376.

2. Guarini A, De Marinis F, Hassan C, et al. Accuracy of trained nurses in finding small bowel lesions at video capsule endoscopy. Gastroenterol Nurs 2015;38:107-110.

Table 1. Concordance between nurses and gastroenterologists in finding small bowel lesions at videocapsule endoscopy.

Lesions detected Nurse

Gastro-enterologist

P value

No abnormality Angiodysplasia/Lymphangiectasia Ulcer/erosion Polyp Tumoral mass Unclassified Bleeding (active/recent)

41 17 20 11 5 1 4/1

41 17 20 11 5 1 4/1

NS

58


P-15 Self-reported quality of life in patients with acute pancreatitis is impaired already on day of admission Sisse Rysgaard, Joy Stinne Timmner, Lise Lotte Gluud, Mikkel Werge, Amer Hadi, Palle Nordblad Schmidt, Srdan Novovic, Department of Gastroenterology and Gastrointestinal Surgery, Hvidovre University Hospital, Copenhagen, Denmark Introduction: The management of acute pancreatitis (AP) has changed over the last decades probably resulting in reduced morbidity and mortality. Few studies have been directed toward the long-term quality of life (QoL) outcomes following an AP attack, but fewer have addressed this issue on short-term. Whether AP plays an independent role in the health-related QoL is of clinical importance so as to better understand the natural history of AP and counsel patients and families of what to expect during the disease course. Objective: To prospectively and longitudinally evaluate the quality of life (QoL) in patients with acute pancreatitis (AP) both during admission and in out-patient setting. Method: We performed a prospective cohort study consecutively including patients with their first attack of AP admitted to our department in the period February 2016 to June 2017. Patients were followed with standardized EQ-5D QoL questionnaire on admission, day 10, and on day 30 in an out-patient clinic. Patients were asked to rate their life quality by using a visual scale ranging from zero (worst possible life quality) to 100 (best possible life quality). Two-sided t-test comparing means was used. Results: We included 44 patients (52% men; mean age 52 years; gallstone pancreatitis 66% and alcohol related pancreatitis 20%). All patients had elevated plasma levels of CRP, WBC and amylase, and low albumin at admission. Eighteen patients (41%) developed severe AP. Three patients died (7%) during admission. On admission, the mean QoL score was 51, on day 10 of admission it increased to 67, and reached 81 one month after discharge. There was a significant increase in QoL from admission to day 10 (p=0.04) and from admission to one month after discharge (p=0.01). Conclusion: Our study suggests that QoL in patients with AP is severely impaired already on admission, but improves throughout admission and is almost at the level of premorbid state one month after discharge. Future studies on this topic should focus on reasons for impaired QoL in AP, with focus on pain, anxiety and improved information and counseling. Summary: AP does not only affect the physical condition of patients, but also has an immediate impact on life quality. Learning outcomes for audience: - Increased focus on QoL and the factors influencing it

early in the disease course of AP - Importance of adequate counselling of AP patients

and their families of what to expect References: 1.Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102–11; 2. Machicado JD, Gougol A, Stello K, Tang G, Park Y, Slivka A, Whitcomb DC, Yadav D, Papachristou GI. Acute Pancreatitis Has a Long-term Deleterious Effect on Physical Health Related Quality of Life. Clinical Gastroenterology and Hepatology 2017; 15:1435–1443

P-16

Descriptive study of the contribution of the colonic nurse to the colorectal cancer screening program in a tertiary-level hospital Alicia Hernández García, Marías del Cristo González Ramos, Mileidis San Juan Acosta, Silvia Morales González. Gastrointestinal. Endoscopy Unit. University Hospital Nuestra Señora de Candelaria.Tenerife-Spain. Introduction: Colorectal cancer (CRC) is the most common cancer in Spain and the second most frequent cause of cancer mortality. The CRC screening program is important for ensuring its detection and early treatment. The phase of patient preparation prior to the colonoscopy appointment is essential for program success. One of the quality criteria according to the Spanish clinical guidelines is that preparation of the colon should be excellent-good “acceptable” in > 90%. Objectives: 1. To describe the contribution to the CRC screening program of the appointment with a nurse, who is responsible for the entire process of preparing the patient for the colonoscopy appointment on colon cleansing in the colonoscopies 2. To describe the results of the colonoscopies into the program. Material and methods: This is a cross-sectional, observational, descriptive study of basal colonoscopies performed as part of the CRC screening program in intermediate-risk population in the University Hospital Nuestra Señora de Candelaria compared with colonoscopies performed without CRC screening program and without a nurse intervention at the consulting but with on demand support of nurses by phone in 2015. Process at the appointment with nurse intervention: 1) After a positive fecal occult blood test, the patient is called to the CRC screening appointment, where an explanation is provided of the importance of performing a colonoscopy, the need for follow-up within the program, and possible complications 2) A medical history is taken that includes the following information: allergies; smoking and alcohol use; personal history of respiratory disease, heart disease, prior surgery, and other data of interest; current treatment: antiplatelets, anticoagulants, and sedatives 3) Patient follow-up after evaluation by other specialists to assess suitability of date of colonoscopy according to patient’s medical history 4) Psychosocial assessment of the patient. Study variables: demographic data, degree of colonic cleanliness, complete colonoscopy, detection rate of polyps and advanced adenomas. Results: We included 384 colonoscopies [median age 62 years±5.3 SD (50-69 years), F/M (53.4% / 46.6%)] performed into CRC program with nurse at the consulting (Group 1) and 384 colonoscopies [median age 61 Years±15 SD (26-99 years), F/M (42.7% / 57.3%) performed without a nurse at the consulting but with on demand support of nurses by phone (Group 2). All the procedures were performed under superficial or deep sedation. Group 1: Complete colonoscopies 97.1%. Excellent-good preparation 90%. Group 2: Complete colonoscopies 90%. Excellent-good preparation 84.1%. The probability of having an unacceptable colon cleansing in the group without a nurse at the consulting is 15.89%, for only 10.65% in the group that received formal training with nursing (p = 0.0419). This implies an increase in the significant risk of unacceptable colon cleansing (Risk Ratio = 1.49, CI [1.038, 2.21]). Description of colonoscopies of the CRC program: 100% of patients followed anticoagulation and antiplatelet protocol correctly. At least one adenoma was detected in 273 colonoscopies (71.1%) and of these, advanced

59


neoplasms were detected in 114 colonoscopies (29.7%). Complications: 9 (2.3%), 1 case post-polypectomy syndrome, 8 cases post-polypectomy bleeding, and no cases of perforation. Follow-up with colonoscopy was decided in 227 patients (64.5%), resumption of the screening program was decided in 121 (34.4%). No residual adenoma in scar of previous resections or tumor recurrence was observed. Conclusions: The appointment with the specialized nurse as part of a CRC screening program contributes to improve compliance with the percentage of correct colonic preparation recommended in clinical guidelines. In addition, patients follow the antiplatelet and anticoagulant substitution protocol correctly. Similarly, the correct colonic preparation observed could contributes to the high detection rate of adenomas into the program. References 1. Ministry of Health. Government of the Canary Islands

[Internet]. Gran Canaria Action guide in colorectal cancer. Canarian health service. 2011 [access October 7, 2015]. Action guide in colorectal cancer. [129 pages] Available in: http://www3.gobiernodecanarias.org/sanidad/scs/content/c01fb8f7-3d4c-11e3-a0f5-65699e4ff786/Agendacolorrectal.pdf

2. Hassan C, Quintero E, Dumonceau JM, Regula J, Brandão C, Chaussade S, et al. European Society of Gastrointestinal Endoscopy. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2013 Oct; 45(10): p.842-851.

3. Jover R, Herraiz M, Alarcon O, Brullet E, Bujanda L, Bustamante M, et al. Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy. 2012; p. 44:444.

4. Lopez-Abente G, Ardanaz E, Torrella-Ramos A, Mateos A, Delgado-Sanz C, Chirlaque MD. Changes in colorectal cancer incidence and mortality trends in Spain. Ann Oncol 2010; 21(Suppl 3): p. 76–82.

5. Portillo Villares I, Arana-Arri na E, Idigoras Rubio I, Espinás Piñol JA, Pérez Riquelme F, de la Vega Prieto M, et al. Lesions detected in six Spanish colorectal cancer screening population based programmes. CRIBEA Project Spain. Rev Esp Salud Pública. 2017, 20 (91).

6. Segnan NPJ, von Karsa L, editores. European guidelines for quality assurance in colorectal cancer screening and diagnosis. 1sted. Luxembourg: European Commission, Publications Office of the European Union; 2010.

P-17 Effects of Patient Education Program on Colonoscopy Efficiency and Patient Satisfaction Ye Lim Song, Jeong-Sik Byeon, Ji Hye Kim, Mi Soon Kim, Dong-Hoon Yang, Sang Hyoung Park, Sung Wook Hwang, Eun Mi Song, Asan Medical Center, South Korea Objectives: Successful colonoscopy requires careful preparation and good cooperation by patients. However, some patients do not read and follow the instructions on taking laxatives, thereby leading to poor bowel preparation and higher rate of colonoscopy failure. Most colonoscopies require good cooperation by the patient as well, such as position change and abdominal pressure, which are not always followed. Also, a main cause of dissatisfaction of colonoscopy patients is that they are often not aware of the expected discomfort following colonoscopy and report them as side effects. We thus newly developed a colonoscopy patient education program to improve the efficiency of colonoscopy and satisfaction of patients, endoscopists, and nurses. Methods: We prospectively performed a single center study on 268 consecutive patients who underwent colonoscopy. A standardized interview form was developed to assess (i) the feedbacks of patients, (ii)

telephone calls, and (iii) the feedbacks of endoscopists and nurses. We also developed structural questionnaires. The patients were randomly divided into experimental group (n = 134) and control group (n = 134). We asked for permission from all patients before colonoscopy. We guided the control group according to the pre-existing manual. We conducted telephone interviews on the experimental group 3 days and 1 day before colonoscopy. The assigned nurses prospectively recorded the data and interviewed the patients. All colonoscopy procedures were performed by gastroenterologists. Results: In the experimental group, males constituted 63.4% (n = 85) and the mean age was 57.9 ±11.3 years. In the control group, males constituted 64.2% (n = 86) and the mean age was 56.9(±11.3) years. The first outcome was patient satisfaction on colonoscopy. Satisfaction rate was 98.5% (n = 132) in the experimental group and 26.9% (n = 36) in the control group (p < 0.005). The second outcome was endoscopist and nurse satisfaction of colonoscopy. Endoscopist Satisfaction rate was 90.4% (n = 121) in the experimental group and 66.4% (n = 89) in the control group (p < 0.001). Nurse satisfaction rate was 85.1% (n = 114) in the experimental group and 50.0% (n = 67) in the control group (p < 0.001). The third outcome was Efficiency (colonoscopy duration & failure rate of colonoscopy). The colonoscopy duration was 9.5±3.5(min) in the experimental group and 14.9±5.4(min) in the control group (p < 0.001). The failure rate of colonoscopy was 7.5% (n = 10) in the experimental group and 38.0% (n = 51) in the control group (p < 0.001). Conclusions: Our newly developed patient education program significantly improved the satisfaction rates of patients, endoscopists, and nurses in terms of colonscopy. The patient education program also resulted in high efficiency of colonoscopy.

P-18

Evaluation bowel preparation in patients hospitalized Clavera C, Estepa L, Navarrete A, Milà MA, Maynard A Digestive Endoscopy Service University Hospital Vall d'Hebron Barcelona, Spain Introduction: Adequate bowel preparation is a prerequisite for colonoscopy in hospitalized patients, however it is often deficient. This can lead to an increase in complication rates, procedure cancellation and rebooking, which can possibly extend overall hospital stay. Benchmarks for an adequate colonoscopy such as the adenoma detection rate and cecal intubation rate are influenced by the quality of bowel preparation. It has been shown that providing written information increases the overall quality of bowel preparation for outpatients and that specific training of dedicated nursing teams leads to improvement in the quality of colonic preparation. Objective: Evaluation of the quality of bowel preparation in hospitalised patients who presented to our unit for colonoscopy from June 2016 to June 2017. Methods: A retrospective descriptive study that included all colonoscopies in hospitalized patients during the study period, excluding those who did not meet the inclusion criteria. The quality of the bowel preparation was evaluated using the Boston Bowel Preparation Scale (BBPS), a simple reliable and validated tool. The admitting hospital service, along with demografica data was obtained for descriptive analysis.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Quintero%20E%5BAuthor%5D&cauthor=true&cauthor_uid=24030244

https://www.ncbi.nlm.nih.gov/pubmed/?term=Dumonceau%20JM%5BAuthor%5D&cauthor=true&cauthor_uid=24030244

https://www.ncbi.nlm.nih.gov/pubmed/?term=Regula%20J%5BAuthor%5D&cauthor=true&cauthor_uid=24030244

https://www.ncbi.nlm.nih.gov/pubmed/?term=Brand%C3%A3o%20C%5BAuthor%5D&cauthor=true&cauthor_uid=24030244

https://www.ncbi.nlm.nih.gov/pubmed/?term=Brand%C3%A3o%20C%5BAuthor%5D&cauthor=true&cauthor_uid=24030244

https://www.ncbi.nlm.nih.gov/pubmed/?term=Chaussade%20S%5BAuthor%5D&cauthor=true&cauthor_uid=24030244

https://www.ncbi.nlm.nih.gov/pubmed/?term=European%20Society%20of%20Gastrointestinal%20Endoscopy%5BCorporate%20Author%5D

https://www.ncbi.nlm.nih.gov/pubmed/?term=European%20Society%20of%20Gastrointestinal%20Endoscopy%5BCorporate%20Author%5D


60


Results: During the study period, a total of 10, 643 colonoscopies were performed, for both diagnostic and therapeutic reasons, of which a total of 854 (8%) were inpatients studies. Of these 126 (14.8 %) where excluded for not meeting the inclusion criteria and thus a total of 728 patients were included in the final analysis. 459 patients (63 %) had an adequate preparation defined as a total BBPS between 6-9, with 267 (37%) having inadequate preparations defined as BBPS below 6 score. Of the 267 inadequately prepared patients, 18 % had regular preparation (BBPS between 4-5 score) and 19 % had poor preparation (BBPS between 0-3 score). 40 patients in the inadequate group underwent a repeat colonoscopy. Conclusions: Overall the in hospital bowel preparation in our center remain insuficiente. We believe that providing written information to hospitalized patients will increase the overall quality of bowel preparation in these patients. We hope that developing a training plan designed for nurses in different hospitalization wards together with providing written information will improve the level of intestinal cleansing. References: 1. Coleman LK, Wilson AS. Impact of nursing education on the proportion of appropriately drawn vancomycin trough concentrations. J Pharm Pract 2015; 81:665–672. [PubMed] 2. Corl DE, McCliment S, Thompson RE, et al. Efficacy of diabetes nurse expert team program to improve nursing confidence and expertise in caring for hospitalized patients with diabetes mellitus. J Nurses Prof Dev 2014; 30:134–142. [PubMed]

P-19

Compliance to Different Methods of Preparation for Bowel Cleansing in Pediatric Colonoscopy Vulpe Valentina,Kubicz Mirela, Dumitra Livia, Laura Olariu, Oana Belei, Pediatric Gastroenterology Department, Emergency Children Hospital “Louis Turcanu” Timisoara, Romania Introduction:Numerous studies have evaluated safety and efficacy of different bowel preparation protocols, but there are not standardized regimens in children.From children's perspective, taking a complete bowel preparation is often the most difficult part of the procedure.Despite the availability of various bowel preparations, the ideal preparation regimen for pediatric colonoscopy remains elusive, and only few well-controlled studies in pediatric population have been published.1

Methods:We conducted a retrospective study that included all children aged between 3 months-18 years that were submitted to colonoscopy in the last year in our unit.Fourth methods for bowel cleansing were analyzed.1:high volume regimen with polyethylene glycol (PEG-4000) 100 ml/kg; 2:PEG-4000 plus two normal saline enemas 3:low volume regimen with split administration of sodium picosulphate with magnesium citrate (SPMC), 4:SPMC plus two normal saline enemas.Boston Bowel Preparation Score was used for evaluation of preparation.The regimens tolerance was assessed by parents/children using a questionnaire. Results:137 children achieved successful preparation.35 received the first regimen, 47 used the second regimen, 24 used the third regimen and 31 received the fourth regimen.Excelent/good bowel preparation was achieved in 19(54%), 41(87%), 14(58%) and 26(84%) of cases in PEG, PEG+enemas, SPMC and SPMC+enemas group respectively.The highest effectiveness was observed among children that received regimens based on PEG-4000 or SPMC, associating two enemas one day prior to colonoscopy.There were no statistical differences between

these groups (p=0.7). Low and high-volume preparation combined with enemas provided a better cleanout compared to oral preparation alone (p=0.001 and 0.002 respectively).The overall compliance for SPMC regimen was excellent(98%), compared to 71% for PEG-4000 regimen (p=0.03).In 29% of cases the nasogastric tube was used for complete preparation with PEG-4000 due to adverse events such as: nausea, abdominal pain, vomiting.According to the questionnaire answers, we have noticed a higher net compliance of those children that didn't get enemas. There was a significant lower regimen tolerance in the lot of children that received high volume preparation and two enemas (37%) compared to high volume regimen alone (67%), p=0.04;Also, there was a significant lower regimen tolerance in the lot of children that received low volume preparation and two enemas (67%) compared to low volume regimen alone (93%), p=0.03. Conclusions: Low volume and high-volume preparation has similar efficacy in terms of bowel cleansing in children. There are advantages in terms of tolerance and efficacy for low volume preparation in pediatric patients. Despite the better cleanout obtained when adding enemas, this association induced higher discomfort and decreased the tolerance among children.2 References: 1.Hassan C, et al. Bowel preparation for colonoscopy: (ESGE) Guideline. Endoscopy 2013; 45:142–150. 2.Turner D, et al. Pico-Salax versus polyethylene glycol for bowel cleanout before colonoscopy in children: a randomized controlled trial. Endoscopy 2009; 41:1038–1045

P-20 Endoscopy Nurse Participation during Screening Colonoscopy Increases the Polyp Detection Rate Mihaela Caliţa, Liliana Preda, Tatiana Ivan, Adrian Săftoiu Research Centre of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania Introduction; Colonoscopy is the gold standard procedure used for the detection of colon polyps and colorectal cancer (CRC). Polyp and adenoma detection rates (PDR, and ADR respectively) are important quality indicators for colonoscopies. The resection of the polyps detected during colonosocopy leads to reduced incidence and mortality rates of CRC. Polyps detection requires attention from both the colonoscopist and the participating endoscopy nurse, as well as the use of additional techniques and devices such as: prolonged withdrawal time, the quality of bowel preparation, high resolution imaging techniques, and distal attachements placed on the colonoscope (e.g. Endocuff). Objective. The aim of our study was to evaluate the influence over the PDR of the endoscopy nurse, participating as a second observer during colonoscopy. Methods. A total of 553 patients undergoing screening coloscopies were included from January to December 2017. For bowel cleansing all patients received 4 L of polyethylen glycol solution and the quality of the preparation was assessed by the colonoscopist as poor (0), acceptable (1), good (2) and excellent (3). For patient comfort all procedures were performed under deep sedation. Patients were randomly assigned to two goups, one with single observation by colonoscopist and the other with observation by both the colonoscopist and the endoscopy nurse. Results. The patients were aged between 50 to 75 years old (mean age 62.5 years), including 258 females and 295 males. Fortyfive patients with poor and acceptable bowel preparation were excluded from the study. Consequently

61


508 patients, which had good and excellent bowel preparation, were included in the final analysis, 249 in the single observation group and 259 in the dual observation group, respectively. The mean withdrawal time was 7.3 minutes for colonoscopies which did not include biopsies or polypectomies. The PDR in the single observation group was 40.5% (101), while in the dual observation group was 50.% (132). Conclusions. Participation of the endoscopy nurse as a second observer during screening colonoscopies increases the PDR. This could lead to increased efficiency of screening programmes for CRC and further decrease CRC incidence on the long term. References. 1. Xu L, Zhang Y, Song H, Wang W, Zhang S, Ding X. Nurse Participation in Colonoscopy Observation versus the Colonoscopist Alone for Polyp and Adenoma Detection: A Meta-Analysis of

Randomized, Controlled Trials. Gastroenterol Res Pract. 2016;2016:7631981.doi: 0.1155/2016/7631981. Epub 2015 Dec 29. 2. Kim TS1, Park DI, Lee DY, Yoon JH, Park JH, Kim HJ, Cho YK, Sohn CI, Jeon WK, Kim BI, Lim JW. Endoscopy Nurse Participation May Increase the Polyp Detection Rate by Second-Year Fellows during Screening Colonoscopies. Gut Liver. 2012 Jul;6(3):344-8. doi: 10.5009/gnl.2012.6.3.344. Epub 2012 Jul 12.

P-21 The diagnostic sensitivity of sigmoidoscopy in bowel endometriosis Krisztina Tari; Péter Lukovich2; Attila Bokor3, Noémi Csibi3; Réka Brubel3; Andrea Ácsné Tóth4

1. Semmelweis University, Emergency Department, Emergency Endoscopy Unit, Budapest, Hungary, 2. Saint John Hospital, Department of Surgery, Budapest, Hungary; 3. Semmelweis University, 1st Department of Obstetrics and Gynaecology, Budapest, Hungary; 4. Joined Saint Istvan and Saint Laszlo Hospital, Endoscopy, Budapest, Hungary Introduction: Endometriosis most commonly found in the lower abdomen involves pelvic and gynecology organs but can appear and spread anywhere in the abdominal cavity also in the urological and gastrointestinal tract. The most common symptoms are chronic pelvic pain, dysnomenorrhoea, dyspareunia, infertility and haematochesia. Although the colonoscopy has high sensitivity in the diagnosis of the primary colon diseases, there are very limited data about the usage in the diagnosis bowel endometriosis. Patients and method: Between 2009 and 2015, 383 sigmoidoscopies were performed in patients with endometriosis. Where mucosal invasion was absent secondary signs (wall rigidity, impression, kinking, pain during the examination, suffusion) were analysed. The patients' average age was 31,2 years, the youngest 21 years and the oldest 41 years old. Where mucosal invasion was absent secondary signs (wall rigidity, impression, kinking, pain during the examination, suffusion) were analysed. Results: From All of the 383 examined patients, 224 patients (58.49%) were found in specific endometriosis lesions during sigmoidoscopy. Complete sigmoidoscopy was performed in 43.47% of the cases. Of the positive cases, only 11 patients (4.91%) were found with intraluminal endometriosis, namely intraluminal appears

nodular soft, bloody tissue growth. Intraluminal endometriosis was found in 4.91%, remaining 95% were only secondary signs as rigidity in 38.39%, impression in 45.54%, kinking in 57.14%, pain (in cases of examination without narcosis)

in 26.06% and submucosal suffusion in 3.82% of the cases was found during sigmoidoscopy. Sigmoidoscopic examination has a 92.8% specificity and 96.2% sensitivity in cases of bowel endometriosis. Conclusion: Endometriosis is clinically scar tissue. The infiltrated intestinal wall loses its elasticity and becomes rigid. The endometrial tissue infiltrate the surrounded tissue, which fix a part of the circumference of the bowel, and leads -due to the insufflation- a significant kinking and pain for the patient. Larger lesions can cause an hard impression on the bowel, these are the secondary signs. The correct interpretation of these signs makes sigmoideoscopy a sensitive examination in evaluation of intestinal infiltration of endometriosis. These signs could be detected usually by assistant who lead up the instrument. In several countries of Europe sigmoideoscopy is performed by nurse endoscopists. Therefore knowing and recognizing of these secondary signs are essential not only for the gastroenterologists but for the nurses, who lead the intrument, as well. Learning Outcomes: Additionally, sigmoidoscopy is time- and cost-effective and mean less load for patients than total colonoscopy. References: 1. Lukovich, P., Csibi, N., Brubel, R., Tari, K., Csuka, Sz., Harsányi, L., Rigó, J. Jr., Bokor, A. Prospective study to determine the diagnostic sensitivity of sigmoidoscopy in bowel endometriosis Orv. Hetil., 2017, 158(7), 264–269.. 2. Simoens, S., Dunselman, G., Dirksen, C., et al.: The burden of endometriosis: costs and quality of life of women with endome-triosis and treated in referral centres. Hum. Reprod., 2012, 27(5), 1292–1299. 3. Bokor, A., Koszorús, E., Brodszky, V., et al.: The impact of endo-metriosis on quality of life in Hungary. Orv. Hetil., 2013, 154(36), 1426–1434. 4. Murji, A., Sobel, M. L.: Bowel obstruction and pelvic mass. CMAJ, 2011, 183(6), 686–689. [First published December 13, 2010]

P-22 Quality of Endoscopy Reporting in Patients with Inflammatory Bowel Disease. Anne Manjalee Liyanage, Vitthal Ramchandra Wadekar , Edie Myers, Israr UnNabi, Gastroenterology Department, University Hospital Kerry, Tralee, County Kerry, Ireland. Introduction The exact prevalence of Inflammatory Bowel Disease (IBD) in Ireland is unknown. It is thought that nearly 20,000 people are affected from it. 5.9 new cases per 100,000 population in Crohn’s Disease (CD) and 14.9 new cases in Ulcerative Colitis (UC) were reported in 2011 [3]. Establishing a uniform departmental policy of endoscopy reporting is crucial to identify, evaluate, manage and follow up these patients. Aim To assess the quality of endoscopy reporting from Nov 2016 to Nov 2017 based on following subcategories. Extent and severity of the disease, global impression of the endoscopist (indicating as either CD, UC or indeterminate colitis), photographic identification, whether the number and site of biopsies that were done are keeping up with recent ECCO guidelines, the treatment (introduction, escalation/ step down or termination) and a follow up plan. Method A retrospective study that was done using Unisoft endoscopy reporting system. We assessed flexible sigmoidoscopy and colonoscopy reports from Nov 2016 to Nov 2017 in University Hospital Kerry. Indications used in searching reports were IBD surveillance, IBD assessment and acute or chronic diarrhoea.

62


Results Among a total of 87, there were 38 flexible sigmoidocopies and 49 colonoscopies. In assessing the extent of the disease there were 53 (60.9%), in severity 51 (58.6%), in global impression of the endoscopist 60 (68.9%), in photographic identification 83 (96.4%). Though biopsies were done in 75 (86.2%) patients, none were keeping up with the guidelines. One patient did not have a biopsy due to been on anticoagulation. Treatment was not given in 24(27.6%) reports and no follow up plan in 20 (23%) reports. None of the reports used a validated scoring system. Discussion Endoscopy plays a crucial role in diagnosis, assessing disease activity, extent, differentiation of UC from CD, in management, prognosis and surveillance of IBD. Ileocolonoscopy with biopsies is the preferred procedure to establish the diagnosis and extent of IBD. Minimum of two samples taken from each of the six segments (terminal ileum, ascending, transverse, descending, sigmoid and rectum), and from macroscopically ‘normal appearing’ segment, increases the reliability of the diagnosis [1] Usage of Montreal classification for classifying UC and CD extend and Rutgeerts score for identifying the recurrence rate in postoperative ileocolonic CD patients are recommended [2]. Conclusion Development of a uniform .

departmental policy is necessary to improve the quality of endoscopy reporting. This policy needs include a detail description on how each subcategory should be reported, a validated scoring system, a follow up protocol, indicating the type of patients with the time frame that need to be used, while referring to a IBD specialist. We will re-audit in a years’ time to review the compliance with the above policy. Learning outcomes + Relevance to Nursing A high-quality endoscopy report covering all the above aspects is essential for a IBD specialist to deicide the further management of a referred patient. The right usage of resources and patient safety (by not having to repeat an invasive procedure) can be achieved by minimising the number of inconclusive reports. References: 1.Vito Annese, Marco Daperno, Matthew D. Rutter, et al. ECCO Guidelines: European evidence based consensus for endoscopy in inflammatory bowel disease. Journal of Crohn’s and Colitis (2013) 7, 982-1018. 2.ASGE Guidelines: The role of endoscopy in inflammatory bowel disease. Volume 81, No.5: 2015 Gastrointestinal Endoscopy. http://dx.doi.org/101016/j.gie2014.10.030. 3.Irish Society for Colitis and Crohn’s Disease. www.iscc.ie

Addresses of Speakers, Chairs and Tutors

Ácsné Tóth, Andrea RN, Gastroenterorogy, Semmelweis University, Budapest, Hungary, [email protected] Bager, Palle Clinical Nurse Specialist, PhD, Dept. of Hepatology and Gastroenterology, Aarhus University

Hospital, Denmark, [email protected] Beilenhoff, Ulrike RN, ESGENA Scientific Secretary, Ulm, Germany; [email protected] Bettin, Jens ERBE Elektromedizin GmbH, Tübingen, Germany, [email protected] Bichel, Silke RN, Endoskopie, Klinikum Nordfriesland gGmbH,Husum, Germany, [email protected] Biering, Holger PhD, Chemist, Grevenbroich, Germany, [email protected] Botzet-Becker, Elmar Micro-Tech Europe GmbH, Düsseldorf, Germany, [email protected] Braga, Vânia RN, Gastroenterology Department, IPO-Porto , Portugal, [email protected] Bre, Rafaela RN,Hospital da Senhora da Oliveira – Guimarães, Portugal, [email protected] Brljak, Jadranka RN, Dept. Gastroenterology, University Department of Medicine, Zagreb-Rebro University Hospital

Center, Zagreb, Croatia, [email protected] Brozičević, Katja

RN, Division Of Gastroenterology, Endoscopy, University Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia, [email protected]

Brümmer, Thomas Chemische Fabrik Dr. Weigert GmbH & Co.KG, Hamburg, Germany, [email protected]

Burga, Patricia J. RN, Bs, Ms, Azienda ospedaliera di Padua, endoscopy, Padua, Italy. [email protected] Burtea, Elena Daniela Senior Nurse, Emergency County Hospital, Research Center of Gastroenterology and Hepatology,

Digestive Endoscopy Laboratory, Craiova, Romania, [email protected] Calita, Mihaela RN, University of Medicine and Pharmacy of Craiova, Romania, [email protected] Caputo, Antonio ovesco Endoscopy AG, Tuebingen , Germany, [email protected] Christensen, Joan Skovlund

RN, Endoskopy, Hvidovre University Hospital, Hvidovre, Denmark, [email protected]

Cimbro, Monica CBC (Europe) Srl, Medical Devices Division, Nova Milanese (MB), [email protected] Clavera Catalan, Carolina M.

RN, Hospital Universitàri Vall d’Hebron. Institut Català de la Salut, Barcelona, Spain, [email protected]

Colombo, Bendetta RN, University Campus Bio Medico, Endoscopy Unit. Roma, Italy, Colombo Benedetta, [email protected]

De Pater-Godthelp, Marjon

RN, Academic Medical Centre (AMC), Gastro-enterologie, Amsterdam, NL, [email protected]

Del Mazo Tomé. Pedro Luis

Central University Hospital of Asturias, Digestive Endoscopy Unit, Oviedo (Asturias), Spain, [email protected]

Dela Cruz, Yulrich Louie Gastroenterology / Endoscopy, Hinchingbrooke Hospital – Northwest Anglia NHS, Foundation Trust, Huntingdon, UK, [email protected]











63


Drmic, Ivan RN, Gastroenterology department – Endoscopy, Clinical Hospital Dubrava, Avenija Gojka Suska 6, 100000 Zagreb, Croatia, [email protected]

Dunkley, Irene Gastroenterology, Hinchingbrooke Healthcare NHS Trust, Huntingdon, Cambridgeshire, UK, [email protected]

Durand, Fanny University diploma endoscopy nurse coordinator, Medical University, Limoges, France, [email protected]

Dwyer, Laura Kathryn RN, Aintree University Hospital, Digestive Diseases Unit, Liverpool, UK, [email protected]

Edenharter, Kathrina RN, Krankenhaus Barmherzige Brüder, Regensburg, Germany, [email protected] Egan, Elaine Nursing Administration, South Tipperary General Hospital,Tipperary, Ireland, [email protected] Ellrichmann, Marc MD; UKSH Campus Kiel, Interdisziplinäre Endokopie , Kiel, Germany, [email protected] Fehrke, Björn RN, Pneumology, Inselspital Bern, Bern, Switzerland, [email protected] Feldhuisen, Vita RN, Academic Medical Centre (AMC), Gastro-enterologie, Amsterdam, The Netherlands, Fellinghauer, Martina RN, Vienna General Hospital, Internal Medicine III, Vienna, Austria, [email protected] Fenne, Wenche Brattebø RN, Gastropoliklinikk, Stavanger Universitetssjukehus, Stavanger, Norway, [email protected] Fietze, Yvonne RN, Department of Infectious Diseases, Inselspital, Bern University Hospital, Switzerland,

[email protected] Gazic, Mario RN; Master of nursing, Department of gastroenterology, General hospital Bjelovar, Bjelovar,

Croatia, [email protected] Ghosh. Devika RN, Irish Society Of Endoscopy Nurses, Endoscopy Unit Connolly Hospital, Blanchardstown Dublin, Ireland,

[email protected] Gjergek, Tatjana RN, Gastroenterology Dept, UMC Ljubljana, Ljubljana, Slovenia, [email protected]

Greveson, Kay Lead Inflammatory Bowel Disease nurse specialist, Royal Free Hospital , Centre for

Gastroenterology, London, www.ibdpassport.com Guarini, Alessandra Gastroenterology and Endoscopy Unit, Rregina Margherita Hospital, Rome, Italy,

[email protected] Guriel, Yuri RN, Gastroenterology Institute, Rambam Health Care Campus, Haifa, Israel,

[email protected] Hauser, Goran MD, PhD, FEBGH, Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia,

[email protected] Hernández García, Alicia

Gastrointestinal. Endoscopy Unit, University Hospital Nuestra Señora de Candelaria.Tenerife-Spain, Ctra. Santa Cruz de Tenerife, Spain, [email protected]

Hernández Soto, Enriqueta

RN, (President Aeeed), Endoscopy Unit, Hospital De Sabadell, Sabadell, Spain, [email protected]

Hessler, Natasa RN, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany, [email protected] Hijaz, Lilishor Farah Medical Campus, Head nurse of GI Endoscopy department . Jabal Amman, Jordan,

[email protected] Hnátová, Pavla

RN, Department of Internal Medicine First Faculty of Medicine Charles, University, Gastrointestina, Endoscopy, Military University Hospital, Prague, Czech Republic, [email protected]

Hoffmann, Rosita RN, St. Katharinen-Hospital GmbH, Frechen, Germany, [email protected] Högenauer, Christoph Ao.Univ.-Prof. Dr.med.univ. Medizinische Universität Graz, Abteilung für Gastroenterologie und

Hepatologie, Graz, Austria Hruškar, Sanja

RN, Bacc. Med. Tech., Endoscopy gastroenterology, KBC Rebro, Zagreb, Croatia, [email protected]

Hruz, Petr RN, University Hospital of Basel, Endoscopy Department, Basel , Switzerland, [email protected] Ivekovic, Hrvoje MD, University Hospital Centre Zagreb, Gastroenterology and Hepatology, Zagreb, Croatia,

[email protected] Jorgensen, Anita Cancer Registry of Norway, Oslo, Norway, [email protected] Jung , Michael MD, Prof. Dr, Kath: Klinikum Mainz, Germany, [email protected] Kamenšek, Tina

RN, Asist. Department of Nursing, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia, [email protected]

Karbo, Tine Endoscopic Nurse, Endoscopi Unit, Hvidovre Hospital, Gastroenheden, Hvidovre, Denmark, [email protected]

Karlovic, Katarina RN, univ. bacc.University Hospital Centre Rijeka, Department of Internal Medicine, Division of Gastroenterology, Endoscopy, Rijeka, Croatia, [email protected]

Karström, Ingrid Nurse Endoscopist, Endoscopy unit, Kristianstad, Sweden, [email protected] Kishta Jogert Gastroenterology, Infectiology, Rheumatology, Charité Campus Benjamin Franklin, Zentrale

Endoskopie, Hindenburgdamm 30, D-12200 Berlin, Germany, [email protected] Koomen, John US ENDOSCOPY, ,[email protected]> Kopic, Boris RN, General hospital Pula, Slovenia, [email protected] Korovina, Evgeniia Endoscopy Department, Headnure, Yaroslavl Region Cancer Hospital, Yaroslavl, Russia,

[email protected] Krolak, Magdalena

RN, Cancer Centre and Institute of Oncology in Warsaw, Department of Gastroenterological Oncology, Endoscopy Unit, Warsaw, Poland, [email protected]

Kubicz, Mirela

Pediatric Gastroenterology, First Pediatric Clinic, Emergency Children Hospital , “Louis Turcanu” , Timisoara, Romania, [email protected]















64


Kuttler, Lea

RN, University Hospital of Basel, Endoscopy Department, Basel, Switzerland, [email protected]

Lahey, Sylvia R.N., Rijnstate Hospital, Endoscopy, Arnhem, NL, [email protected] Landschoof, Ralf RN, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany, [email protected] Leary, Alison Professor, PhD FRCN FQNI, School of Health, London South Bank University, London, England,

[email protected] Leidcker, Camilla RN, Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University

Hospital Hvidovre, Endoscopy,Hvidovre, Denmark, [email protected] Liyanage, Anne Manjalee

University Hospital Kerry, Gastroenterology, Tralee, Irland, [email protected]

Maarsen, Mechteld RN, Academic Medical Centre (AMC), Gastro-enterologie, Amsterdam, The Netherlands Maasen, Siiri Tallinn Healthcare College, Kännu 67, 13418 Tallinn, Estonia, [email protected] Markos, Pave MD, Gastroenterology and hepatology, University hospital Centre Zagreb, Zagreb, Croatia,

[email protected] Meier, Amanda RN, University Hospital of Basel, Endoscopy Department, Basel, Switzerland,

[email protected] Menin Ostani, Monica Steelco, Riese Pio X (TV), Italy [email protected] Merk, Guido KARL STORZ GmbH & Co. KG, Marketing Manager Gastroenterology, Mittelstraße 8, D-78532

Tuttlingen, [email protected] Mochet, Mikael RN; Endoscopy, Hospital " Edouard Herriot" , 5 place d'Arsonval, 69003 Lyon, France,

[email protected] Mustac, Ana RN, Bacc.med.techn, Postintesive care, Clinic for pulmonary diseases Jordanovac, Jordanovac

104, 10000 Zagreb, Croatia, [email protected] Oliveira, Rafael Santos

RN, - Hospital Stº António dos Capuchos , SAMS Hospital, Barreiro, Portugal, [email protected]

Ortmann, Michael

RN, University Hospital of Basel, Endoscopy Department, Petersgraben 4, CH 4031 Basel , Switzerland,[email protected]

Paya, Cecile Soluscope S.A.S, Aubagne, France, [email protected] Petersen, Christine RN, William Barlowlaan 105, 1086 ZR Amsterdam, The Netherlands, [email protected] Petrocco, Massimo Unit of Surgical and Digestive Endoscopy, Bernabeo Hospital of Ortano (Chieti), Contrada Santa

Liberata, 66026 Ortana, Italy, [email protected] Pfeifer, Ute Garbriele Dr. rer. Cur., Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany, [email protected]

Pflimlin, Eric

RN, University Hospital of Basel, Endoscopy Department, Basel , Switzerland, [email protected]

Pineau , Lionel Eurofins Biotech Germande, Marseille, France,[email protected] Poley, Jan. Werner MD, PhD, Gastroenterology & Hepatology, Erasmus MC, Rotterdam, The Netherlands, [email protected] Rembakken, Björn Consultant Gastroenterologist and Endoscopist, Leeds General Infirmary, Leeds, United Kingdom Rey , Jean Francois Gastroentérologue à Saint-Laurent du Var , France , [email protected]

Rivara, Cinzia RN, Gastrenterologia, Endoscopia digestive, Cirie’ (to), Italy, [email protected] Rustemović; Nadan MD, PhD, Department of Gastroenterology, University Hospital, Zagreb, Croatia,

[email protected] Rysgaard, Sisse RN, Department of Gastroenterology and Gastrointestinal Surgery, Hvidovre University Hospital,

Denmark, [email protected] Schäfer, Denise RN, Ordensklinikum Linz Elisabethinen, Linz, Austria, [email protected] Schober, Theresia RN, Vienna General Hospital, Internal Medicine III, Vienna, Austria, Schröder, Daniela Fijifilm Europe,, Düsseldorf, Germany, [email protected] Schuster, Anja OLYMPUS EUROPA SE & CO. KG,. Hamburg, Germany, [email protected] Shandarovska, Nataliya Mater Dei Hospital, Endoscopy Unit , Msida, Malta, [email protected] Song, Ye Lim, Gastrointestinal Department, Asan Medical Center, Seoul, Rep. of Korea, [email protected] Sosic, Tanja Clinical centar of Montenegro, GE Endoscopy, Podgorica, Montenegro , [email protected] Stadwijk, John RN, Academic Medical Centre (AMC), Amsterdam, The Netherlands, [email protected] Steenbakkers, Nancy Ultrazonic, Academy & workshop , Beerse, Belgium, [email protected] - www.ultrazonic.com Tari, Kriszitina Semmelweis University, I.st. Dept. of Surgery, Budapest, Hungary, [email protected] Taveira, Clara RN, Gastroenterology Department, IPO-Porto Porto, Portugal, [email protected] Tillett, Jayne RGN Cert Ed Dip Nursing, Research Department , St Woolas Hospital, Newport, Gwent, United

Kingdom, [email protected] Trinidat, Aireen Gastroenterology, Hinchingbrooke Healthcare NHS Trust, Huntingdon, Cambridgeshire, UK Valori, Roland Gloucestershire Royal Hospital, Great Western Road, Gloucester, UK Von Garnier, Christophe Prof. MD Pneumology, Inselspital Bern, Bern, Switzerland, [email protected] Vos, Margret Prof Dr, Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The

Netherlands, [email protected] Waagenes, Wendy Jo Endoscopic Nurse, Endoscopi Unit, Hvidovre Hospital, Denmark, [email protected] Weilguny, Gerlinde RN, BSc, Vienna General Hospital, Internal Medicine III, Vienna, Austria,

[email protected] Wietfeld, Kornelia RN, Klinikum Vest GmbH, Paracelsus-Klinik, Marl, Germany, [email protected] Willekens, Hilde RN, UZ Leuven, Endoscopie, Leuven, Belgium, [email protected]





















http://www.ultrazonic.com/






65

ESGENA Sponsors

We would like to thank the following companies for their financial contributions. Without their help, we would not be able to provide such a varied and interesting programme.

Major Sponsors

General Sponsors

BHT Hygienetechnik GmbH Chemische Fabrik Dr. Weigert

Cantel CBC Group

Cook Medical Erbe Elektromedizin GmbH

KARL STORZ GMBH & CO. KG Micro-Tech-Europe GmbH

Ovesco Endoscopy AG Pullthru

SOLUSCOPE STEELCO SPA

UltraZonic US Endoscopy

66

ESGENA Annual News

ESGENA Membership Update ESGENA has over 7500 members in 49 countries in Europe, the Middle East and overseas. National societies and national nursing associations join ESGENA as group members. National societies for Endoscopy/Gastroenterology nurses and associates can join as group members. The current ESGENA group members come from 27 European countries, representing 31 societies and nursing associations: Austria, Belgium, Bosnia Herzegovina, Croatia, Denmark, Estonia, Finland, France, Germany, Hungary, Iceland, Ireland, Israel, Italy, Jordan, Macedonia, Montenegro, Norway, Portugal, Romania, Russia, Serbia, Slovenia, Spain, Sweden, Switzerland, The Netherlands, United Kingdom. Some countries have 2 groups (societies or nursing associations) which are group members of ESGENA. In order to ensure equal rights between countries and to prevent the dominance of any single countries, each European country with an active group membership has the right to cast one vote in elections and decisions. Non-European countries are also welcome to join ESGENA should they wish to exchange information with European countries. However, as ESGENA is a European society, group members from non-European countries do not have the right to vote. In addition to national societies and nursing associations, individual nurses who work in Gastroenterology/Endoscopy, teach or research in gastroenterology and endoscopy nursing, can join as ESGENA individual members: There are currently 104 ESGENA individual members from 38 countries within Europe, the Middle East and overseas: Albania, Belgium, Bulgaria, Croatia, Denmark, Egypt, Finland, Germany, Hong Kong, Iceland, India, Iraq, Ireland, Israel, Italy, Japan, Jordan, Luxembourg, Malaysia, Malta, Mexico, Oman, Portugal, Republic of Cyprus, Romania, Russia, Saudi Arabia, Slovenia, Spain, State of Qatar, Switzerland, Sudan, Thailand, The Netherlands, Turkey, United Kingdom, Ukraine, United Arab Emirates, USA Individual members have access to all ESGENA services (e.g. grants, data bases, etc). ESGENA has 2 passive members who are retired nurses from Norway and the United Kingdom. ESGENA has 6 honorary members:

• Dr. Jean Francois Rey, France

• Eric Pflimlin, Switzerland

• Christine Petersen, The Netherlands

• Christiane Neumann, United Kingdom

• Diane Campbell, United Kingdom

• Ulrike Beilenhoff, Germany

• Sylvia Lahey, The Netherlands ESGENA major sponsors are

• OLYMPUS EUROPA SE & CO. KG

• Boston Scientific

• Pentax Europe

• FUJIFILM Europe GmbH ESGENA has 16 affiliated members from various companies.

ESGENA Membership Update ESGENA has launched a new membership area on the ESGENA website. Individual ESGENA members receive their individual access codes. Each national group receives a group code from ESGENA. This national access code allows nurses, who are members of their national group, free access to the ESGENA membership area. Nurses who are members of their national Endoscopy nurses society, receive the group code from their national societies. The membership area offers the following information

• Updates on ESGENA activities

• Reports from working groups

• ESGENA Abstracts

• ESGENA E-NEWS

• Links of Interest

• Statutes Individual and Group members can administer and update their contact data by themselves. ESGENA has also developed an electronic membership application form

EEWG The ESGENA Education Working Group (EEWG) consists of representatives from every European country holding an ESGENA Group Membership. Representatives meet to work on educational issues relevant to Endoscopy/Gastroenterology nurses (see Table 1). The group met in October 2017 in Barcelona and in April 2018 in Budapest. The next meeting will take place during the ESGENA conference in Vienna, Table 1: EEWG national Representatives in 2018

Country National delegate

Austria Gerlinde Weilguny

Belgium Hilde Willekens

Bosnia Herzegovina Daliborka Jelisavac

Croatia Jadranka Brljak

Denmark Joan Skovlund Christensen

Estonia Siiri Maasen

Finland Päivi Muranen

France Fanny Durand

Germany Ulrike Beilenhoff

Hunhary Krisztina Tari

Iceland Lára Björk Magnúsdótti

Ireland Deirdre Clune

Israel Yurie Guriel

Italy Patricia Burga

Jordan Lilishor Hijaz

Macedonia Maja Ilijevska

Montenegro Tania Sosic

Norway Anita Jorgensen

Portugal Rafael Oliveira

Romania Daniela Burtea

Russia Evgeniia Korovina

Slovenia Tatjana Gjerek

Spain Enriqueta Hernandez-Soto

Sweden Ingrd Karström

Switzerland Michael Ortmann

The Netherland Marjon de Pater

United Kingdom Irene Dunkley

67

ESGENA Annual News

The group work on various position statements on patient care in Endoscopy, staffing level and team time out.

ESGENA Endorsed meetings By endorsing national and local events, ESGENA - promotes education opportunities for staff working in

gastroenterology and endoscopy nursing - supports the quality of endoscopic procedures and

patient care in Gastroenterology by stimulating the exchange of knowledge and experience in Endoscopy/Gastrointestinal nursing

- underlines the scientific quality of the endorsed events This category consists of events organised by third parties which are endorsed by ESGENA. Third parties are e.g. national societies, hospitals or institutes of higher education. In 2018 ESGENA endorsed events in Croatia, Serbia and Italy,

Benefits of the ESGENA endorsement - ESGENA endorsed events are announced with

programme details on the ESGENA website and in the ESGENA e-NEWS

- The ESGENA endorsement logo can be used for promotional purposes o on meeting material (see format guidelines below) o in local journals o on local websites

- Promotional material of the event can be displayed at the ESGENA booth during the ESGENA conference and other European events

By granting this endorsement, ESGENA undertakes no financial involvement nor has any obligation to provide any support services for the event. Application Detailed information about the application and the application form are available on the ESGENA website. In order to apply, detailed information regarding the complete scientific program, including the speakers, is required. An English version of the programme should be available. The role of Endoscopy and/or Gastroenterology nursing must be prominent among the topics under discussion. Conditions - Application must be made at least three months prior

to the event. - The event must last at least one day. - Confirmation that the endorsement applies only to the

single event. - The ESGENA logo should be used in accordance with

the ESGENA format guidelines (see details on website)

ESGENA Clinical Grants ESGENA Clinical Grants are being offered to registered European nurses who wish to undertake further clinical training in specialised endoscopic or gastroenterological nursing at an ESGENA Training Centre or another specialised centre.

Due to legal restrictions, hands-on training may not be available in many countries; however nurses may still participate in clinical work as observers, learning from their colleagues. At the ESGENA training centres in Basel and Zagreb, hands-on training is possible as the trainee works together with a local tutor. Clinical grants cover 1-2 weeks in order to achieve the planned aims and learning objectives.

ESGENA Training Centres ESGENA has two training centres focused on Gastroenterology: the University Hospital of Basel, Switzerland and the University Hospital of Zagreb, Croatia. In addition to grants, the Endoscopy department at the University Hospital in Zagreb also offered workshops with hands-on training and lectures as part of the ESGENA training centre activities. In 2016 the Pneumology Department of the University Hospital, called “Inselspital”, in Bern, Switzerland became the first ESGENA training centre specialised on Bronchoscopy and thoracic medicine. ESGENA aims to establish a European network of training centres in European membership countries and invites endoscopy departments to submit their applications. The ESGENA Education Working Group (EEWG) has developed quality criteria which give guidance for ESGENA Training Centres. Quality Criteria - Wide range of interventions - Opportunity to fulfil advanced nursing roles - Clarification of legal restrictions - Good cooperation with ESGENA - Highly qualified tutors - Defined aims and learning outcomes for each grantee - Access to learning facilities - Team support for training centre - Accommodation for grantees Detailed information and application forms are available on the ESGENA Website www.esgena.org.

Guideline Update ESGENA initiated the update of the ESGE-ESGENA guideline on hygiene relevant issues, In November and December 2017 the following position statements of ESGE and ESGENA will be published in ENDOSCOPY: - Prevention of multidrug-resistant infections from

contaminated duodenoscopes - ESGE-ESGENA-Technical Specification for Process

Validation And Routine Tests of Reprocessing Endoscopes in Washer Disinfectors according to EN ISO 15883, parts 1, 4, and ISO/TS 15883-5.

- ESGE-ESGENA guideline: Cleaning and disinfection in gastrointestinal endoscopy -update 2018, online available

- ESGENA curriculum on endoscope reprocessing, online available

68

Announcement of next ESGENA Conference

Join us ! at the 23rd ESGENA Conference

during the 27th UEG Week

October 19-21, 2019 in Barcelona, Spain

You will enjoy a three days conference full of interesting lectures, workshops, hands-on training and live endoscopy with interesting colleagues from all over the world. Join us in Barceona

Deadline for submitting abstracts:31th May 2019

https://www.ueg.eu/week/esgena/ www.esgena.org
