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UCLA’s Superbug Isn’t a Public Health Issue…Yet

In general, many patients with gall bladder, pancreas, bowel, and other conditions may, for diagnostic or therapeutic reasons, undergo a procedure called ERCP (endoscopic retrograde cholangiopancreatography) where a high-tech tube—called an endoscope—is passed through the mouth and stomach and into the upper part of the small intestine (the duodenum). This procedure has been going on for decades and has saved and improved countless lives.

The problem is that the ERCP endoscope can be difficult to completely sterilize. That means that the next patient may be exposed to bacteria harbored by the previous patient. As a result, in the case at UCLA, more than 100 others who were treated…

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Featured

 Medical scopes still causing superbug infections and deaths, FDA says

The agency said it is still tracking reports of infection and device contamination on a monthly basis. It is also working with facilities and care providers to modify processes and reduce the risk to patients.

Articles of Interest

CRE Outbreaks Draw Focus on ERCP, Device-related Infections

“My opinion is that this happens more often than we think,” Muthusamy told Healio Gastroenterology. “The sophisticated techniques that we used in our lab to confirm the duodenoscope-associated transmission of CRE are not available at many small hospitals, so it may be occurring, and they’re not able to detect it.”

Quality indicators for ERCP

ERCP is one of the most technically demanding and highrisk procedures performed by GI endoscopists. It requires significant focused training and experience to maximize success and to minimize poor outcomes

Superbugs on Duodenoscopes: the Challenge of Cleaning and Disinfection of Reusable Devices

Reprocessing of reusable medical devices is an essential but often underestimated part of infection prevention strategies in health care facilities. Recent outbreaks associated with the contamination of CRE on flexible GI endoscopes have highlighted these concerns.

Watch Out for Endoscopes Linked to Superbug Outbreak, FDA Says

"The FDA wants to raise awareness among health care professionals, including those working in reprocessing units in health care facilities, that the complex design of ERCP endoscopes (also called duodenoscopes) may impede effective reprocessing. Reprocessing is a detailed, multistep process to clean and disinfect or sterilize reusable devices."

What Are The 'Superbugs' Known As Carbapenem-Resistant Enterobacteriaceae?

Carbapenem-resistant Enterobacteriaceae is a class of germs that is highly resistant to treatment with antibiotics, according to the Centers for Disease Control and Prevention. Some Enterobacteriaceae are actually a normal part of human gut bacteria, like Klebsiella and E. coli, but experts say the overuse and misuse of antibiotics has been causing some bacteria to become resistant to modern medicine.

Resources

Gastro.org

ERCP may be useful in diagnosing and treating problems causing jaundice (a yellowing of the whites of the eyes) or pain in the abdomen.

National Digestive Diseases Information Clearinghouse

Endoscopic retrograde cholangiopancreatography is a procedure that combines upper gastrointestinal (GI) endoscopy and x rays to treat problems of the bile and pancreatic ducts. ERCP is also used to diagnose problems, but the availability of non-invasive tests such as magnetic resonance cholangiography has allowed ERCP to be used primarily for cases in which it is expected that treatment will be delivered during the procedure

MedicineNet

Endoscopic retrograde cholangio-pancreatography (ERCP) is a diagnostic test to examine: the duodenum (the first portion of the small intestine), the papilla of Vater (a small nipple-like structure with openings leading to the bile ducts and the pancreatic duct), the bile ducts, and the gallbladder and the pancreatic duct.

MedlinePlus

ERCP may be used to: •Open the entry of the ducts into the bowel (sphincterotomy) •Stretch out narrow segments (bile duct strictures) •Remove or crush gallstones •Diagnose conditions such as biliary cirrhosis or sclerosing cholangitis •Take tissue samples to diagnose a tumor of the pancreas, bile ducts, or gallbladder •Drain blocked areas.

Patient

ERCP stands for 'endoscopic retrograde cholangiopancreatography'. ERCP is a very useful procedure, as it can be used both to diagnose and to treat various conditions, such as gallstones, acute pancreatitis (inflammation of the pancreas that develops quickly over a few days) and chronic pancreatitis (inflammation of the pancreas that is more persistent).

SAGES

ERCP is most commonly performed to diagnose conditions of the pancreas or bile ducts, and is also used to treat those conditions. It is used to evaluate symptoms suggestive of disease in these organs, or to further clarify abnormal results from blood tests or imaging tests such as ultrasound or CT scan. The most common reasons to do ERCP include abdominal pain, weight loss, jaundice, or an ultrasound or CT scan that shows stones or a mass in these organs.

UpToDate

Many patients who need ERCP are hospitalized, but ERCP can also be performed as an outpatient procedure, depending on the patient's condition and on the complexity of the required procedure.