22Nd ESGENA CONFERENCE 20-22 October 2018

22nd ESGENA CONFERENCE 20-22 October 2018

In Conjunction with the

Hosted by

Austrian Society of Endoscopy Nurses and Associates (IVEPA)

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

Word of Welcome

Dear colleagues,

On behalf of ESGENA and the Austrian Society of Endoscopy Following past meetings in 2008, 2014 and 2016, this is the Nurses and Associates (IVEPA) it is our great pleasure to fourth time that the medical and nursing community of welcome you to the 22nd ESGENA Conference and the 26th Gastroenterology and Endoscopy meet in Vienna. United European Gastroenterology Week in Vienna. The city on the Danube is known not only for the Prater, the The relaxed atmosphere of the ESGENA conference is a Hofburg and delicious pastries, but also for great experiences wonderful opportunity to meet colleagues from different with and without adrenalin factor. countries and to expand your professional network. Enjoy the extraordinary Austrian hospitality, combined with the The ESGENA conference includes state-of-the-art lectures, multicultural atmosphere of an international meeting. free papers & posters, lunch sessions, workshops with hands- on training and live transmissions. We welcome you to the 22nd ESGENA Conference and 26th UEG Week in October 2018 in Vienna and wish you an Last breaking news about new trends and developments as interesting conference. 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 Marjon de Pater, President of ESGENA exceptional educational event. 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 Phone: +49 (0) 731 950 39 45 89075 Ulm Fax : +49 (0) 731 950 39 58 Germany Email: [email protected]

ESGENA Website

www.esgena.org

General Information

Attendance Certificates ESGENA Hands-on-Training will be sent out in the first week of November in electronic Hands-on-training on bio simulators is offered on Saturday format. For special request, please contact [email protected] . and Sunday in the ESGE Learning Area in Room L-2 / L-3 See Workshops 5, 10-12 in the ESGENA detailed programme.

Cloakroom Please note that there are only a limited number of tickets The cloakroom is located in Foyer F in back of Level 0 and available in order to ensure small training groups at each can be used free of charge from Saturday, October 20 through station. Tickets for nurses are available at the entrance of the Wednesday, October 24. Participants can also store their ESGE Learning Area- on a first-come-first-served basis. luggage there..

ESGENA Lunch Sessions Coffee & Lunch Two parallel lunch sessions on Sunday, October 21, 2018 Lunch and coffee are not included in the registration fee. UEG combine state-of-the-art-lectures and hands-on-training. offers a certain amount of catering during the breaks on a first- Lectures are given in room G and K from 12:30-13:40 while come, first-served basis. Throughout the venue there will be hands-on training is offered in the area in front of room G. water dispensers and catering kiosks to buy refreshments and snacks. ESGENA Membership Desks ESGENA Catering The ESGENA membership desk is located - Saturday, October 20 (Foyer M) - On Saturday, October 20, 2018, in front of Room L-8 Coffee Break 10:30 – 11:00 // 15:30 – 16:00 - On Sunday, October 21, 2018, in front of Room G Lunch 13:00 – 14:00 - Sunday, October 21 (Foyer G) Coffee Break 10:30 – 11:00 // 16:30 – 17:00 ESGENA Participants at UEG Week Lunch 13:00 – 14:00 ESGENA participants have full access to the UEG Week from Saturday to Monday, October 20-22, 2018 with their ESGENA PGT Catering name badges. - Saturday, October 20 and Sunday, October 21 (Foyer A, B, C) Nurses who also attend the UEG Week on Tuesday and Coffee Break 10:30 – 11:00 Wednesday have on contact the registration desk, either on Lunch 13:00 – 14:00 Monday afternoon (after 15:00 h) or Tuesday morning, to get a special marking on their names badges (free of charge). UEG Week Catering (Mon–Wed) - Monday, October 22 and Tuesday, October 23 It is not possible to get this marking earlier than Monday (Halls X2 – X5) afternoon after 15:00 h !!! Coffee Break 10:00 – 10:30 // 15:30 – 15:45 Lunch 12:00 – 14:00 - Wednesday, October 24 (Halls X2 – X5) ESGENA Poster Sessions Coffee Break 10:00 – 10:30 ESGENA posters are displayed in front of room G. Posters Lunch 12:00 – 14:00 should be mounted on the assigned board on Sunday, October 21, 2018, between 9:00 h to 18.00 h.

Conference Language Poster authors receive material to fix the posters at the The official language of the ESGENA Conference is English. ESGENA membership desk. No simultaneous translation will be provided. ESGENA has two poster sessions on Sunday, October 21, 2018: Emergency and First Aid - From 10:30-11:00 h In case of emergency please contact the staff at the - From 13:30-15:00 h registration counters in the Entrance Foyer. The attentive staff will be pleased to help. ESGENA Free Paper & Poster Award The winners of the best free papers and poster presentations ESGENA Annual General Meeting will be announced ESGENA Annual General Meeting is held on Sunday, October - during the ESGENA Session 7 “Present & Future in GI 21, 2018 from 18:00-19:00 h in Room G. Access for ESGENA Endoscopy” members only. - on Sunday from 17:00-19:00 h - in Room G. Presenting authors are requested to attend this session. ESGENA Feedback form Your feedback is important to us ! Please use the ESGENA electronic evaluation form to give us your feedback and to Internet Centre and WiFi suggest topics for the next ESGENA conference. Link: 2 Internet Centres with several terminals are located in Foyer E on Level 0 and in the Hands-on Area on Level 1. Here is the link https://www.surveymonkey.de/r/2018_Vienna WiFi is available throughout the venue. UEGWifi by Pfizer Thank you very much for your support - Password: uegweek18

General Information

Name Badges Silent Room Participants are requested to wear their name badge at all There is a room set apart for prayer. It is a quiet place, where times during the congress. In case the badge is being delegates may withdraw to seek divine strength and guidance. scanned at exhibition booths or during an Industry Sponsored The silent room is located in Room 0.81 on Level 0. 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 Speakers Centre passed on to UEG sponsors/exhibitors listed on the website The Speakers Centre is located in Foyer E on Level 0. It is ueg.eu for the purpose of providing marketing and information equipped with PCs where speakers can work on their slides. material relating to the field of digestive health as well as Speakers are asked to hand in their CD-ROM or USB stick, information on scientific events. 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 Photos, Filming and Recording of Scientific Sessions slides will be transferred to the central congress server and It is strictly forbidden to film, take photos or record any oral or will be available afterwards on a special congress notebook in poster presentation of UEG Week without the consent of the the session room. The use of personal notebooks is not organiser (including smart phones, mobile devices, etc). allowed. Technical staff will be happy to assist. Please note that numerous sessions will be recorded and published at ueg.eu/education/library immediately aVer the Opening Hours congress and will be available for all congress delegates. This - Friday October 19 14:00 – 18:00 archive will also include all abstracts, E-Posters and the - Saturday October 20 07:30 – 18:00 Syllabus of the Postgraduate Teaching Programme. - Sunday October 21 07:30 – 18:00 - Monday October 22 07:00 – 18:00 - Tuesday October 23 07:00 – 18:00 Programme Changes - Wednesday October 24 07:00 – 14:00 The organizers cannot assume liability for any changes to the programme, due to external or unforeseen circumstances. Taxi A taxi stand is located close to the ACV next to the Public Transport Ticket underground station ‘Kaisermühlen – VIC’. Taxis can be called The congress badge serves as a public transportation ticket if day and night at the telephone numbers: it includes the logo of the public transportation company +43 1 401 00, +43 1 601 60 or +43 1 313 00 Wiener Linien alongside the validity date.

ESGENA delegates may use the public transportation ticket Technical Exhibition free of charge from Saturday through to Monday, October 20– UEG Week is accompanied by a major technical exhibition 22. taking place in Halls X2, X3, X4, X5 on Levels –2 and 0. This provides an excellent opportunity for physicians, pharmacists, Vienna’s public transportation system includes bus, pharmacy assistants, nurse practitioners, physician assistants Straßenbahn (tram), U-Bahn (underground) and S-Bahn to interact with the industry and familiarise themselves with (express city train). However, transportation to/from the airport the latest advances in technology and pharmacology. For using the CAT train, or S-Bahn (rail city train) once the city further information and floor plans please see the list of boundaries are left, requires the purchase of a separate ticket. exhibitors on next pages and following, in the UEG Week Please check the Metro Map of Vienna. 2018 App as well as on the UEG website ueg.eu/week. Kindly note that the congress badge only serves as a public transportation ticket if shown in conjunction with a valid ID Please note that according to the EU Directive 2001/83/ EC (passport) in case of ticket checks. promotional material related to prescription-only medicines must be distributed or provided exclusively to healthcare How to get from the city centre to the venue professionals who are authorised to prescribe or dispense The fastest way to get from the city centre to the ACV is the them. underground line U1 (red) with direction ‘Leopoldau’. Get off the U1 at ‘Kaisermühlen – VIC’ and take exit ‘Schüttaustrasse’ Opening Hours (Austria Center Vienna is also indicated). - Monday October 22 09:00 – 17:30 - Tuesday October 23 09:00 – 17:30 How to get to the airport - Wednesday October 24 09:00 – 14:00 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 UEG Week 2017 App minutes. The fastest way is the airport bus VAL 3 which takes Get the UEG Week 2018 App for your smartphone and you hourly and directly from/to Kaisermühlen – VIC in 40 min. experience the congress at your fingertips! Send questions One-way ticket EUR 8, return ticket EUR 13. during sessions via the Q&A tool or quickly find your way through the most up-to-date congress schedule. Cast your Alternatively, you can take the underground line U1 (red) from vote in interactive sessions via the app. Have a look at floor the station ‘Kaisermühlen – VIC’ with direction plans and browse the exhibition and company profiles. The ‘Reumannplatz’. Change at ‘Schwedenplatz’ and take the app is free of charge for iPhone/iPad and Android smartphone underground line U4 (green) with direction ‘Hütteldorf’. Get off users. The UEG Week 2018 App is available at:Apple App the train at ‘Landstrasse – Wien Mitte’ and take the City Store and Google Play Airport Train or the S-Bahn (S7). The City Airport Train operates every 30 minutes, S7 every hour. Please note, the ESGENA programme is available on the App.

General Information

UEG Week Abstracts UEG Week Core Programme The abstracts of UEG Week Vienna 2018 will be available Nurses are welcome to attend the medical lectures of the online in the Library on the UEG Education website. 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 UEG Week Congress News and Website badges. The UEG Week website, UEG Week App and our social media channels will provide an overview of sessions and data Nurses who also attend the UEG Week on Tuesday and presented each day and “what not to miss” the following day Wednesday have on contact the registration desk, either on along with hot topics and snapshots of the congress. For more Monday afternoon (after 15:00 h) or Tuesday morning, to get information, visit the UEG Week website (ueg.eu/week). 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 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 UEG Week Programme Book live stream on the UEG Week Live website. The UEG Week programme book will be handed out at the Lean back and get updated on relevant GI and liver topics free congress material counter. of charge, and connect with the community via the UEG Week Social Wall. Insurance / Liability Simply sign in to myUEG. For more information, please visit UEG or ESGENA do not accept any liability for damages live.ueg.eu. 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 UEG Week Post Graduate Course congress at their own risk. Participants are advised to take out Nurses are welcome to attend the UEG Week post graduate insurance against loss, accidents or damage that could be course on Saturday to Sunday at no extra charge. incurred during the congress.

Color code for ESGENA Program

ESGENA Lectures ESGENA Poster Exhibition

ESGENA Workshops Hands-on Training ESGENA Lunch Session 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

Useful Information about Vienna

Bank Safety Most banks in Vienna are open from Monday to Friday from As in all major cities and congress venues, people should 8.00 am to 12.30 pm and from 1.30 pm to 3.00 pm, and until always keep an eye on their personal belongings. Please be 5.30 pm on Thursdays. In the city centre (1st district), almost aware of pickpocketing and bag-snatching and make sure to all banks are open over lunchtime 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. Climate In October the average temperatures range from 7 to 14° C during the day in Vienna. 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 Currency Secession, from the magnificent baroque palace Schönbrunn Payments will be accepted in EURO. At most banks as well as to the Museum of Fine Arts to modern architecture at the at exchange bureaus in the city currency can be exchanged. MuseumsQuartier. Record-breaking: In Vienna, there are over Credit cards are widely accepted. 27 castles and more than 150 palaces. A special registration desk for sightseeing is located in the registration area.

Electricity The voltage in Austria is 230 Volts, 50 Hertz. Sockets meet Shopping hours European regulations and use the two-round pin system. 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 Emergency numbers holidays at the large railway stations, at the airport and in the In case the worst should happen, here are the most important museum shops. telephone numbers in Vienna. - European emergency and fire service: tel. 112 - Emergency doctor: tel. 141 Telephone - Ambulance / rescue: tel. 144 Country code: +43. Outgoing international code: 00. - Police: 133 - Vienna Med doctor's hotline for visitors (0-24): tel. +43-1- 513 95 95 Time Zone - Evening and Sunday drugstores (0-24): tel. 1455 The time zone in Austria is Central European Time (CET), - Evening and weekend dental service (taped service): tel. which is Greenwich Mean Time (GMT) +1 hour in winter and +43-1-512 20 78 +2 hours in summer.

Floor Plans

Exhibition Plans

List of Exhibitors

Booth Major Partners Major Partners No. 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

Booth General Exhibitors 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 HITACHI Medical Systems / PENTAX Europe amg International GmbH X5/41 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 LA LETTRE DE L'HEPATO- Boston Scientific International X2/19 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

List of Exhibitors

Booth Booth General Exhibitors No. Members Village - Level 0 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 Association & Future Booth SUMITOMO BAKELITE CO., LTD. X5/17 Events Area - Level 1 No. EGEUS - European Group for Endoscopic Surgical Science X5/46 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 European Section and Board of W. L. Gore & Associates X5/44 Gastroenterology and Hepatology (ESBGH) AFA1/11 Wassenburg Medical B.V. X5/11 GEEW AFA1/7 International Foundation for Gastrointestinal Wego Group X3/2b 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

Booth Patient Organisations - Level 1 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

ESGENA Programme Overview

Saturday, October 20, 2018 Room E2 ESGE Learning Rooms Lounge 7 Lounge 8 Room 1.61/1.62 Room M Area

08:30-10:30

UEG Week Postgraduate Training Programme

11:00-13:00 11.30-13.00

UEG Week ESGENA Postgraduate Opening Training Session Programme Quality makes the difference

13:00-14:00 Lunch

14:00-16:00 14:00-15:30 14:00-15:30 14:00-15:30 14:00-15:30 14:00-15:30

UEG Week Workshop 1 Workshop 2 Workshop 3 Workshop 4 Postgraduate Training Special Electrosurgery The nurse’s Health and Hands-on- Programme Bronchoscopy in Endoscopy: role in tissue Safety in training on Session I How to make it resection and Endoscope biosimulators: safe and infection Reprocessing effective? prevention

Olympus Boston Dr Weigert

15:30-16:00 Coffee

16:00-17:30 16:00-17:30 16:00-17:30 16:00-17:30 16:00-17:30

Workshop 5 Workshop 6 Workshop 7 Workshop 8

Special More than nice Electrosurgery The influence Hands-on- Bronchoscopy to know – – Prevention of of endoscopes training on Session II Damage complication reprocessing biosimulators prevention & on successful correct infection endoscope prevention handling

Olympus Erbe Cantel

ESGENA Welcome Reception 20:00 Venue to be confirmed

ESGENA Programme Overview

Sunday, October 21,2018 ESGE Room G Room K Poster Area Learning Area

09:00-10:30 09:00-10:30

Session 1 Session 2 Abstract based Quality starts with building and reconstruction

10:30 – 11:00 10:30 – 11:00 10:30 – 11:00

Coffee Coffee Poster Exhibition I

11:00-12:30 11:00-12:30 11:00-12:30

Session 3 Session 4 Workshop 9 Education Management - safety Hands-on-training on first Bio simulators

12:30-15:00 12:30-15:00

Lunch Session 1 Lunch Session 2 GE Endoscopy Hygiene & Infection control

13:00-14:00 13:00-14:00 13:30-15:00 14:00-15:30

Lunch Lunch Poster Exhibition II Workshop 10 Hands-on-training on bio simulators: 15:00-16:30 15:00-16:30

Session 5 Session 6 Hygiene – points of IBD discussion

16:30-17:00 16:30-17:00

Coffee Coffee

17:00-18:00

Session 7 Present & Future in GI Endoscopy

18:00-19:00

ESGENA Annual General Assembly

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

ESGENA Sessions Sat, 20 Oct 2018

11:30-13:00 ESGENA Opening Session: Quality makes the difference Room E2

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 L-1 Alison Leary, United Kingdom

12:15-12:35 Performance measures for endoscopy services: The ESGE Quality Improvement L-2 Initiative Roland Valori, United Kingdom

12:35-12:55 Delegation of tasks to unregistered staff - what - when - how - why L-3 Ulrike Beilenhoff, Germany

12:55-13:00 Discussions

14:00-15:30 Special Bronchoscopy Session I Room M

Chairs Björn Fehrke, Switzerland Michael Ortmann, Switzerland

14:00-14:20 Diagnostic and interventional broncoscopy- which options do we have? (From EBUS, L-4 EMN to cryo therapy, ELVR and stenting) Björn Fehrke, Switzerland

14:20-14:40 Endoscopic Lung Volume Reduction (ELVR) L-5 Christophe von Garnier, Switzerland

14:40-14:55 The introduction of capnography monitoring in endoscopy L-6 Elaine Egan, Ireland

14:55-15:10 Continuous tracking, control and safety of pulmonary patients through nursing L-7 documentation Ana Mustač, Croatia

15:10-15:30 Management of bronchial haemoptysis and desaturation - or how not to panic when it L-8 goes red! Michael Ortmann, Switzerland

16:00-17:30 Special Bronchoscopy Session II Room M

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

ESGENA Workshops Sat, 20 Oct 2018

14:00-15:30 Workshop 1: Electrosurgery in Endoscopy: How to make it safe and Lounge 7 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 Workshop 2: The nurse’s role in tissue resection and infection prevention Lounge 8

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 Workshop 3: Health and safety in endoscope reprocessing Room 1.61/1.62

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

ESGENA Workshops Sat, 20 Oct 2018

14:00-15:30 Workshop 3: Health and safety in endoscope reprocessing Room 1.61/1.62

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 Workshop 4: Hands-on training on bio simulators ESGE Learning Centre

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 Workshop 5: More than nice to know – Damage prevention & Correct Lounge 7 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

ESGENA Workshops Sat, 20 Oct 2018

16:00-17:30 Workshop 6: Electrosurgery – Prevention of complication Lounge8

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 Workshop 7: The influence of endoscopes reprocessing on successful Room 1.61/1.62 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

16:00-17:30 Workshop 8: Hands-on training on bio simulators ESGE Learning Centre

This workshop is organised by ESGENA

Chairs Eric Pflimlin, Switzerland

ESGENA Sessions Sunday, 21 Oct 2018

09:00-10:30 ESGENA Session 1 : Abstract based Room G

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 L-9 Ulrike Beilenhoff, Germany

09:15-09:30 The 7-Month Journey from Endoscopy Nurse to Nurse Endoscopist L-10 Yulrich Louie dela Cruz, Irene Dunkley, United Kingdom

09:30-09:45 Process optimization in endoscopy by implementing a checklist for patient safety L-11 Silke Bichel, Germany

09:45-10:00 Access to nursing care for people with autism with special emphasis on preparation L-12 for endoscopic examination Katja Brozičević, Croatia

10:00-10:15 Analysis of the awareness of population about risk factors and methods of colorectal L-13 cancer prevention Nataliya Shandarovska,, Malta

10:15-10:30 Microbiological surveillance of the endoscopes: experience of Endoscopy Unit of the L-14 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

09:00-10:30 ESGENA Session 2 : Quality starts with building and reconstruction Room K

Chairs Martina Fellinghauer, Austria Tatjana Gjergek, Slovenia

09:00-09:20 Restructuring of an Endoscopy Unit as an outcome of a work environment report L15 Tine Karbo, Denmark

09:20-09:40 Building a new hospital – using the chances for endoscopy L-16 Jan-Werner Poley, The Netherlands

09:40-10:00 Safety systems in endoscopy – How to prevent steeling of Endoscopes L-17 Ute Pfeifer, Germany

10:00-10:20 Transfer of reprocessing of the endoscopes from the endoscopy department to the L-18 department for central sterilization - everyday life Eric Pflimlin, Switzerland

10:20-10:30 Discussion

ESGENA Sessions Sunday, 21 Oct 2018

10:30-11:00 Poster Exhibition I ESGENA Poster Area

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- P-1 ANIGEA. Alessandra Guarini, Elena Rossetti, Pierangelo Simonelli, Teresa Iannone, Daniela Carretto, Antonella Giaquinto, Giorgio Iori, Monia Valdinoc, Cinzia Rivara, Italy

Life in Germany - Integration in an Endoscopy unit P-2 Jorgert Kishta. Urte Stahlberg, Germany

Innovations in the Gastroenterology Nurses Training in Israel P-3 Yuri Guriel, Shirly Luz, Revital Barkan, Galia Niv, Rina Assulin, Israel

Mindfulness as a challenge in today's nursing P-4 Tina Kamenšek, Darja Thaler, Slovenia

11:00-12:30 ESGENA Session 3: Education Room G

Chairs Devika Ghosh, Ireland Denise Schäfer, Austria

11:00-11:20 Competency development and team work – the basis for patient safety L-19 Camilla Leidcker, Denmark

11:20-11:40 Mentorship and training to retain and sustain the endoscopy workforce L-20 Laura Dwyer, United Kingdom

11:40-12:00 Self-directed learning – how to implement in daily routine? L-21 Fanny Durand, France

12:00-12:20 ESGENA Statement: Quality indicators for patient care in Endoscpy L-22 Jadranka Brljak, Croatia

12:10-12:30 Discussion

11:00-12:30 SESSION 4: Management – safety first Room K

Chairs Mario Gazic, Croatia Joan Skovlund Christensen, Denmark

11:00-11:20 Risk management and quality control in Endoscopy – an analysis L-23 Patricia Burga, Italy

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

11:40-12:00 Track and trace – Documentation and follow-up of endoscope reprocessing, repair and L-25 maintenance Mikael Mochet, France

12:00-12:20 ESGENA Statement: Sign-in, team-time out and sign-out – safety netting in Endoscopy L-26 Ulrike Beilenhoff, Germany

12:20-12:30 Discussions

ESGENA Sessions Sunday, 21 Oct 2018

11:00-12:30 Workshop 9: Hands-on training on bio simulators ESGE Learning Centre

This workshop is organised by ESGENA

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 Lunch Session 1: Endoscopic techniques Room G

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 (Mi c ro -Tech Europe GmbH) 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 Lunch Session 2: Hygiene & infection control Room K

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

ESGENA Sessions Sunday, 21 Oct 2018

12:30-15:00 Lunch Session 2: Hygiene & infection control Room K

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

13:30-15:00 Poster Exhibition II ESGENA Poster Area

Poster round Fanny Durand, France committee 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 P-5 Massimo Petrocco, Maria Pia Caldarella, Nicoletta Cicconetti, Gilda Napoletano, Paolo Panaccio, Maria Teresa Tartaglia, Maria Marino, Italy

Patient assessment: Checklist for endoscopic procedures P-6 Rafaela Bré, Carla Sousa, Hospital da Senhora da Oliveira – Guimarães, Portugal

Patients’ perspectives towards quality of a digestive endoscopy service: a qualitative P-7 approach Vânia Maria Braga, Marta Pinto, Sílvia Ferraz, Mário Dinis Ribeiro, Luís Filipe Azevedo, Portugal.

Hygiene

Storage time of flexible endoscopes longer than 30 days is associated with an P-8 increased contamination rate Yvonne Fietze, Switzerland

Technical report on the reprocessing of thermolabile endoscopes: An Italian P-9 experience Cinzia Rivara, Italy

Upper GI Tract

Pain in upper gastrointestinal endoscopy. Is gastroscopy really painful? P-10 Pedro Luis, del Mazo Tomé. Esther, González Nieto, María Concepción, Martínez Sexto, María Almudena, Pousada González, Ana María, Nieto Quesada, Alejandro, Toledo Soriano, Spain

Alternative usage of endoscopic band ligation P-11 Andrea Ácsné Tóth, Péter Lukovich, Péter László Lakatos, Magdolna Kardos, Andrea Arany, Krisztina Tari, Hungary

Nursing care for patients with bleeding gastric ulcerus P-12 Boris Kopić, Croatia

Colon capsule endoscopy: comparison of clinically relevant findings evaluation P-13 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

ESGENA Sessions Sunday, 21 Oct 2018

13:30-15:00 Poster Exhibition II ESGENA Poster Area

High concordance between trained nurse and gastroenterologist in evaluating P-14 recordings of small bowel Video Capsule Endoscopy (VCE). Alessandra Guarini, Francesca De Marinis, Cesare Hassan, Angelo Zullo, Italy

Self-reported quality of life in patients with acute pancreatitis is impaired already on P-15 day of admission Sisse Rysgaard, Joy Stinne Timmner, Lise Lotte Gluud, Mikkel Werge, Amer Hadi, Palle Nordblad Schmidt, Srdan Novovic, Denmark

Lower GI Tract

The colorectal cancer screening program in a tertiary-level hospital. P-16 Alicia Hernández García, Marías del Cristo González Ramos, Mileidis San Juan Acosta, Silvia Morales González, Spain

Effects of patient education program on colonoscopy efficiency and patient P-17 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

Evaluation bowel preparation in patients hospitalized P-18 Carolina M Clavera, L. Estepa, A. Navarrete, A Milà, A, Maynard, Spain

Compliance to different methods of preparation for bowel cleansing in pediatric P-19 colonoscopy Valentina Vulpe, Mirela Kubicz, Livia Dumitra, Laura Olariu, Oana Belei, Romania

Endoscopy nurse participation during screening colonoscopy increases the polyp P-20 detection rate Mihaela Caliţa, Liliana Preda, Tatiana Ivan, Adrian Săftoiu, Romania

The diagnostic sensitivity of sigmoidoscopy in bowel endometriosis P-21 Krisztina Tari, Péter Lukovich, Attila Bokor, Noémi Csibi, Réka Brubel, Andrea Ácsné Tóth, Hungary

The quality of endoscopy reporting in Patients with IBD P-22 Anne M. Liyanage, Vitthal Ramchandra Wadekar , Edie Myers, Israr UnNabi, Ireland

14:00-15:30 Workshop 10: Hands-on training on bio simulators ESGE Learning Centre

This workshop is organised by ESGENA

Chairs Michael Ortmann, Switzerland Eric Pflimlin, Switzerland

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.

ESGENA Sessions Sunday, 21 Oct 2018

15:00-16:30 Session 5: Hygiene – points of discussion Room G

Chairs Jadranka Brljak, Croatia; Jean Francois Rey, France

15:00-15:20 High prevalence of digestive bacteria in duodenoscopes – how does a national survey L-27 influence daily practice Margret Vos, The Netherlands

15:20-15:40 Endoscopy related infections – is sterilisation an answer? L-28 Michael Jung, Germany

15:40-16:00 Biofilm formation and prevention - a challenge with flexible endoscopes L-29 Lionel Pineau, France

16.00-16.15 ESGENA Curriculum on reprocessing of flexible endoscopes L-30 Ulrike Beilenhoff, Germany

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

15:00-16:30 SESSION 6: Inflammatory Bowel Disease (IBD) Room K

Chairs Irene Dunkley, United Kingdom Ingrid Karström, Sweden

15:00-15:20 Monitoring of IBD patients – what is essential? L-31 Irene Dunkley, United Kingdom

15:20-15:40 IBD – Passport – a tool for information and communication in daily live and for L-32 travelling Key Greveson, United Kingdom

15:40-16:00 Iron-deficiency, anaemia and fatigue in IBD L-33 Palle Bager, Denmark

16:00-16:20 N-ECCO Continuing education – what can Endoscopy learn? L-34 Palle Bager, Denmark

16:20-16:30 Discussion

17:00-18:00 SESSION 7: Present & Future in GI Endoscopy Room G

Chairs Marjon de Pater, The Netherlands Denise Schäfer, Austria

17:00-17:20 Artificial intelligence in digestive endoscopy L-35 Jean-Francois Rey, France

17:20-17:40 New aspects of microbiome therapy L-36 Christoph Högenauer, Austria

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

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

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.

ESGENA Abstracts Oral Presentations

L- 1 on the environment within which endoscopists work (including the facilities and equipment), and the staff who The value of nursing in Endoscopy and work in that environment. Gastroenterology Alison Leary, United Kingdom In recognition of the importance of the environment within which endoscopists work, and whom they work with, the Introduction: The national standards for IBD care defined ESGE Quality Improvement Committee has created the numbers of nurse specialists required as 1.5 FTE per Performance Measures for endoscopy services to support 2 50 000 population. The aim was to publish a new, robust, the process of quality improvement. This presentation will validated national standard and caseload. explain and explore the ESGE Endoscopy Services Methods: A concensus workshop of 15 IBD nurse Performance Measures and discuss how they might be specialists from across the UK met to check assumptions used to improve the quality and safety of endoscopy, and regarding workload and activity of this group. A 24-item the experience of the patient. questionnaire, exploring demographic data, caseload, workload and experience was developed. This was was distributed through the RCN IBD Nursing Network. Data L- 3 was modelled using descriptive statistics and pattern recognition. Delegation of tasks to unregistered staff - what - when Results: 164 responses were received (55% response - how - why rate). 76% were from England. Responses were received Ulrike Beilenhoff, Germany from all four countries of the U.K. Most respondents covered a single (60%) or two (25%) hospital sites. 38% of Qualification and competencies of registered nurses are respondents had less than 3 years experience working clearly defined by European law. But the role, tasks and with IBD patients. 62% having four years plus experience. responsibilities of specialised nurses are not clearly 32% had over ten years’ experience. 90% of the defined in many European countries. Therefore, ESNO, responding CNS were working solely in IBD. 82% reported ESGENA and national societies developed statements of spending 80% to 100% of their time on IBD. 51% worked staffing level, training, competencies and delegation (1-5). with adult and transition patients. 72% of respondents Independent from the setting where the endoscopy worked full time. 84% of respondents regularly carried out procedure is performed, the safety of the patients must be unpaid overtime. The amount of unpaid overtime carried paramount. Each patient has the right to be treated by out equalled 17.6 FTE per week. Most common title was competent and trained staff. Consequently, endoscopy ‘Clinical Nurse Specialist’. Grade 7 most common grade departments need to have sufficient numbers of for respondents (65%). 61% received either no admin adequately trained staff to meet the safety needs of both, support or support for clinic letters only. The number of patients and health care workers (1,4,5). In many unfilled posts was estimated to be equivalent to 24.5 FTE. European countries, the lack of specialised nurses and No respondents reported frozen posts. 43% of physicians leads to long waiting lists with prolonged respondents had a prescribing qualification. 82% reported diagnosis and therapy. On the other hand, more and more participation in CPD/education within the last 12 months. complex tasks and responsibilities have to be covered by 63% of respondents had a higher caseload than the medical and nursing staff in Endoscopy. Can delegation be recommended level. Caseloads as high as 2000 patients a solution? If so, which framework conditions have to be plus were reported. Respondents generally had a positive taken into account? experience of working in an MDT. Due to shortage of staff and increased work load, Conclusions This study recommends a caseload of 2.5 delegation is a necessary management tool in endoscopy. Full Time Equivalent (FTE) IBD specialist nurse per Delegation is a complex process in professional practice 2 50 000 population (a static caseload of 500 per FTE). which require The original recommended caseload for IBD specialist • a detailed understanding of legal and nurses is 666 patients (or 1.5 FTE per 2 50 000 population) professional frameworks per FTE nurse. This does not allow for proactive • profound clinical judgement management, advancing practice, cover arrangements and • final accountability for patient and staff safety is not optimal for care. There is a shortfall in the UK. 63% have much higher • good team work with healthy interpersonal caseloads than the original recommended standard. relationships • supervision and continuing education Legal situation: Legal and professional regulations vary from country to country. But in all health care systems, the L- 2 delegating person is responsible for ensuring or controlling that the performing person is capable to do the job. The Performance measures for endoscopy services: The performing person has the duty to check if she/he is able ESGE Quality Improvement Initiative to take over the tasks. She/he also has the duty to reject Roland Valori, United Kingdom tasks which exceed her knowledge and skills (obligation to remonstrate). Historically, the focus on improving the quality and safety Both the delegating person and the performing person of endoscopy has been on the performance of individual need to know which activities can legally be delegated endoscopists. There has been less emphasis on the under the national regulations. Many tasks cannot legally environment within which endoscopists work. An be delegated to other qualified staff because they exceed endoscopy is part of the patients’ diagnostic or therapeutic the scope of practice of these job roles. Many tasks require 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

ESGENA Abstracts Oral Presentations

specialist knowledge and skills which require an additional L- 4 training or recognised courses. Clinical judgement and patient safety: Endoscopy Diagnostic and interventional broncoscopy- which departments have multidisciplinary teams. In addition to options do we have? (From EBUS, EMN to cryo registered nurses and endoscopists, a great variety of staff therapy, ELVR and stenting) work in Endoscopy such as • Ancillary staff (e.g. nursing aids, technicians), Björn Fehrke, Switzerland • Staff for cleaning and decontamination (e.g. staff from Central Sterile Supply Department (CSSD) Interventional bronchoscopy is a large field with different or Health Care Support Worker (HCSW), diagnostic and therapeutic indications. First reports date • Administrative staff (e.g. medical secretaries, back to as early as 300 b.c. with the descriptions of the receptionists). cannulation of the trachea by Hippocrates. The real hour of Other specialities also work in Endoscopy providing birth of modern interventional bronchoscopy was the specialised services (e.g. staff from Anaesthesiology, introduction of rigid bronchoscopy by Gusatv Kilian in Radiology, Pathology, Surgery, etc). 1897. Since then, rigid as well as flexible bronchoscopy In Endoscopy delegation takes place from physicians to have rapidly evolved, especially in the last decades and nurses and from nurses to other qualified staff. Examples facilitate important diagnostic and therapeutic intervention for delegation to nurses are informed consent, iv injection, in the lower airways and the lungs. Interventions can be technical tasks (e.g. stent release, PEG insertion, feeding performed via flexible or rigid bronchoscopy or as a tubes), sedation, patient monitoring, discharge. Some combination of both and a multitude of different tasks require additional education and training (e.g. interventional tools are available. NAPS). Mainly in Beveridge countries, medical tasks have Over the last decades, the diagnostic yield of diagnostic been substituted to specially trained nurses like clinical procedures such transbronchial forceps biopsies, nurse specialist, ANP or nurse endoscopists. Examples for brushings and catheter aspirations was improved by the delegation from nurses to other qualified staff are patient introduction of modern navigation tools. These include transport, patient preparation, service support, cleaning fluoroscopy, as a basic tool, and more advanced and administrative work. Professional nursing assessment procedures such as ultrasound guided and and judgment remains to nurses. The level of delegation electromagnetic navigation as well as virtual depends on the patients health status, the complexity and bronchoscopy. All of these facilitated an increase in risks of the planned procedure, the endoscopy diagnostic yield, especially in small peripheral pulmonary environment and the staff competencies (4,5). Supportive lesions. Central airway stenosis is a common indication for work can be delegated. Some tasks like endoscope therapeutic interventional bronchoscopy. Recanalization reprocessing require additional courses and training. with or without the introduction of an airway stent is one of Conclusion: Delegation is not just a hand-off. It is an the main domains of interventional bronchoscopy. Various important leadership skill that directly affects patients` “hot” techniques such as electro cautery, laser and argon safety in Endoscopy. We have to realize that we don’t plasma coagulation and “cold” interventions such as have the capacity to do everything on our own. Successful cryotherapy and cryoextraction are applied. Hemoptysis is delegation can improve efficiency, safety and outcome another indication for diagnostics and intervention via quality. If someone or a group feel rushed or overworked, bronchoscopy. Foreign body aspiration can be an delegation can be an option to keep our patients safe and emergency, especially in children, and may require rigid or comfortable instead of doing something in a hurry. flexible bronchoscopy to retrieve the object. A new field in Delegation can release from workload and can give interventional bronchoscopy is the treatment of severe resources for advanced roles. Delegation has to be emphysema by implanting valves and coils. This lecture planned and agreed by hospital management in order to aims to provide the audience with an overview of the fulfil all legal requirements. Ad-hoc delegation should be different interventional techniques available. avoided. Transparent job descriptions and structured training plans ensure that patient and staff safety will be reached. References: L- 5 1. U. Beilenhoff et al. ESGENA Statement: European Job Profile for Endoscopy Nurses. Endoscopy 2004;36:1025–30. Endoscopic Lung Volume Reduction (ELVR) 2. European Society of Gastroenterology and Endoscopy Nurses Christoph von Garnier, Switzerland and Associates (ESGENA). ESGENA Core Curriculum for Endoscopy Nursing. 2008. www.esgena.org In patients with severe chronic obstructive pulmonary 3. European Specialist Nurse Organisation (ESNO). disease (COPD) and lung emphysema that are still Competences of the Clinical Nurse specialist (CNS): Common plinth of competences for the Common Training Framework of symptomatic despite optimal medical treatment, each specialty. 2016. www.esno.org endoscopic lung volume reduction (ELVR) may constitute 4. Beilenhoff U. et al. Personelle Anforderungen für die a therapeutic option. ELVR requires appropriate patient Betreuung von Patienten in der Endoskopie – DEGEA- selection through assessment of lung function, exercise Positionspapier. Endo-Praxis 2017; 33: 135–142 performance and chest CT imaging. We perform ELVR 5. Dunkley I, et al. UK consensus on non-medical staffing under general anesthesia and employ two device types – required to deliver safe, quality-assured care for adult patients valves and coils. Prior to insertion of valves, we measure undergoing gastrointestinal endoscopy. Dunkley I, et al. Frontline Gastroenterology 2018;0:1–11. doi:10.1136/flgastro- collateral ventilation, whereas this procedure is not 2017-100950 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.

ESGENA Abstracts Oral Presentations

L- 6 endoscopy causes and associations. www.ncbi.nlm.nih.gov/pubmed/213204242 7. ESA. (2017) Evidence Based Guidelines on Adult Procedural Capnography monitoring in endoscopy Sedation and Analgesia. http://www.eba- Elaine Egan, Ireland uems.eu/resources/Budapest/Guidelines-Budapest/ESA- PROC-SED-2016-FINAL-DRAFT.pdf Introduction: Capnography monitoring is internationally 8. Saunders R., Struys M., Pollock RF., Mestek., Lightdale recommended as a standard of care for patients who are JR.(2017) Patient safety during procedural sedation using administered moderate to deep sedation for endoscopy capnography monitoring: a systematic review and meta – procedures. analysis https://www.ncbi.nlm.nih.gov/pubmed/28667196 Objective: To reduce the gap between what evidence- based research supports and what is done in clinical practice. The feasibility of integrating capnography L- 7 monitoring in endoscopy was investigated. Research Methods: Multiple searches of the databases Continuous tracking, control and safety of pulmonary provided a gold standard literature selection required to patients through nursing documentation develop a portfolio of evidence. It includes literature Ana Mustak, Aleksandra Trupković, Slava Šepec, reviews, a business plan, an education plan and Jadranka Brljak, Croatia correspondences with hospital stakeholders, Irish Society of Endoscopy Nurses and ESGENA committee members. Introduction: Nursing documentation is a collection of The aim of the correspondences was to identify if any data used for quality control (QC) of planned and endoscopy units were using capnography monitoring in implemented health care. It is an integral segment of the endoscopy in Ireland or within Europe. medical records. Continuous recording of condition of the Learning Outcomes: Education sessions were given to patient forms of nursing documentation we provide quality endoscopy staff on capnography monitoring. Care plans, health care, nursing research, provides the basis for the policies procedures and protocols were updated. An audit education of nurses and further development in nursing. programme was introduced to evaluate the full Rehospitalization of chronic lung patients have access to implementation of education and training, the the previous course of health care, we plan to present the appropriateness of interventions, the procedural benefit course of health care and treatment, and we plan to and the service impact. continue health care and treatment. Nurses must Conclusion: The results of ongoing audits have permanently record all planned and implemented highlighted capnography monitoring improves patient procedures for 24 hours. safety and leads to early recognition of respiratory Aims: The aim is to represent the importance of keeping depression prior to development of hypoxaemia. Early records in nursing. Systematic implementation of all detection of respiratory depression provides the phases of the process of health care, offered safety in opportunity to perform timely corrective action, thus likely patient care through continuous tracking, recording, reducing the need to disrupt the procedure. We have planning, implementation and evaluation of health care. demonstrated that it is possible to integrate capnography Nurses enable professional development of individual monitoring at a low cost and we encourage other hospitals consultations, expert meetings, conferences, courses that to adapt this safety and quality improvement initiative. are conducted on the basis of the annual plan. Relevance to Nursing Practice: Recommendations from Objectives: Nursing documentation contains mandatory evidence-based research supports nurses to develop their forms, depending on the condition of the patient are skills and extend their practice. Endoscopy nurses feel carried out additional forms for tracking pressure ulcers, empowered using capnography monitoring in endoscopy, forms tracking of pain, a forms of tracking fluid, a report on which enhances the delivery of a high-quality patient the incident. Every three months evaluate the forms of centred service. health care as indicators of the quality of health care. References: Depending on the needs of health care, patients are 1. ASA (2018) Practice Guidelines for Moderate Procedural categorized into four categories depending on the required Sedation and Analgesia. Anaesthesiology 123 (3) 437-479 assistance to meet basic human needs and depending on https://static1.squarespace.com/static/54d14bfce4b02b4744e7 0d6d/t/5a8708ad24a6943b16cb9ea2/15 the diagnostic and therapeutic procedures in patients 18799460707/ASA+Practice+Guidelines+Moderate+Procedur conducted. Categorizing patients provides a quick insight al+Sedation_2018.pdf into the severity of the condition the patient and therefore 2. AAGBI. (2016) The Association of Anaesthetists of Great points to the need for health care needed by, respectively Britain & Ireland. Recommendations for standards of number nurses is required to provide adequate health monitoring during anaesthesia & recovery. www.aagbi.org care. Electronic nursing documentation enables 3. Beitz A., Riphaus A,. Meining A,. Kronshage T,. Geist C,. et al. communication between team members and other (2012) Capnography monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol departments. Re-hospitalization of patients we can see sedation for colonoscopy. The American Journal of earlier planned, implemented and evaluated interventions Gastroenterology 107, 1205-1212. health care. To enable the access to previous physical and 4. Jopling MW & Qui J. (2017) Capnography sensor use is psychological condition of the patient, ability to associated with reduction of adverse outcomes during communicate, vital signs, compare the current situation gastrointestinal endoscopic procedures with sedation before diagnostic and therapeutic procedures. There administration. BMC Anesthesiology. needs to be in the same patient at the same time solves 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., the acute and chronic problem in all stages process of Lo Y. (2017) Capnography monitoring the hypoventilation nursing care. Health care is individualized and focused on during the induction of bronchoscopic sedation: A randomized the patient and provides the individual approach in controlled trial. Scientific Reports 7, 8685 gratification of based human needs. Health care plans are https://www.nature.com/articles/s41598-017-09082-8 made targets that form the basis of evaluation. Focusing 6. Qadeer M., Lopez AR., Dumot JA., Vargo JJ. (2011) on patients means attainment of the goal. Nursing Hypoxemia during moderate sedation for gastrointestinal documentation can be used for researches and can

ESGENA Abstracts Oral Presentations

contribute significant results for improved quality of nursing L- 9 care and nursing practice. Learning/Outcomes: Record keeping of continuous National training programme for sedation in GI monitoring, implementation, documentation and evaluation Endoscopy – 9 years experience of nursing work creates a good basis for communication and contributes to a better understanding of the patient's Ulrike Beilenhoff, Germany condition and results of health care. We conduct measures to improve nursing practice, we make standard operating Introduction: In Germany approx. 90 % of endoscopic procedures (SOP) and work instructions. Monitoring the procedures are performed under sedation. For over 15 indicators of the quality of health care, evaluation of years, aside from the traditional medication with keeping of nursing documentation. We organize courses of Benzodiazepines - often in combination with an opioid, the keeping nursing documentation. Health care plan are short-acting hypnotic Propofol has increasingly been used precondition of well-organized health care which can in Germany. National guidelines give precise significantly affect of the overall success of treatment. recommendations for the structure and process quality for Conclusions: Implementation of record keeping provides safe sedation which also includes the qualifications for evaluate of the patient's condition, establishment of the medical and nursing staff (1). Irrespective of the type of problem, assessment course of the monitoring and make sedation used in GI Endoscopy, the same structure and conclusions on the progress of health care for each process quality are required to ensure same level of safety patient. Nursing documentation creates good professional for all patients undergoing endoscopic procedures. communication that substantially influences the success German regulations allow the delegation of sedation to overall treatment. qualified nurses under certain conditions and underlines References the necessity of suitably trained and competent staff. 1. www.hkms.hr/.../1316431501_827_mala_sestrinske_dijagnoze Specific knowledge and skills on risk assessment, _kopletn. sedation, recovery and resuscitation are necessary not just 2. www.nanda.org/nanda-international-nursing- diagno...NANDA International Nursing Diagnoses: Definitions for physicians, but also for supporting nurses (1). and Classification 2015-2017 Method: A national training programme was developed by 3. issuu.com/kvaliteta.net/docs/rezic, S. Režić, Hrvatska the national societies of Gastroenterologists and konferencija o kvaliteti, svibanj 2015; str 211-215 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, L- 8 patient monitoring, different sedation regimes, recovery, airway management and resuscitation:

The basic course is a 3 days course with 16 hours theory Management of bronchial haemoptysis and and 8 hours practice (2). The theoretical part includes legal desaturation - or how not to panic when it goes red! aspects, pharmacology, structural and personnel Michael K. Ortmann, Switzerland requirements, peri-endoscopy care, sedation

management, prevention and management of adverse Significant iatrogenic bleeding during flexible events and complications. Knowledge is assessed by bronchoscopy is fortunately rare and usually self-limiting. written exam. The practical training on human patient Life-threatening bleeding, however, can occur, especially simulators includes basic live support (BLS), advanced after conventional or cryoprobe-assisted transbronchial cardiac life support (ACLS) and training on different biopsy. The aim of this review is to provide the practising sedation concepts. An intensive reflection of practice in pulmonologist with a concise overview of the incidence, small groups ensures effective reflection of previous severity and risk factors for bleeding, to provide sensible practice, improvements and reinforcement of experience. advice on prophylactic measures and to suggest a plan of After the course an internship of 3 days supports the action in the case of significant bleeding. Bronchoscopy practical implementation. Further training and assessment units should have a standardised approach and plan of of competencies in the own department are recommended action in the case of life-threatening haemorrhage. before delegation of sedation can take place. The basic Wedging the bronchoscope in the bleeding segment, course is recommended for all endoscopy nurses. turning the patient in an anti-Trendelenburg position and The refresher course is a one-day course. 4 hours of onto the side in order for the bleeding lung to be in the theory updates background knowledge and supports dependent position, installing vasoconstrictors and using a students to reflect / improve their daily practice (3). 4 hours tamponade balloon early are the recommended first-line with practical training on human patient simulators updates strategies. Involving a resuscitation team should be practical skills on emergency management. The refresher considered early in the case of massive bleeding, course is recommended every 2 to 3 years in addition to desaturation and haemodynamic instability. the yearly BLS / ACLS. In conclusion, significant iatrogenic bleeding during FB is The course data between February 2009 and May 2018 rare and usually self-limiting. Life-threatening bleeding may were evaluated. A survey was performed among members occur, especially after conventional or cryoprobe-assisted of the national society for endoscopy nurses. Endoscopy TBLB. Bronchoscopy units should have a standardised departments were asked to send one answer per unit only. approach and plan of action in case of life-threatening The survey asked to identify improvements as well as haemorrhage, including the involvement of a resuscitation weaknesses in the translation of national policies. team. Wedging the bronchoscope in the bleeding segment, Results: Between February 2009 and Oktober 2018, 1353 instillations of vasoconstrictors and the early use of a basic courses with more than 18.800 students and 495 tamponade balloon are the recommended first-line refresher courses with more than 7425 students were strategies. 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.

ESGENA Abstracts Oral Presentations

253 endoscopy units answered the survey (preliminary Trainees were required to undertake the following results from September 2, 2018). The following programme elements: in-house clinical/practical skills improvements were identified: training; completion of training and academic portfolios; number of staff increased in 53,94% of departments blended learning including eight taught days and e- in 55% of departments 100% of nurses followed basic and learning modules; JAG-accredited basic skills course; and refresher courses, in 24% of units 75% of staff have the clinical supervision and mentorship. required qualification, in 20% of units less than 50% of Results: A total of 244 gastroscopy procedures and 24 staff have the required qualification formative and summative Direct Observation of Procedural 70% of departments already used refresher courses Skills (DOPS) recorded on the JAG Endoscopy Training A risk assessment was established - with ASA System (JETS) e-Portfolio from October 2017 to May 2018 classification in 79,34% units, with checklists in 79,75% were reviewed. Of these 244 procedures, 228 were unit performed to completion without physical assistance from 82% of departments performed Propofol mono sedation trainers. DOPS submitted by trainers showed increasing 85,08 % of units had dedicated recovery areas with staff independence in technical (e.g. visualisation, scope A structured discharge was standard in 85% of handling, lesion recognition, reporting) and non-technical departments skills (situation awareness, communication, teamwork). No The following limitations were identified which need further serious complications or adverse events were reported in evaluation this period. 37,20 % of unit did not establish a team-time-out Discussion: The in-house training was achieved with a Due to staff shortage only 40% of units had a dedicated dedicated endoscopy trainer and training lists; the trainee person for sedation during ALL procedures, other being physically assisted initially to eventually only needing departments provided a sedating person for advanced to be observed while performing gastroscopy. The JAG procedures only. Some procedures were performed basic skills course provided opportunity to fine-tune scope- without sedation. handling skills and peri-endoscopy management. DOPS Conclusion: The national training programme of basic feedback forms were recorded at intervals on the JETS e- and refresher courses is well established. First evaluations Portfolio and were completed to track trainee’s acquisition showed improvements in the participants departments. of the technical and non-technical endoscopist skills and Nurses are aware of their knowledge, skills and limitations. assess competence for independent practice. The training Areas for further improvements could be identified and academic portfolios provided a skills framework and Learning outcomes: Participants should be facilitated identification of learning needs and Aware of the nurses advanced roles and limitations in achievements through reflective practice using the Driscoll sedation in GE Endoscopy and Kolb models. Taught days equipped trainees with Aware of different options how to organize a national knowledge to support advanced GI practice and clinical- courses to train nurses in sedation and emergency decision-making like pharmacology, anatomy and management pathophysiology, and treatment algorithms. Mentorship References: from an advanced nurse practitioner, which involved 1. Riphaus A et al. Update S3-Leitlinie „Sedierung in der regular face-to-face meetings, were crucial for successful gastrointestinalen, Z Gastroenterol 2015; 53: 802–842 role transition. Ad-hoc debriefing sessions with trainer 2. Beilenhoff U, Engelke M, Kern-Wächter E, et al. Curriculum and/or mentor provided the trainee with emotional support Sedierung- und Notfallmanagement in der Endoskopie. and coaching after particularly challenging Endopraxis 2009; 1; 32-35 / Update 2018. Endo-Praxis 2018; 34: 89–93 training episodes. Further local support included access to 3. Beilenhoff U, Engelke M, Kern-Wächter E, et al. Curriculum für additional lists supporting technical and lesion recognition den Refresherkurs. Endo-Praxis 2010; 26: 185-186 / skills. The accelerated nature of the programme presented Update 2018. Endo-Praxis 2018; 34: 154–156 unique challenges. For example, it required high self- directedness to complete multiple course elements in less time. Contingency planning was also vital to ensure L- 10 deadlines were met despite shortfalls from procedure cancelations, bank holidays, or planned trainer/trainee

time-off from work. The 7-Month Journey from Endoscopy Nurse to Nurse Conclusion and relevance to nursing practice: Two Endoscopist lessons can be culled from this reflective account. Firstly, Yulrich Louie dela Cruz; Irene Dunkley, Rizwan Kassam, commitment to active learning, time management, and a North West Anglia NHS Foundation Trust, Hinchingbrooke high degree of self-motivation are required to gain the Hospital, Huntingdon, Cambridgeshire, United Kingdom necessary competencies and confidence within the

accelerated programme timeframe. Secondly, transitioning Introduction: Nurse endoscopists have been an integral from nurse to a specialist role to perform diagnostic part of endoscopy services in the UK for over 20 years gastroscopy is achievable if support mechanisms from accounting for over 20% of all endoscopy procedures. In employing hospital, clinical supervisor, nurse mentor, 2016, Health Education England (HEE) and the Joint colleagues, fellow students and tutors are in place for the Advisory Group for GI Endoscopy (JAG) launched a pilot trainee to develop clinically, technically and academically programme for fast track training of non-medical to safely perform diagnostic gastroscopy. endoscopists to meet the demand for endoscopy services References in England. This is a reflective account of a nurse trainee - https://hee.nhs.uk/our-work/endoscopy Accessed 18/05/2018 endoscopist’s personal experience of this training - https://hee.nhs.uk/sites/default/files/documents/Non- programme. Medical%20Endoscopists%20%28NMEs%29%20Competence Aim: To describe the challenges of HEE fast track training %20Assessment%20Portfolio_0_0.pdf Accessed 18/05/2018 and the support mechanisms crucial to successfully - https://www.jets.nhs.uk/ePortfolio.aspx Accessed 18/05/2018 completing the programme requirements. - https://skillsforlearning.leedsbeckett.ac.uk/preview/content/mo Methods: This reflective account describes the challenges dels/02.shtml Accessed 18/05/2018 and successes of participation in the HEE pilot programme for fast track training of non-medical endoscopists.

ESGENA Abstracts Oral Presentations

L- 11 implementation into the procedures. Sub-tasks were the determination of the number of steps, the definition of Process optimization in endoscopy by implementing a evaluation criteria and the enumeration of possible checklist for patient safety interruption of work processes. These were worked on in Silke Bichel, Germany the project group and presented to the interfacing units during the kick-off meeting. Further milestones were given Introduction and Background: The project was carried by two temporally defined test phases. The introduction of out as a final project of continuing education concerning the checklist in phase one only for members of the project "management of a nursing unit". The focus is on improving group over two weeks, and phase two with the entire processes and avoiding mistakes as well as interruptions endoscopy team involved over three weeks. Both phases of the work process. A checklist was designed which were concluded with feedback and an evaluation. The test enables the endoscopy team to check specific parameters phases were successfully completed, so that after with regard to the safety of patients within the scope of approval by management, the checklist for patient safety in endoscopic procedures, and counteract deviations if endoscopy was introduced into routine procedure. The necessary. Despite well-structured processes and resulting documentation was added to the manual of competent employees, repeated interruptions of the work quality of the endoscopy team. processes occur due to extrinsic and intrinsic factors. In Results: During the test phase, the safety checklist was view of high-quality patient care, the objective of optimized applied in 278 endoscopic procedures. In 2.16% of cases patient safety is approached in the project group in a way (6 patients), where patients were anxious, action stage 2 that enables smooth integration into existing structures and (team time out) was only executed after sedation of the processes. The idea of this project originated within the patient. In 1.1% of cases (3 patients), the supervising endoscopy team due to an adverse event, which would nurse of the station was consulted to ensure correct have led to a complication, had it not been recognized in identification of the patient, since the identification bracelet time. The adverse event happened due to high workload of of disoriented patients was missing. In 12.95% of cases an otherwise very dependable employee and despite (36), the endoscopic procedures was not conducted after principally well-structured procedures1. Lessons learned sign-in, since the patients were not fasted, deviating from from the WHO initiative "Safe surgery saves lives" of 2009 preparatory standard. In 1.44% of cases (3), the show that interdisciplinary employment of safety checklists endoscopic procedure was cancelled or postponed during invasive procedure can decisively improve patient because anticoagulant therapies were not interrupted in security. A worldwide study of Haynes A. et al. confirms time. ASA classification was not performed during patient that safety checklists according to the criteria of the WHO education about sedation in 8.99% (25) of cases, leading initiative can significantly reduce morbidity and mortality2. to delay of treatment procedure. The experiences and study results led to rapid Summary and discussion: During the project phase, the implementation in the processes by the surgical department-specific checklist for patient safety in professional societies. The medical and nursing endoscopy was developed and integrated into operating professional associations in Germany (DGVS and DEGEA) procedure. During process optimization, the focus was on have adopted "patient safety by checklists and team time improving patient safety, communication structures as well out" into the SK2 guideline for quality requirements in as motivation and satisfaction of employees. A further foal gastro-intestinal endoscopy3. was comprehensible documentation of safety-relevant Objectives parameters while avoiding additional expenditure of time. Project work includes goals following the SMART method: In the first action stage, considerable mistakes with - Specific: Reduction of foreseeable and avoidable possible safety-relevant consequences could be observed. complications by test criteria Due to documentation and the deduction of further steps, employees were enabled to act in a safe and uniform - Measurable: Measurable improvements of patient manner. Patients predominantly perceive the method as safety by reduction of interruptions od work processes improving safety and confidence in the endoscopy team. Attractive: Increase of employee satisfaction by more - The expenditure of time stayed within reasonable bounds, transparent work routines as well as improved with 1-3 minutes. The required discipline was rated communication positively especially when faced with high workload, where - Realistic: Comprehensible documentation of already interruptions of work processes are most likely. This established measures in the context of patient emphasizes the aspect of safety of the checklist. The preparation in endoscopy endoscopy nurse team rated action stage 2 (team time - Time sequence: A period of ten weeks has been set out) and the related uniform information transfer regarding and a kick-off event with the affected interfacing units the endoscopic procedures as very advantageous. Research methods: After defining the subject of the Interfacing units highlighted the improved communication project and approval of the continuing education institute structure. and management, a project group of two experienced Conclusion: From the point of view of the project group members of the endoscopy team was assembled. To and the interfacing units, the project "process optimization ensure uniform level of knowledge heading into the project, in endoscopy by implementation of the checklist for patient I presented background information available on team time safety" was completed with success, and the employment out, the relevance of patient safety in all procedures, as of the checklist in endoscopy was evaluated as sensible. well as the availability of safety checklists in endoscopy to Management confirmed the success of the project. The the project group. As a basis for successful project employment of the checklist for patient safety in management, a project pyramid consisting of budget, endoscopy will be integrated into standard operating schedule and requirements and task allocation was procedure for all endoscopic procedures. devised. The communication plan guarantees the flow of Learning outcomes and relevance to nursing practice: information about the results with the defined interfacing Using a safety checklist directs focus on safety-relevant units. The project structure plan set the development of a aspects of patient care. The employment ensures checklist for patient safety in endoscopy as the primary goal, together with respective instructions for

ESGENA Abstracts Oral Presentations

transparent documentation of structured processes. Learning outcomes: Explain the specificity of preparing Communication structures are improved, which supports and performing endoscopic examinations in people with self-reliant action of employees and improves patient autism. This area of work requires basic knowledge of the safety during situations. problem, correct approach, patience and adaptation to References: work. 1. https://www.nejm.org/doi/pdf/10.1056/NEJMsa0810119, References: (05.10.17) 1. Margaret C. Souders, Denise DePaul, Kathleen G. Freeman, 2.http://apps.who.int/iris/bitstream/handle/10665/44186/978924159 Susan E. Levy. Caring for Children and Adolescents With Autism 8590_eng.pdf?sequence=1&isAllowed=y, (05.10.17) Who Require Challenging Procedures. Pediatr Nurs. 2002;28 3. https://www.dgvs.de/wp-content/uploads/2016/11/S2k- 2. Adriane A. Jolly, MSN, RN, CPN, AE-C, PCNS-BC. Top Ten Leitlinie_Qualitaetsanforderungen_in_der_gastrointestinalen_Endo Tips a Nurse Should Know Before Caring for a Hospitalized Child skopie__Langversion_.pdf, Kap. 3.4, E41-E43, Patientensicherheit With Autism Spectrum Disorder. Pediatr Nurs. 2015;41 (1):11-16 durch Checklisten und Team Time Out (05.10.17)

L- 13 L- 12 Analysis of the awareness of population about risk Access to nursing care for people with autism with factors and methods of colorectal cancer prevention special emphasis on preparation for endoscopic Nataliya Shandarovska,, Ukraine examination Brozičević Katja, Croatia Objectives. Globally, colorectal cancer (CRC) ranks the third place among all cancers for the incidence rate, and in Introduction: Autistic disorder is a pervasive Ukraine - occupies a second rank position [1, 2]. This developmental disorder that occurs in childhood and lasts disease can be effectively prevented by detecting for a lifetime. The basic features are deviations in social precancerous conditions and cured when diagnosed at the interaction, communication, stereotypes and bizarre early stages. The effect from preventive measures can be behavior. Performing health care for people with autism achieved by informing the public about the risks of CRC, requires educated staff. Because of their ignorance, promoting healthy lifestyles and educate on the possibility nurses are sometimes unable to understand this problem, of preventing CRC through a regular screenings [3]. resulting in improper access and inappropriate The aim of the study is to determine the level of interventions. Care requires individual approach. Since awareness of Ukrainian citizens about risk factors, causes, work with people with autism is not often the area of our main signs and symptoms, prevalence of malignancies in work, it always represents a challenge. the large intestine and rectum and ways of its prevention. Methods: The first step of the nurse is that in first contact Material and Methods with the parents establish a quality relationship. It must be We conducted a survey about colorectal cancer given enough time and try to collect as much information interviewing ordinary people over the age of fifty who as possible about how the person communicates, habits, already belong to the risk group (through age). The everyday routines, sensitivity and possible aggressive questionnaire included questions related to awareness behaviors. People with autism have their own routine, and about CRC itself and its symptoms, main risk factors, any change cause discomfort. According to the way a clinical manifestations, and screening programs and their person communicates, a nurse can adapt their adherence to them. communication using a thumbnail if a person is Results communicating nonverbal. If there is a possibility of verbal To conduct the survey, we distributed 100 questionnaires communication, the nurse should use clear and simple to ordinary people over the age of 50. It should be noted sentences in explaining the procedures. If a person is that only 58 (58%) people filled out and returned the prone to aggressive forms of behavior, parental suggestion questionnaires and agreed to talk about the CRC. Almost must be accept in correcting these behavior. If the person all participants (56 (97%)) have heard about colorectal is sensitive to stimuli, we must provide the environment cancer. Most often, 40(68%) respondents got information without noise, people, light and equipment. from the media,10 (17%) indicated relatives or friends and Results: It is recommended that the terms of procedures 9 (15%) – from medical institutions. However, the majority be in the morning when there is no crowd in the of respondents would like to receive such information from ambulance. It is important to avoid waiting. If waiting is a family doctor (39 (69%)), from doctor specialised in inevitable, the person should be placed in a quiet room. oncology - (2 (3.5%)), or nurse (1 (1.7%)). 42 (72%) Parents should be familiar with the details of the persons know the correct localization of CRP, however endoscopic examination: preparation, duration and only 12 (21%) respondents know that the disease most examination complexity. Since endoscopic examinations often develops in the age group older than 50, the rest are unpleasant and can last long, we do them in general believe that at a younger age. Only 9 (16%) of the anesthesia. respondents recognized the genetic factors as a risk factor Discussion: Before performing any activites, the person for this disease, 19 (33%) did not agree with it, and half of must be explained what will be done. Physical contact is them -28 (50%) could not give the answer.Awareness of achieved slowly. The nurse should receive verbal or non- the risk factors, which are related to nutrition, is quite high. verbal feedback. Parents' presence is something that must The majority of respondents referred here to obesity (39 always be enabled. For successfull work nurses must have (69%)), alcohol use (35 (62%)), consumption of red meat the will, desire, and understanding. (34 (60%)). Only 4 (8%) respondents understand that the Conclusion: In performing health care for people with disease can be asymptomatic, while the remaining 26 autism, health care professionals need to be creative, (46%) believe that it is impossible and the same number - possess basic disease knowledge, and be prepared to do not know. It is shows that the majority of the population adapt their work and conditions to people with autism. is poorly informed about the "saliency" of this disease. 27 Collaboration with parents is an important precondition of a (48%) participants know that CRC can begin with intestinal positive outcomes of health care.

ESGENA Abstracts Oral Presentations

polyp, and 28 (50%) believe that timely removal of a polyp Among those who responded “Yes” to this question, 30 can prevent the development of cancer. The obtained people (86%) selected an ultrasound examination as results indicate that two thirds of the respondents (35 diagnostic measure. Only 5 (14%) participants indicated (63%)) believe that there are methods for early detection of the most effective examination - colonoscopy. None of the CRC, and 21 (37%) - that such methods don’t exist. respondents indicated the faecal occult blood test, which is an affordable and effective method to detect malignancy of Endoscopy Unit, with special regards on side-viewing the colon and rectum and their precancerous conditions. endoscopes. Conclusions. Methods: From September 2016 to December 2017, all 1. Ukrainian citizens aren’t well aware about this disease, the 45 endoscopes of the Endoscopy Unit were submitted and especially with modern methods of early detection and to microbiological surveillance; 8 of them were side- prevention. viewing endoscope. Side-viewing endoscopes were 2. The source of information about CRC, as a rule, was the sampled monthly while all remaining endoscopes were media, but they would like to receive more information submitted to microbiological control twice a year. The from health professionals, in particular, a family doctor. sampling solution was Tampon DNP + 0,5% thiosulfate 3. The people we interviewed do not have information on (Thermoscientific) with a flush-to-flush technique in all the risk factors for the development of colorectal cancer, channels. The samples were carried out during the since they do not consider age, genetic predisposition and endoscope storage, at least after 12 hours from smoking as such. But they agree that the unbalanced diet, disinfection in an endoscope washer-disinfector (EWD). obesity, alcohol, red meat may be its causes. For the side-viewing instruments, a buffer was also used 4. The respondents interviewed by us were little informed for the recess behind the elevator. In case of positivity, the about the "quiet", asymptomatic course of the disease, and endoscope was stopped until a negative microbiological only half assume the possibility of its development from sample was obtained. benign polyp and the possibility of preventing the disease Results: 85% of the endoscope were found to be negative by removing of those polyps. at microbiological sampling. 37.5% of the side-viewing 5. Despite the current development of information endoscopes underwent the replacement of channels or technology, there is a significant lack of information on dismissal. In particular, most frequently used instruments colorectal cancer, methods of early detection and (over 200 cases a year and in activities for more than 10 prevention, which adversely affects people's awareness years) presented major problems. Even an 4,4% of NON- about the danger of this disease. Therefore, it is critical endoscopes (2 gastroscopes) have been dismissed encourages the search for effective methods to increase or have channels replaced. The percentage of endoscopes the level of awareness of the population about CRC. The negative for microbiological sampling has gone from 85% nurse plays important role in this task to 100% today. In January 2017 we had a complete References. renovation of the reprocessing system (washing module, 1. Cancer in Ukraine, 2015 – 2016. Захворюваність, смертність, EWD, storage cabinets and traceability). In January 2018 показники діяльності онкологічної служби / Бюлетень all endoscopes where replaced. A schedule of preventive національного канцер-реестру України № 18 // за ред. О. О. maintenance for all instrument by the manufacturer was Колеснік. - КИЇВ - 2017 also introduced. 2. Howlader N, Noone AM, Krapcho M, editors. , etal. , eds.SEER CancerStatisticsReview, 1975–2012.Bethesda, MD: Summary and discussion: Basing on this results, it was NationalCancerInstitute; necessary to implement the following strategies: 1) 2015.http://seer.cancer.gov/csr/1975_2012/. AccessedJune 10, Retraining of staff in reprocessing procedure, 2) 2016. introduction of disposable brushes and valves, 3) correct 3. Centersfor Disease Control and Prevention. National vital monitoring of the drying of endoscopes, 4) replacement of statistics system. internal channels of endoscopes 5) update of the entire https://www.cdc.gov/nchs/nvss/bridged_race/data_documentation. reprocessing system and traceability. htm. Accessed December 22, 2016 4. http://gco.iarc.fr 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 L- 14 current standards (EN ISO 15883 and EN ISO 16442), do not guarantee the complete disinfection of the endoscope, Microbiological surveillance of the endoscopes: especially for instruments with a higher frequency of use. experience of Endoscopy Unit of the University Learning Outcomes+Relevance Nursing Practice Campus Bio Medico of Rome. Alongside the technological renewal, standardised B. Colombo, M.L. Candela, A. Minciullo, E. Portalino, G. retraining of personnel and constant microbiological Bencivenga, F. Antonelli, A. Conti, S. Angeletti, F.M. Di sampling should be used as a measure of quality of the Matteo, University Campus Bio Medico of Rome , Itlaly entire process of endoscope reprocessing. References Background: Recently an outbreak of multi drugs 1. Kovaleva J, Peters FT, van der Mei HC, Degener JE. resistant (MDR) organisms in endoscopy has been Transmission of infection by flexible gastrointestinal reported. Altough no evident breaches in reprocessing endoscopy and bronchoscopy. Clin Microbiol Rev. 2013 procedures were identified, the problems appears to be Apr;26(2):231-54. more relevant in side-viewing endoscopes. Crevices in 2. Claire Aumeran, E. Thibert, F. A. Chapelle, C. Hennequin, O. Lesens, et al. Assessment on experimental bacterial biofilms ruined channels of over-used instruments and complexity and in clinical practice of the efficacy of sampling solutions for of design at the elevator region of the duodenoscopes microbiological testing of endoscopes. Journal of Clinical facilitates the formation of bacterial biofilm that may impair Microbiology, American Society for Microbiology, 2012, 50 (3), the disinfection, even if reprocessing protocols are pp.938-42. correctly applied. Aim: The aim of this study was to evaluate the effectiveness of endoscope disinfection process in our

ESGENA Abstracts Oral Presentations

3. Ulrike Beilenhoff et all. Prevention of multidrug-resistant There is a lot of praise from the doctor and secretary infections from contaminated duodenoscopes: Position groups. They like being in the endoscopy unit and working Statement of the European Society of Gastrointestinal with the nurses. Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA). All nurses are in speciality teams and they also have Endoscopy 2017; 49(11): 1098-1106 meetings. They make descriptions and can make 4. Lee DH, Kim DB, Kim HY, Baek HS, Kwon SY, Lee MH, Park decisions in cooperation with management. JC Increasing potential risks of contamination from repetitive We have a good working environment. The nurses are use of endoscope. Am J Infect Control. 2015 May 1;43(5) acting professionally and have a high degree of 5. Rapporto tecnico UNI/TR 11662: Ricondizionamento dei accountability. The nurses are aware of this and respect dispositivi medici. Guida al ricondizionamento degli endoscopi each other's competences. termolabili (Dicembre 2016) References: 1.Yukl, G. (2013):” Leadership in organizations- Global edition.” New York. Pearson Education, Prestice hall. (page 17-38,188-243, L- 15 272-300, 328-346) 2.Drath, W., McCauley C., Paulus C., Van Velsor, O´Connor., McGuire, J. (2008): Direction, alignment, commitment: Toward a Restructuring of an Endoscopy Unit as an outcome of more integrative ontology of leadership a work environment report 3. Benner PE. From novice to expert: excellence and power in Tine Karbo, Denmark clinical nursing practice. Menlo Park, CA: Addison

Introduction: High quality and professionalism are contributing to the endoscopic nurses feeling of pride and L- 16 motivation in their field. In recent years, Denmark have merged small units into larger sections. At the same time, Building a new hospital – using the chances for the complexity and development of what can be done endoscopy endoscopically has increased. This has been one of the Jan-Werner Poley, The Netherlands reasons for the need to reconstruct and think of the Not aubmitted 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 L- 17 attitudes. It is important that every member of the team feels that their suggestions and ideas are heard and taken Safety systems in endoscopy – How to prevent seriously. steeling of Endoscopes Methods: We used questionnaires and staff meetings, to Ute Pfeifer, Germany conclude which areas we should prioritize. The nurses themselves were put into working groups, so they could Objectives: Since 2014, there have been thefts of have influence and help determine the actions. It was clear endoscopes, processors and monitors in several German after a few months, what the nurses wanted: clinics and gastroenterological practices, resulting in Structured training of new nurses. Structured teaching losses of several million euros. In order to reduce the risk and development of experienced nurses. in the future and to avoid the risk of treatment failures or - Description and alignment of patient visits bottlenecks, a nationwide safety survey was conducted in - Time to study and develop skills endoscopy departments. In addition, the survey was also - Better communication and cooperation both mono- extended to several European countries. and interdisciplinary Method: From July to August 2018, an 11-items- - Specialized teams questionnaire was online delivered in Germany and some - Responsibility from management and employees European countries. SurveyMonkey software was used to Results: We got resources to hire a clinically specialized create the questionnaire. The questionnaire included nurse who can initiate and develop guidelines. She is at multiple choice questions with the additional possibility of the front of the development of clinical practice and unit free text information and the request to fill in the research We now have a mentor team of dedicated questionnaire only once per endoscopy department. nurses, who one-on-one are partners with the new nurses Various e-mail distributors of educational institutes and in the first few months. New staff who join the department societies as DGVS, DEGEA and ESGENA were used to get schedules for training and follow-up by mentors and send the link and the QR-code (n = 2807). leader. We have regular teaching sessions once a week Results: 451 completed questionnaires were collected for all nurses and many participates in external courses. from Germany. Overall, 50.1% of all endoscopy is on the We have a daily coordinator, who ensures that patients get ground floor (29,8% 1st floor, 20,0% higher than 1st floor). to the correct examinations/treatments and staff with the The majority (64.7%) of the endoscopies have two right competences. The coordinator manages our entrances from the corridor or are connected to other care resources, so everyone helps each other to get through areas (15,6%) (f.e. intensive care unit). In 68 cases a theft the examination list of the day. We are working with “short- in the endoscopy department was perpetrated in Germany. time nursing” and talk a lot about the role of the nurses The loss in Germany was estimated at between 40,000- assisting and performing endoscopic procedures As 100,000 EURO per burglary. In 27 cases (40,3%) the leader, I have prioritized that nurses get time out of the insurer paid for the loss or refunded only the current fair surgery rooms, so that they can write procedure value (n = 18, 26.8%). In 47% of the cases, patient care descriptions and have professional discussions. Several could be continued with loan equipment in the affected are now responsible for specialized areas and they also facilities. In total, in 128 (36,9%) facilities cleaning get time to do this. We have meetings every morning, personnel have access to endoscopy outside normal where we make an overview of today's program. Short working hours and 41,6% (n = 173) of departments use information is also given here. Nurses have become more ordinary keys for closure (closed-circuit television camera active at these meetings. In addition, there is generally a (CCTV) 14,9%, audible alarm 17,1%, key cards 20,9%). much better dialogue, which is also felt in staff meetings.

ESGENA Abstracts Oral Presentations

The main entrance as wel as the examination rooms will - To ease the workload of endoscopy departments as be closed in 46,8% (n = 206). In 25% (n = 110) of the well as to reduce exposure to chemicals, contaminated cases the corridor area of the endoscopy is also an escape equipment and noise route, so that only the intervention rooms can be closed. - To optimise and reduce running costs by investing in 63 questionnaires came from abroad. In Israel, Italy, centralised services and establishing efficient Portugal and Hungary there was also a burglary with theft. reprocessing pathways The endoscopy departments were located on the first floor Responsibilities: A multidisciplinary working group was or higher and have one or more entrances. The loss is established with representatives from hospital stated per case between 80,000-100,000 EURO. Only in management, technical experts, architects, hygiene one case did the insurer take over the loss. In all 5 cases experts and the managers of the main endoscopy units. It surveillance cameras, audible signals and keycards were is of utmost importance to involve experts from endoscopy used. because they have a deep knowledge of and experience in Conclusion: In 514 questionnaires in 73 cases there was endoscope reprocessing. a burglary in endoscopy with theft (68 in Germany, 5 in Key features of the new department: Transport other European countries). The loss was estimated at System: The hospital has an automated transport system 40,000-100,000 EURO per break-in. In about 40% of the using containers on an internal rail system. In order to cases, the insurer came up for the damage. Outside the avoid any contamination of the transport system, special service period, beside nurses and physicians often containers were developed which fit into the transport cleaning staff and technicians have access to the containers. The transport system needs a maximum of 7 examination rooms of the endoscopy departments. In the minutes for endoscope transportation, depending on the majority of cases, conventional keys are used to close the distance to the CSSD. doors. If the corridor of the endoscopy is also an escape Service time: The CSSD offers the service for endoscope route only the intervention rooms are closed (25% in reprocessing 18 hours a day, seven days a week. The Germany; 12,9% in european countries). entire reprocessing cycle will take place in the CSSD. References: Conclusion: The relocation of the complete reprocessing 1. www.dgvs.de (10.08.2018) cycle in the CSSD represents an interesting alternative to 2. https://www.volksfreund.de/region/diebstahl-von-endoskopen- conventional reprocessing in endoscopy departments. It is aus-kliniken-die-angeklagten-schweigen-weiter_aid-22305407 cost-effective and efficient, eases the workload of (03.05.2018) endoscopy units and ensures safe reprocessing with high 3. https://www.swr.de/swraktuell/rp/kliniken-verschaerfen- sicherheitsvorkehrungen-wieder-endoskopiegeraete-geklaut/- hygiene standards, performed by experts in this field. /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- 19

Competency development and team work – the basis

for patient safety L- 18 Camilla E. Leidcker , Denmark

Transfer of reprocessing of the endoscopes from the The term "competence" is defined as "to be able to." That endoscopy department to the department for central is, to possess the knowledge, skills and attitudes that sterilization - everyday life make it possible for you as an employee or human being Eric Pflimlin and Michael Ortmann, Switzerland to act appropriately, ie. behave in the given context - either in working contexts or in other life-related situations. Endoscopes are not only used in GI Endoscopy, but also Development is about increasing this ability over time. (1) in Bronchoscopy, Urology, Neurology, ENT, Cardiology, The development of competence can be planned to Surgery, Anaesthesiology and Intensive Care units. That facilitate that the nursing staff in the department over time means that each of these single units need to provide a develop their professional level in a continuous process, purpose designed reprocessing room with specially trained thereby gaining new knowledge and insight into achieving staff. the right skills for performing care and treatment for Current situation: At the University Hospital Basel, complex patients. This is achieved through participation in Switzerland, a large number of departments use flexible the competence process, as well as by bringing own endoscopes. The reprocessing protocols vary from qualifications and experiences into play with others. (2). department to department with different washer Framed team work and competence cards are methods disinfectors and different process chemicals in use. It is used in this competence development. difficult to keep the staff updated. After purchasing new The implementation of competence cards is done in equipment, difficulties often arise due to organisational cooperative with mentors, and acts as a natural part in the problems and lack of experience. revision of the existing endoscopy procedures manuals New Reprocessing area The University Hospital Basel and teaching plans. Competence courses are prepared for built a centralised reprocessing area within the Central the individual nurse inspired by Patricia Benner's Sterile Supply Department (CSSD) where all hospital development ladder. (3) This means that nursing staff at endoscopes will be reprocessed. The aims of this project the level corresponding to Novice are included in the was competence course individually, staff at the level - To unify the reprocessing of flexible endoscopes by corresponding to competent are planned to be part of the providing high hygiene standards competence course in clinical partner pairs, and that staff - To build an efficient unit with a high capacity that will at level equivalent to expert initiate or participates in be ready to meet future needs and a high workload scientific projects in the endoscopy ward. The competence - To centralise expertise and know-how for the cards are built upon separate main topics and are divided reprocessing of crucial equipment into knowledge, skills and competencies, based on the areas of competence given by the bologna qualification

ESGENA Abstracts Oral Presentations

framework. In addition, there is included a tool for new generations of nurses and adapt accompaniment for assessing non-technical skills. (4). Non-technical skills are these different generations. The language is different social and cognitive skills used in conjunction with between generation, the life vision, not to take into account technical skills in pre, procedure-oriented and post- the different generations of risk seeing teams exhausted operative endoscopy nursing. Endoscopy teams are often by frequent destabilizing mobilities. The team is a group of temporary, changeable and loosely formed. actor’s different manager must create harmony between Communication and teamwork (examples of social and them. It need new tutorial system, by computers, nurses interpersonal skills) and situational awareness and need to access easily to the web to find information during decision making (examples of cognitive skills), are key the work, do training by simulators : “never a first time on a non-technical skills and are central to high quality safe patient without training “ French recommendation. Nurses teams, and therefor worth focusing on in the competency must follow specific program in university, example development. (5). By increasing focus on competency endoscopy university program, education in disinfection development and teamwork, it caters to the staff's desire to with national society, to improve that nurses are valid for develop professionally, increase quality, promote well- working in endoscopy unit. being and ensure the patients safety and the best possible Findings: The forums, congresses, are important for care and treatment. endoscopy nurses, GIFE association give all the References: presentations in free access for endoscopy nurses, to help 1. Danelund, J., Jørgensen C. 2002 Kompetencebroen – strategisk them, and federate these professionals. With university reflekterende kompetenceudvikling systemteoretisk og program, all the students, and graduates continue to diskursteoretisk perspektiv Danmarks forvaltningshøjskole, 2. interact continuously witch each other founded discuss udgave. group web. They can exchange video they make, 2. Mentorskab i sygeplejen i Gastroenheden AHH 2016 https://intranet.regionh.dk/ahh/afdelinger/gastroenheden/om- information of their life work and also their private life. afdelingen/Documents/Mentorskab beskrivelse 310516.docx Conclusions: This work will prepare managers, and 3. Benner, Patricia. From novice to expert. Addison-Wesley nurses , to understand and to adapt new training models. Publishing Company, Menlo Park. California 1984 It answers to pedagogy activities for new generations. 4. Kompetenceudvikling af sygeplejen i Gastroenheden, Klinisk References: sygeplejespecialist Lena Veye, AHH. Bibliography :HEALTHCARE TEXT for become nurse 2012-256 , 5. Matharoo M et. al. Endoscopic non-technical skills team training: 27 June 2012 the next step in quality assurance of endocopic training, WJG The next generation of project management: how to develop 2014;20 (40): 17507-17515 technical and leadership expertise July 15-17, 2019

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Mentorship and training to retain and sustain the ESGENA Statement: Quality indicators for patient care endoscopy workforce in Endoscpy Laura Dwyer, United Kingdom Jadranka Brljak , Croatia Not aubmitted

Introduction: Since the 1960s quality assurance has become an integral part of medicine and nursing. The L- 21 International Council of Nursing (ICN) and national nursing associations underline the nurse’s role in delivering high Self-directed learning: How to implement continuing standard of care based on quality assurance programmes. training in daily routine? Quality assurance is the responsibility of the whole team. Fanny Durand, France Quality can be evaluated if minimum standards are defined and clear measurable criteria are identified for structure, Introduction: We says that the world change, of course process and outcome quality. Measurable outcomes the system and the actors change, how to accompany enable the identification of deficiencies and facilitate these evolutions in endoscopy. improvements. Quality criteria for endoscopy nursing cover Aims/Objectives: Economy context change in France, in pre, intra and post procedure care. However, a complete Europe, the teams must combine the knowledge how to separation between clinical medical and nursing outcome do, how to be, more and more quickly. The system criteria is often difficult in Endoscopy, as the clinical become more complex when activities such as endoscopy interventions are a combination of both medical and are concerned, because nurse studies doesn’t prepare for nursing actions. endoscopy activities. Generally, nurses accompany and Method: The ESGENA Education Working Group (EEWG) train the new professional in endoscopy unit on variable developed quality criteria for patient care in Endoscopy, lengths. Endoscopy activities are more and more complex, covering structure, process and outcome quality. The the materials change, the disinfection process are in group consists 25 members, representing the ESGENA constant evolution, guidelines must be known and applied, group members. it need time for new nurse in endoscopy and for the team. Results: Structure quality for patient care in Endoscopy French society for endoscopy nurses ( GIFE) for covers rooms, equipment and staff necessary to provide physicians (SFED) organize congresses, publishes professional patient care in the pre, intra and post recommendations for doing acts safety.To answer to the endoscopy phases. Quality criteria are defined for patient security of actions care , GIFE by the web ,communicate contact areas like registration, waiting area, assessment & by forum, try to help nurses and give different information. preparation rooms, endoscopy rooms, recovery areas and The system is it adapted really? consultation rooms as well as for supporting services Methods: A research is indispensable to understand the areas like reprocessing room, storage, disposal and actors. Nurses are different by experiences, but also by administration areas. generations. Managers must take into consideration the

ESGENA Abstracts Oral Presentations

Process quality covers all steps of the patient´s clinical the many clinical specializations in which even the pathway in Endoscopy scientific societies have developed many initiatives for risk 1. Admission management through retraining, research and surveys 2. Assessment & Consenting both on national and international levels, development of 3. Preparation & Pre-procedure care guidelines both clinical and for the reprocessing of the 4. Intra procedure care endoscopic equipment. 5. Assistance Scientific literature points out the risk factors for the patient 6. Recovery from complications during the different endoscopic 7. Discharge procedures. Co-morbidity and age are important factors, All parts are consistently structured with which must be taken into consideration before performing - General recommendations an endoscopic procedure. Adverse events may occur at - The time frame any phase of the endoscopic procedure: before, during - Description of patient care and after. - Responsible staff Key Words: Adverse event, Digestive endoscopy, - Necessary knowledge and skills Complication, Incident reporting 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 L- 24 to improve patient care in endoscopy by defining clear quality criteria for pre-, intra- and postendoscopy patient 24 hours service in Endoscopy – Organisation, quality care. The document provides also arguments for qualified indicators and limitations personnel. Marjon de Pater, The Netherlands References - Donabedian A. Evaluating the quality of medical care. Milbank Introduction: Most of us are frequently engaged on-call Mem Fund Q 1966; 44: 166-206 the emergency service of the endoscopy unit. The 24 - ESGENA Statement: European Job Profile for Endoscopy hours accessibility of an experienced endoscopy team is Nurses. Endoscopy 2004;36:1025–30. installed in many hospitals and is vitally important for the - European Society of Gastroenterology and Endoscopy Nurses rapid and effective treatment of gastrointestinal bleeding, and Associates (ESGENA). ESGENA Core Curriculum for clearance of foreign bodies and food bolus impactions. Endoscopy Nursing. 2008. www.esgena.org However only a minority require an immediate endoscopic - SGNA. Minimum Registered Nurse Staffing for Patient Care in the Gastroenterology Setting update 2016, www.sgna.org therapy. - Dunkley I, et al. UK consensus on non-medical staffing Aims/Objectives: Many cases in endoscopy could safely required to deliver safe, quality-assured care for adult patients be postponed and performed electively or as an out- undergoing gastrointestinal endoscopy. Frontline patient. My talk will highlight the guidelines and scores for Gastroenterology 2018;0:1–11. doi:10.1136/flgastro-2017- the initial assessment of GI patient in the emergency room. 100950 This approach will may provide assistance for an appropriate time of endoscopy and triage of patients. Method L- 23 - Describing the indications for an emergency endoscopy following the guidelines Adverse Events in Endoscopy - For bleeding/perforation and GI foreign body& food Patricia Burga, Italy bolus - Various scoring systems Introduction: As defined by Kohn, IOM 1999. an adverse - How to organize in daily practice event is an injury resulting from a medical intervention, or - Training program in other words, it is not due to the underlying condition of Conclusions: A responsible risk stratification should the patient. While all adverse events result from medical improve patient care without enforcement of dispensable management, not all are preventable (i.e., not all are invasive procedures or inadequate waste of personal attributable to errors). resources Method: The possibility of an adverse event in an References endoscopic setting has been analyzed through the review - The role of endoscopy in the management of acute of bibliographic literature. In this analysis of adverse non-variceal upper GI bleeding, ASGE Guideline 2012. events, various definitions were taken into account, in Gastrointestinal Endosc. 2012:75:1132-1138 addition to the different types of adverse events caused by - Blatchford O, Murray WR, Blatchford M, A risk score to organizational management, communication, and predict need for treatment for upper gastroinstestinal endoscopic procedures both diagnostic and therapeutic. haemorrhage. Lancet 2000:365: 1318-1321 Conclusion: Always according to Kohn : Human beings, - AMC protocol in all lines of work, make errors. Errors can be prevented - Guideline NVMDL by designing systems that make it hard for people to do - Up to date: Airway foreign bodies in children the wrong thing and easy for people to do the right thing. - ESGE guideline 2016: Removal of foreign bodies in In health care, building a safer system means designing the upper gastrointestinal tract in adults 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

ESGENA Abstracts Oral Presentations

L- 25 Safety Briefing: Based on national and international guidelines, many endoscopy units established a safety Track and trace : Documentation and follow-up of briefing in the morning (before the endoscopy list starts) to endoscope reprocessing, repair and maintenance ensure that all equipment and staff is available for the list Mikael Mochet, France of planned patients and to discuss the strategy for complex procedures (8). Sign-in, Team time out and sign-out should Endoscopy still be in progression and there is more and be performed for each individual patient. more acts in endoscopy department. Thats also mean we Sign-in should be performed when the patient arrives in need more and more materials and specially endoscopes. the endoscopy department. The sign-in is a standardized Today there is a lot of different endoscope and each have risk assessment that identifies the patient's individual risks his own particularity. Furthermore operator solicited them a concerning the planned intervention and sedation. The lot because time of procedure always increase, they need following parameters have to be checked (5-8): utilisation of bending for a long time during Endoscopic - Identification of the patient (name, date of birth, Pat-ID) Submucosal Dissection for example. At the same time, we - Completeness of the patient's record including signed still have to be focus on controlling the microbiological risk. informed consent, laboratory parameters and findings For this there is lot of different step like multistep cleaning - Correct preparation of the patient and desinfection process, storage localisation. So - Risk assessment concerning sedation and the planned endoscopy department really need to have a good follow- procedure including ASA classification, comorbidity, up: « track and trace » endoscope. cardio-respiratory problems, allergies, infections, Objective: Evaluate the best way to follow endoscope in anticoagulants, glaucoma and other items which are real time and have the documentation and follow-up of to relevant for the respective procedure all step. Team-time-out (TTO) should be performed just prior to Method: If we want to answer this objective we have to the endoscopic procedure to verify that the right patient is considerate that there is two way to track and trace appropriately prepared in the correct room with the correct endoscopes, the written follow-up or software. Today there equipment is ready for use and that the team is aware of still have a big part of endoscopy department whose using the individual risks of the respective patient. The following paper support with a big work of archiving. But now parameters have to be checked (5-8): software begin install in different unit. - Introduction of team members with their function Result : Current recommandation encourage computer during this procedure software development. Thanks to that you can have any - Identification of the patient (name, date of birth, Pat-ID) information in very short time and you minimize error - Planned procedure with indication, aim and planned sources. strategy Conclusion : Endoscopy department should invest in - Correct function of all necessary equipment computer tracability and specially the biggest department. - Planned sedation These organization facilitate management and allow to - Relevant comorbidities and risks of the patient (e.g. have more safety. 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 L- 26 is performed with a structured checklist (9). Sign-out is performed directly after finishing the procedure ESGENA Statement: Sign- in, time-out, sign-out safety before the patient leaves the procedure room. All team netting in Endoscopy members must be present and must stop all other tasks. Ulrike Beilenhoff, Germany The following items should be confirmed: - End of the procedure with result Introduction: Adverse events and complications are - Any equipment problems? common in all fields of medical treatment and often - Completeness of the documentation including status of preventable. An international, systematic review showed patient and instructions for aftercare that adverse events may occur in 1 in 10 hospitalized - All Specimens labelled patients (1). Possible causes of errors and mistakes are Noise and interruptions should be avoided during the sign- (2): in, TTO and sign-out. The use of standardised Endoscopy - Structural deficiencies (inadequate equipment, lack of specific checklists ensure objectively reproducible staff, insufficient qualified staff) processes, safe time and contribute to patient safety. - Lack of communication and coordination Implementation phase - Work intensification and stress A multidisciplinary working group should be established to - Errors in the implementation of knowledge. develop department specific checklists based on national In 2008 the World Health Organisation published its or WHO recommendations. The entire endoscopy team initiative “Safe surgery safe lifes” (3). A 19-item surgical has to be informed about the background, aims, objectives checklist was developed to improve team communication and implementation procedure. The checklist should be and to identify patient´s risks. The efficiency of this tested and improved during an implementation phase of checklist was evaluated in a worldwide study (in 8 some weeks before the final document will be approved as hospitals on 4 continents, in rich and poor countries) (4). an official document. The checklists can be designed in Failures, errors, complications (like surgical infections, paper format or included in electronic endoscopy pneumonia) and mortality were significantly reduced by documentation systems. using this checklist. This led to the worldwide Summary & Conclusion: Checklists in Endoscopy are implementation of surgical checklists. In the last 10 years helpful tools to assess patient´s risks, to intensify team checklists have increasingly been implemented in communication and to prevent failures. Sign-in, TTO and Endoscopy (5-8). The ESGENA Education Working Group sign-out can easily be implemented in Endoscopy units. developed an official statement.

ESGENA Abstracts Oral Presentations

References: L- 28 1. de Vries EN, Ramrattan MA, Smorenburg SM, et al. The incidence and nature of in-hospital adverse events: a Endoscopy related infections – is sterilisation an systematic review. Qual Saf Health Care 2008;17: 216–23. 2. Cullinane M. Scoping our practice: The 2004 Report of the answer? National Confidential Enquiry into Patient Outcome and Death. Michael Jung, Mainz National Confidential Enquiry into Perioperative Deaths, London, 2004. Thermolabile flexible endoscopes are classified as semi- 3. World Health Organisation. Safe surgery saves lifes. critical devices and were consequently reprocessed with www.who.int/patientsafety/safesurgery/en/ manual cleaning, disinfection by automatic washer- 4. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global disinfector and thorough drying before storage. population. N Engl J Med 2009;360:491–9 Numerous infectious series by contaminated 5. AGA, ACG, ASGE. Gastroenterology Safe Surgery Checklist duodenoscopes with multi-drug resistant organisms in the for Ambulatory Surgical Centers. http://gi.org/wp- last five years have raised questions, if standard protocols content/uploads/2012/03/TriSocietyASCChecklist.pdf for disinfection are sufficient enough or if sterilisation 6. Matharoo M, Thomas-Gibson S, Haycock A et al. modalities should be considered. There are 3 main Implementation of an endoscopy safety checklist. Frontline reasons for possible failure of high level disinfection of Gastro. 2014; 0, 1–6, doi:10.1136/flgastro-2013-100393 endoscopes: the complex design of the instruments with 7. Denzer, U. et al. S2k guideline: quality requirements for gastrointestinal endoscopy, Z Gastroenterol 2015; 53: E1– small narrow lumina and branch channels, difficult to clean E227 and disinfect, in particular the area around the Albaran 8. NHS National Safety Standards for Invasive Procedures elevator in duodenoscopes. The contamination of fluids (NatSSIPs) Endoscopy, published in September 2015. and accessories (cleaning brushes, adaptors, water bottles https://www.england.nhs.uk/wp- etc.) and the risk of developing biofilms. And finally human content/uploads/2015/09/natssips-safety-standards.pdf factors with untrained personnel and the risk of errors during the procedure Several attempts to optimize reprocessing of flexible L- 27 endoscopes, either with doubled cycles in washer- disinfectors (Rex, Endoscopy 2017) or ethylene oxide gas sterilisation (Narytzky GIE 2016) did not lead to complete High prevalence of digestive bacteria in elimination of microorganisms but to increased costs and duodenoscopes – how does a national survey time loss. influence daily practice As heat sterilisation would damage and destroy flexible Margreet C Vos, The Netherlands. endoscopes, only low temperature sterilisation can be

regarded as a possible alternative. Ethylene oxide gas Increasing numbers of outbreaks caused by contaminated sterilisation has not proven to be superior to disinfection in duodenoscopes used for Endoscopic Retrograde this regard. Cholangiopancreatography (ERCP) procedures have been The European view so far is based on intensifying and reported, some with fatal outcomes. We conducted a optimizing the current process of reprocessing with nationwide cross-sectional study to determine the validation and regular re-qualification of washer- prevalence of bacterial contamination of reprocessed disinfectors, a regular microbiological surveillance and the duodenoscopes in The Netherlands. All 73 Dutch ERCP focus to personnel training and qualification. ESGE- centers were invited to sample ≥2 duodenoscopes using ESGENA guidelines (Endoscopy 2018 in press) on centrally distributed kits according to uniform sampling reprocessing may serve as a basis for the European view. 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 L- 29 (MGO). Sixty-seven out of 73 centers (92%) sampled 745 sites of 155 duodenoscopes. Thirty-three (22%) Biofilm formation and prevention - a challenge with duodenoscopes from 26 (39%) centers were contaminated flexible endoscopes (AM20). On 23 (15%) duodenoscopes MGO were Lionel Pineau, France detected, including Enterobacter cloacae, Escherichia coli, Not submitted 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 L- 30 a new guideline on methods and frequency of culturing endoscopes. We developed a program of repeating ESGENA European Curriculum for endoscope cultures depending on the outcome of the culture results. reprocessing With this, the frequency of cultures and the prevention Ulrike Beilenhoff, Germany; Jadranka Brljak, Croatia; measures taken depends on the results of the Christiane Neumann, UK measurements. However, no results of working with the guideline are available yet. Principles: Flexible endoscopes are reusable, complex Keywords endoscopic retrograde medical devices with numerous lumens and narrow cholangiopancreatography; reprocessing; disinfection; channels. Due to their thermo labile construction and contamination 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

ESGENA Abstracts Oral Presentations

endoscopic procedure (universal precautions). Sufficient life long condition can vary in its severity from occasional number of trained, dedicated, competent staff and interference with daily living to being a continuous burden sufficient time are prerequisites for correct reprocessing of for patients causing suffering, hardships and loss of social endoscopes and endoscopic accessories. A formal interactions. Healthcare professionals supporting patients officially recognized training is recommended, followed by and their families with a diagnosis of inflammatory Bowel competency assessment. Disease aim to enable a supporting therapeutic Aims: ESGENA developed a European Curriculum for relationship that allows patients to decide on the endoscope reprocessing recommendations offered to them with the aim of helping in order them lead a ‘normal’ and active life. The interactions - to set standard for education of nurses and other patients have with healthcare professionals will determine health care workers who are responsible for how engaging they are with care decisions and treatment endoscope reprocessing recommendations. Nurses provide one of the key - To support national nursing societies, official bodies relationships with patients, they are seen as more and course organisers to establish educational accessible and having more time to give information, structures for staff reprocessing flexible endoscopes psychological support to patients and their families. and endoscopic equipment Inflammatory Bowel disease is complex, healthcare teams - To establish equivalence of training and consequently need tools to help them make the right recommendations support free movement within the EU for patient care decisions to be made in a timely manner to Target group: This curriculum is aimed to train health care prevent disease progression. workers Aim: This presentation will aim to provide: - working in Endoscopy department and Central - An overview of Inflammatory Bowel disease. Sterilization Service Departments (CSSD) - Drugs used to treat IBD and the monitoring - involved in the reprocessing of flexible endoscopes requirements. and its components - Types of monitoring and their influence on treatment Course Content: The course consists of different decisions. modules. The suggested number of hours results in a 3 - The role of Endoscopy in the management of IBD. days course for health care workers. - The role of IBD nurses in supporting patients. - Module 1: Basics of hygiene, epidemiology and - Influences on patient engagement in treatment. microbiology References - Module 2: Occupational health and safety https://www.ecco-ibd.eu/publications/ecco-guidelines-science.html - Module 3: Structural requirements for Endoscope https://www.nice.org.uk/guidance/cg152/ifp/chapter/monitoring Reprocessing units Clinical usefulness of therapeutic drug monitoring of thiopurines in patients with inadequately controlled inflammatory bowel disease - Module 4: Design, construction and use of endoscopes Melissa L. Haines MB, BS, FRACP Yousef Ajlouni MD, JB and its components and Accessories (Medicine), JB (Gastroenterology) Peter M. Irving MA, MD, MRCP - Module 5: Standardised and validated reprocessing of Miles P. Sparrow MB, BS, FRACP flexible endoscopes and its accessories - Module 6: Validation and routine testing of

standardised reprocessing cycles for flexible endoscopes and its accessories L- 32 A formal assessment is recommended.Regular practice and updated training are essential to maintain IBD – Passport – a tool for information and competency. Initial training, regular updates and regular communication in daily live and for travelling competency assessment should be documented for Key Greveson, United Kingdom endoscopy and reprocessing staff. Regular audits should be performed in order to assess compliance with Inflammatory bowel disease (IBD) and foreign travel is guidelines and to identify any lack of competence or associated with an increased risk of travel-related inconsistent attitudes at an early stage. morbidity caused through exacerbations of IBD, References: acquisition of infectious diseases endemic to the - ESGENA Statement: European Job Profile for Endoscopy destination and availability of healthcare and medicines Nurses. Endoscopy 2004;36:1025–30. whilst abroad. This presentation will outline research - European Society of Gastroenterology and Endoscopy Nurses undertaken to examine the patient’s experience of travel and Associates (ESGENA). ESGENA Core Curriculum for with IBD, including pre-travel preparation and will present Endoscopy Nursing. 2008. www.esgena.org the development of IBD Passport online travel resource for - Beilenhoff U, Neumann CS, Rey JF, et al. ESGE-ESGENA IBD. guideline: Cleaning and disinfection in gastrointestinal endoscopy. Update 2008. Endoscopy 2008; 40: 939-957, Update 2018 in press - VEDAS - Vocational Education Disinfection and Sterilisation” L- 33 (October 2011 - November 2013). www.evedas.com Iron-deficiency, anaemia and fatigue in IBD Palle Bager, Denmark

L- 31 This presentation will take you through three common conditions for patients with inflammatory bowel disease Monitoring of IBD patients – what issential? (IBD): iron deficiency, anaemia and fatigue. How do we assess disease state and patient well being The prevalence of iron deficiency in IBD is approximately in inflammatory Bowel disease? 35% and for anaemia the prevalence is close to 20%. Irene Dunkley, United Kingdom Fatigue is present in approximately 40% of patients with IBD in remission and much higher if IBD flare is present. Introduction: Patients with Inflammatory bowel disease The presentation will focus on each condition and the are monitored from the time their diagnosis is made. This

ESGENA Abstracts Oral Presentations

possible relationship between them. Furthermore, In healthcare AI is involved in classification and reflections on treatment will be presented. recognition, advise and search task, complex task planning The presenter holds a position as clinical nurse specialist or interference and prediction. In digestive AI is used for and achieved a PhD degree in 2014 based on research assist or execution assist with endoscopy three main within the present topic. 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. L- 34 This is already achieved on colonoscope prototype. Detection function guide practitioner during examination N-ECCO Continuing education – what can Endoscopy allowing to enhance area with abnormalities. learn? For classification, the computer has to be fed with Palle Bager, Denmark thousands of pictures in order to obtain a learning machine the classification is obtain with the trained model. various This presentation will focus on how the European Crohn's model has been already publishing on Barrett or stomach. and Colitis Organisation (ECCO) have created their The most impressive study has been published Y. Mori education activities. Special attention will be on the from S, Kudo group using AI with endocystoscopy on polyp education of inflammatory bowel disease (IBD) nurses classification with impressive accuracy and specificity.AI organised by Nurses-ECCO (N-ECCO) and how this allows also to guest outcome after ESD on superficial activity is integrated with the rest of ECCO. The presenter carcinoma on lateral spreading tumour. S.Kudo show the holds a position as clinical nurse specialist and has been benefit of AI in prediction of lymphanode metastasis. committee member of N-ECCO between 2014-2018, the Finally, AI is using in digestive endoscopy during last year as committee chair.As a teaser you can visit the interventional procedure in order to achieve delination on ECCO homepage at: https://www.ecco-ibd.eu/ 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 L- 35 quality endoscopy not only for experts but to all endoscopist Artificial intelligence in digestive endoscopy Jean Francois Rey, France L- 35 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 New aspects of microbiome therapy like intelligence then a new form of intelligence (super Christoph Högenauer, Austria human expert). These systems require knowledge and Not submitted 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.

ESGENA Abstracts Poster Presentations

P-1 7. Guarini A (2010). Il reprocessing in Endoscopia Digestiva: l’ottimizzazione delle risorse è possibile. Infermiere Oggi 2:22- Organizative aspects in italian digestive endoscopy 7P-2 units: A national survey by ANOTE-ANIGEA 1 2 3 Alessandra Guarini , Elena Rossetti , Pierangelo Simonelli , 4 5 6 Teresa Iannone , Daniela Carretto , Antonella Giaquinto , P-2 Giorgio Iori7, Monia Valdinoci8, Cinzia Rivara9 1Nuovo Regina Margherita Hospital, Rome; 2IRCCS Humanitas, My experience of integrating into an endoscopy unit in Milan; 3 ‘Spedali Civili’ Hospital, Brescia;4 ‘Polistena’ Germany coming from Albania Hospital;5 ‘Cardinal Massaia’ Hospital, Asti; 6‘Tor Vergata’ Jorgert Kishta und Urte Stahlberg, Charité University University Hospital, Rome; 7 ‘Santa Maria Nuova’ Hospital, Medicine Berlin, Campus Benjamin Franklin, Berlin, Reggio Emilia; 8 ‘Careggi’ University Hospital, Florence; 9 Germany ‘Ciriè’ Hospital, Turin, Italy Background: The project started as a pilot project for Introduction Novel technologies, techniques and devices nurses who wanted to work in Germany. First, an intensive are continuously introduced in Digestive Endoscopy Units. language course until the level B2 was mandatory. Therefore, an adequate organization is required, including Second, passing the professional exam allowing the work apposite structures, technologies, and presence of in Germany was necessary. The main aim was to learn dedicated nurses. ANOTE-ANIGEA performed a Nation- and adapt new methods and standards developed recently wide survey to assess all these aspects in the Italian in the field of diagnostic and therapeutic endoscopy. Endoscopy Units. Differences between a German endoscopy unit to Materials and Methods A specific questionnaire was home country: There are two examination rooms at the prepared with different items regarding structures, hospital in Albania, one for gastroscopy and the other for organization and nursing activities in the Endoscopy Units. colonoscopy, and the sterilization room for the endoscopes The questionnaire was distributed to ANOTE-ANIGEA and instruments. During the endoscopic procedures two associates working in different Hospitals distributed nurses and one doctor were present in the examination through Italy. Data were statistically analysed by using Chi- room. Sedation for gastroscopy was performed with square test or Fisher’s test, as appropriate. midazolam and fentanyl and for colonoscopy, propofol was Results Overall, questionnaires from 176 different used. In cases of therapeutic interventions such as Endoscopy Units were evaluated (Figure 1). Data found sclerotherapy, APC, polypectomy, PEG, oesophageal that a recovery room and a distinct dirty-clean area were band ligation and ERCP, anaesthesiologists routinely lacking in 15% and 45% of centres. In 19% of centres, the performed the sedation. Regarding the endoscopic reusable devices were reprocessed with high level examinations in the Charité, there is a difference in the disinfection rather than sterilization, as well as the number and diversity compared to the situation in Albania. reprocessing traceability was lacking in 23% of centres. In the Charité, propofol is used for outpatients. For There was a median of 6 (range: 1-30) nurses in different inpatients and longer or more therapeutic interventions, a centres. The number of nurses working in each combination of midazolam and propofol is recommended. Endoscopic room was provided in Figure 2. In as many as Sedation in Germany is mostly administered by the 56% of centres, only the nurses perform reprocessing, assistant personal after special training. Lack of personal other trained staff being lacking. Of note, significant experience existed in ERCP, PTC, EUS or innovative new differences emerged when comparing data from Northern, techniques like FTRD, cholangioscopy with lithotripsy or Central, and Southern centres (Figures 3-5). RFA. For these examinations intensive training and Conclusions This survey found concerns on reprocessing support from the colleagues was necessary. of reusable devices (high level disinfection rather than Personal deficiencies in Language and Experience sterilization) in several centres. A distinct dirty-clean area Implementing new standards was challenging for different is lacking in half Endoscopy Units. Lacking of dedicated interventions such as ERCP, PTC or EUS and other staff for reprocessing other than nurses lead to therapeutic examinations. Several practice sessions inappropriate use of resources in half of centres. occurred and for intensifying special techniques, hands-on- Significant differences emerged among Northern, Central training courses are planned in the future. A good and Southern Italy. collaboration and the support from colleagues are References important and very efficient. 1. ANOTE-ANIGEA (2011). Linee Guida. Pulizia e disinfezione Overcame the deficiencies: Integration in a German in Endoscopia. Update 2011. 1-51 endoscopy unit is a process that requires time and 2. UNI Technical Report 11662 (2016). Ricondizionamento dei commitment. Beside several difficulties and problems in dispositivi medici – Guida al ricondizionamento degli the beginning, the barrier of language was the main endoscopi termolabili. 1-51. challenge of all. During initial training, the support of the 3. Bazzoli F, Buscarini E, Cannizzaro R, et al. (2011) Libro bianco della Gastroenterologia italiana. colleagues is very helpful. In the first two weeks, basic 4. Beilenhoff U, Neumann CS, Rey JF et al. (2008) ESGE- observation of the whole unit was recommended. One ESGENA guideline: cleaning and disinfecion in gastrointestinal week was scheduled for each examination room endoscopy. Update 2008. Endoscopy 40:939-57. (gastroscopy, colonoscopy, EUS, recovery room) and two 5. Caletti G, Chilovi F, De Boni M, et al. (2003) Il libro bianco weeks for the ERCP-room. dell’Endoscopista. Centri di endoscopia e soluzioni adottate. 5- Conclusion; The project for emigration to Germany was 21. successful despite difficulties in language and adaption of 6. Caruso R, Pittella F, Ghizzardi G, et al (2016). Che cosa professional abilities. The experience for five years in an ostacola l’implementazione di competenze specialistiche per endoscopy unit in Albania significantly facilitated the l’infermiere? La prospettiva degli infermieri clinici: uno studio integration. However, integration is a continual process esplorativo e descrittivo. L’infermiere 53:e22-e28. that needs further education and specific training.

ESGENA Abstracts Poster Presentations

Learning outcome: Integration is an intensive experience P-4 which needs time and energy but brings a lot of joy after this new start of life. A good teamwork facilitates inclusion. Mindfulness as a challenge in today's nursing Integration to be continued …! Tina Kamenšek1, Darja Thaler2,1 Department of Nursing, Faculty of Health Sciences, University of Ljubljana, Slovenia, 2 Department of Nursing, Faculty of Health P-3 Sciences, University of Ljubljana, Slovenia

Innovations in the Gastroenterology Nurses Training Introduction: Mindfulness is a holistic approach to person, in Israel that improves the function of human in all aspects. It is Yuri Guriel, Rambam Health Care Campus, Haifa, Israel; important to be aware of mindfulness being the central Shirly Luz, Nursing Division, Ministry of Health, Jerusalem, pathway during nursing, which puts in the forefront mutual Israel: Revital Barkan, Rabin Medical Center, Petah Tikva, relations and holistic treatment of patients and evidence- Israel; Galia Niv, Nursing Division, Clalit Medical Services, based medicine. In Slovenia, not only the relation to the Israel; Rina Assulin –Ophir, Rambam Health Care fellowman, but also the understanding of its needs during Campus, Haifa, Israel the illness, is very deteriorated. Due to the weakening of Nursing training in Israel for registered nurse begins with the culture of relationships among healthcare workers, this bachelor’s degree in nursing extending for four years. After also reflects in relation to the patient. All this affects the graduation, nurses can choose a specific field of quality of the care and the patient's satisfaction during specialization and a career path. Training in advanced treatment. fields is carried out as part of post basic courses. Aim: The aim of this contribution is to draw attention to the The purpose of the training program is to address the problem of relationships in nursing. We also want to changing challenges of the health care system as well as encourage and educate healthcare professionals about the to provide solutions for the future demands of hospitals importance of using empathy and sympathy during work and the community clinics training requirements. Studies in with their patient. post basic courses provide theoretical knowledge to Methods: There was a descriptive method of work, used learners, as well as practical experience in the relevant with a review of professional and scientific literature, clinical field and simulations of representative clinical published in English between 2008 and 2018. The situations and patient-care scenarios. keywords, used for searching, were »mindfulness, nursing, The curriculum is determined by the Nursing health workers and patients«. The articles were selected Administration in the Ministry of Health and is updated according to the keywords, and the relevance of the once a year with the help of experts from the clinical field research, where patient and healthcare workers were and is based on evidence-based nursing studies. involved, in order to examine the impact of mindfulness. Currently, training programs take place in 21 fields, such We examined selected articles with a qualitative analysis. as intensive care, emergency medicine, oncology, Findings / Results: The studies, that were included in the geriatrics, etc review, indicated the positive effect of mindfulness on the This year, for the first time, a post basic course training relations among nurses and patients, and consequently program for gastroenterology nursing will be launched. As better treatment outcomes were shown. The main reason part of this training, nurses will undergo extensive for that is in bigger listening, an increased sense of education program and clinical training. empathy, and less judgmental attitude of nurses towards The educational framework includes topics such as the patients. Examples of good practice describe training physiology of the digestive system, advanced endoscopy, of mindfulness, that reduces the stress of nurses and Inflammatory Bowel Disease, gastrointestinal diseases, patients, it improves communication, that by inference nutrition, sedation, infection prevention and legal aspects causes better satisfaction of involved one, and higher of nursing work and other related subjects. quality of health care. In addition, nurses will undergo workshops designed to Summary and Discussion: Mindfulness enables people help them improve their skills for coping and for to become more aware of their body sensations and the emotionally supporting patients and their families suffering way they think and feel. It has the potential to produce from chronic illnesses. benefits in the prevention and treatment of physical and The duration of theoretical studies is about 450 academic mental illnesses. Trained nurses can safely offer hours. Furthermore, nurses will also undergo a clinical mindfulness as a choice for patients to assist them in training lasting between 130 and 200 hours depending on healthcare process and to self manage their disease. One their experience in the gastroenterology field. After of the successful forms of training is supervision. Research graduation of the course and after preforming a simulation- in Slovenia revealed that nurses consider supervision based exam the graduate nurse will get credential and a useful and they want to integrate it into their work. That is wide scope of practice that will enable her to provide why supervision has been included as obligated study specific services and treatments such as independent subject for registered nurse and midwife in Slovenia. sedation supplementation, referral to imaging and Conclusion: The fact is, that the attitude towards the laboratory tests, change of steroid dose for IBD patients, human was, is, and always will be topical and necessary. gastrostomy maintenance treatment, IBD patient Over time, its form changes, but it should not disappear. preparation for biological treatment and other related Introduction of mindfulness into education and practice can activities. 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.

ESGENA Abstracts Poster Presentations

P-5 Conclusions: Sedation with Propofol, administered by a trained endoscopy team has a good safety profile when Right time for Propofol? A 4-years experience in an administered in ASA 1-2 patients and it guarantees an Italian center excellent level of confort for patients with an improvement Massimo Petrocco, Maria Pia Caldarella, Nicoletta of the quality of procedures. Furthermore endoscopy Cicconetti, Gilda Napoletano, Paolo Panaccio, Maria nurses can improve their profile getting advanced Teresa Tartaglia, and Maria Marino. Unit of Surgical competences in management of patients and Digestive Endoscopy; “G.Bernabeo” Hospital of Ortona complications in deep sedation. (Chieti) – Italy References: [1] ASGE Standards of Practice Committee, Early DS, Lightdale Introduction: Propofol-induced deep sedation in JR, Vargo JJ 2nd, Acosta RD, Chandrasekhara V, Chathadi endoscopy improves procedure's quality (caecal KV, Evans JA, Fisher DA, Fonkalsrud L, Hwang JH, Khashab MA, Muthusamy VR, Pasha SF, Saltzman JR, Shergill AK, Cash intubation, adenoma detection rate) and eases patient BD, DeWitt JM. Guideline for sedation and anesthesia in GI discomfort and anxiety [1]. The Italian Digestive endoscopy. Gastrointest Endosc 2018 Feb;87(2):327-337 Endoscopic Society (SIED) released a document with [2] Giorn Ital End Dig 2014;37:223-227 La sedazione in endoscopia recommendations for using Propofol by a trained digestiva; Rita Conigliaro, Lorella Fanti, Matteo Gazzi 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 P-6 monitoring and in management of complications (training courses as Basic and Advanced Life support: BLS- Patient assessment: Checklist for endoscopic ALS/ACLS). procedures Aim: Complications rating of the Propofol-induced deep Rafaela Bré, Carla Sousa, Hospital da Senhora da Oliveira sedation made by non anesthesiologist (NAPS) to – Guimarães, Portugal demonstrate safety and feasibility of deep sedation administrated by a trained endoscopy team through Introduction: There is an increasing emphasis on the improving of competences. patient safety culture. In a digestive endoscopy unit (DEU) Method: Retrospective observational study. Between the common mistakes are often inconsequential and as February 2014 and February 2018, 8412 patients (females such are not valued. Our ability to perform therapeutic 4724, males 3688 mean age 62 +/- 6) had colonoscopy procedures has increased exponentially, both in number with NAPS, for patients with a ASA (American Society of and in specificity, which has an impact on the associated Anesthesiologists classification) 1 and 2. Each patient inherent risks and complications. However, minor errors compiled a satisfaction questionnaire (measuring anxiety can lead to significant adverse events. In 2012, the and comfort before and after the procedure) and nurses National Department of Health's Patient Safety Agency redacted a nursing documentation to record clinical history, updated the list of serious but preventable patient safety risk factors, allergies, pharmacological therapy and vital incidents, and integrated incidents that are directly related signs during the procedure and the awakening ( oxygen to DEUs: overdose of benzodiazepine during conscious saturation, heart rate and blood pressure). A crash cart to sedation; failure to monitor and respond to oxygen manage the complications has been set; endoscopy team saturations during a sedation procedure; incorrect patient performed trainings through BLS and ALS/ACLS courses. identification; wrong endoscopic procedure; and A dedicated person was used for propofol administration, positioning of the nasogastric tube. In Portugal, the with available anesthesiologist (on the same floor of the Ministry of Health has developed the National Plan for endoscopy unit) and emergency team (MET). Patient Safety 2015-2020, which aims to achieve 9 Results: In all recruited patients there were no significant strategic objectives, four of which directly related to the heart rate alterations.About 12% developed hypoxaemia patient evaluation in a DEU: to increase communication (SpO2 <90%) and about 10% required oxygen security; correct procedure identification; ensuring the supplementation. Hypoxaemia (SpO2 <85%) was unambiguous identification of patients; and prevent the observed in about 2% of cases, but the use of supraglottic occurrence of falls. Current evidence suggests that the airway devices or tracheal intubation were not necessary. implementation of the pre-examination checklist can help Hypotension was observed in 5% (sBP <90mmHg) with prevent errors in a DEU. spontaneous resolution. More than 99% of colonoscopies Aims: The purpose of this research was to improve the were completed reaching the caecal fund ..Furthermore we ability to elaborate and implement the checklist for recorded a significant decreasing of anxiety and discomfort endoscopic procedures. of patients after the procedure. Methods: We reviewed the literature in databases: Discussion: Hypoxaemia was the most common adverse PubMed, EBSCO host web and other data sources. event encountered with propofol sedation during Results: The current evidence tells us that the checklist endoscopic procedures and it was easily managed by should include the following items: correct patient endoscopy team. The absence of several complications identification; correct procedure identification; confirmation and the low rate of moderate complications (2%) avoided of signed informed consent; allergies; relevant clinical resuscitation procedures and/or anesthesiologist and pathology; current medication; examination, if necessary; emergency team intervention. and recording of vital signs. The model of the checklist Limitations. The study included only NAPS, without must be developed and consensus obtained by all recording anesthesiologist–administrated propofol (AAP) members of the team that will use it. Education of the which would be useful to make a comparison between multidisciplinary team, should be carried out through in- complication ratings. Furthermore the study didn't observe service training actions. Strong leadership is needed within complications of midazolam or petidine-induced sedation the nursing and medical team to establish a change in (sometimes considered safer then propofol because of practice. A period of time should be stipulated for the reversibility), although we observed 2 severe complications training and implementation of the checklist. An exclusive with sedoanalgesia and “conscious sedation”. person must fill out the checklist.

ESGENA Abstracts Poster Presentations

Discussion: The checklist is a simple and inexpensive members considered that the service has good tool, is feasible and significantly increases the perception professionals and equipment, but the facilities could be of team communication and teamwork. The checklist is improved and the relational aspect with the patient should dynamic, needs constant improvement, and does not work be optimized. This study was performed in a single if it is not properly filled and engaged with all the team. centre and there are potential biases related to the Conclusion: Improving patient safety is a team researcher previous conceptions. Nevertheless, these responsibility and a collective process, which aims to results indicate that patients have an uncritical attitude, ensure the highest possible safety of patients, avoiding not positioning themselves on quality issues and this is an unnecessary incidents. important issue that healthcare providers must consider. Learning outcomes: The preparation and implementation It seems that both patients and providers agree that the of the checklist should be adequate to the DEU reality. The technical parameters must be hold by health providers checklist should be concise and easy to fill out. The whole and are in general good, but that communication can be multidisciplinary team must be involved. 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 P-7 communication seem to be dimensions to be improved

Patients’ Perspectives Towards Quality of a Digestive and relevant in the quality of health care from a patients’ Endoscopy Service: A Qualitative Approach perspective. Nurses must be involved in all these Vânia Maria Braga, MSc (1); Marta Pinto, PhD (2)(3); processes towards an improvement and to a patient- Sílvia Ferraz, MSc (1); Mário Dinis Ribeiro, MD, PhD centeredness care obtained. (1)(3); Luís Filipe Azevedo, MD, PhD (3) References 1) Gastroenterology Department, Portuguese Institute of • Brown, S. et al. (2015). Patient-derived measures of GI endoscopy: a meta-narrative review of the literature. Oncology, Porto; 2) Department of Psychology of Addictive Gastrointest Endosc, 81(5), 1130-1140.e1131-1139. Behaviours, Faculty of Psychology and Education Science, • Cohen, J., & Pike, I. M. (2015). Defining and measuring University of Porto; 3) Center for Health Technology and quality in endoscopy. Am J Gastroenterol, 110(1), 46-47. Services Research (CINTESIS) & Department of • Rees CJ. et al. (2016) European Society of Gastrointestinal Community Medicine, Information and Health Decision Endoscopy - Establishing the key unanswered research Sciences (MEDCIDS), Faculty of Medicine, University of questions within gastrointestinal endoscopy. Endoscopy, Porto. Portugal. 48(10):884-891. • Rutter, M.D. et al. (2016). The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: Background: Quality of endoscopy is of paramount developing performance measures. Endoscopy, 48(1), 81-89. 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, P-8 but the focus was the overall satisfaction and only a few instruments were truly based on patients’ experiences. Storage Time of Flexible Endoscopes Longer than 30 Objective: We hypothesized that by understanding the Days is Associated with an Increased Contamination expectations of patients, the quality of endoscopy Rate services would be improved. We aimed to identify Yvonne Fietze, Universitätsspital Bern. Switzerland elements of quality most important to patients in their perspective, to offer information to healthcare providers Background: Recommendations of professional societies on how to improve the quality of delivered care. on storage times for flexible endoscopes vary considerably Methods: Qualitative research study using in-depth, between twelve hours to two months, or even no semi-structured, face-to-face interviews performed by a recommendation at all. Underlying high quality clinical data single interviewer involving 16 patients and 10 healthcare are scarce. We aimed at identifying a time point that could providers, and content analysis. Participants were trigger reprocessing. selected by theoretical sample and sample size was Materials/methods: Single centre surveillance study achieved by saturation. The inclusion criteria were between march 2014 and april 2017. We prospectively patients submitted to upper or lower gastrointestinal analysed routine microbiological samples from flexible endoscopy in a single hospital, including diagnostic or endoscopes where the date of last disinfection processing therapeutic procedures, and healthcare providers working was available. Co-variables were information on the at the same endoscopy unit. The exclusion criteria were sampled channel, on the endoscope setup, centralised refusal or inability to answer to questions. Ethical versus localised processing, use in an endoscopy center, approval was obtained. Results and Discussion: and storage condition. Detection of ≥10 CFUs/ml flush Patients seemed to rely on the healthcare providers medium were defined as the contamination cut-off. aspects related to technical quality of the procedure. Also, Generalized linear and additive models (GAM) were used they reported receiving care as expected and to describe effects predicting endoscope contamination. demonstrated a positive image of the staff and the Results: 1,024 flush samples from 106 flexible service. In addition, they showed a great feeling of endoscopes were included. The co-variables were gratitude and attachment to the institution. In general, normally distributed for the different storage times (0-7; 8- patients expected to be well cared for, not feel pain and 30; >30 days). The contamination rate for a storage time be properly informed. In fact, they mentioned that >30 days was 6% and significantly higher compared with communication skills and the option and waiting time for a 0-7 days (1.2%; OR 5.3; 95% CI, 1.2-17.9, p=0.014). This procedure under sedation are aspects to be improved. On rise in contamination rate at about 30 days was confirmed the other hand, healthcare providers stated that they must in a GAM (p=0.045, Figure 1). None of the co-variables be holders of current scientific knowledge and technical were associated with contamination. skills and that the most important issue for the patient should be to perform the procedure safely. The staff

ESGENA Abstracts Poster Presentations

Conclusions: Storage times over 30 days were the only P-10 parameter predicting increased endoscope contamination. Contamination rate was not influenced by storage PAIN IN UPPER GASTROINTESTINAL ENDOSCOPY. IS condition and centralised processing. Our data suggest, GASTROSCOPY REALLY PAINFUL?. that endoscopes should be reprocessed prior to clinical Pedro Luis, del Mazo Tomé1,2/ Esther, González Nieto1/ use if storage is >30 days. María Concepción, Martínez Sexto1/ María Almudena, Keywords: endoscopes, microbiologic sampling, storage Pousada González1,2,3/ Ana María, Nieto Quesada1/ Alejandro, Toledo Soriano1,2 / (1) Hospital Universitario Central de Asturias (HUCA), (2) Instituto de Investigación P-9 Sanitaria del Principado de Asturias and (3) Universidad de Oviedo / Oviedo (Spain) Technical report on the reprocessing of thermolabile endoscopes: an Italian experience Introduction: Gastroscopy is not as aggressive a Cinzia Rivara, Italy procedure as surgery might be, however, it is an invasive technique. Frequently, patients suffer discomfort and even Introduction: Guidelines from Scientific National and pain of changeable intensity. International Associations are today available and overlook Objective: Evaluate number of patients who suffer pain the reprocessing of flexible endoscopes. However, a and/or discomfort in upper gastrointestinal (GI) endoscopy technical standard is missing, which should define the and quantify it. overall characteristics of the reprocessing process Method: Observational, quantitative, prospective and non- (operational phase and related tests, controls and randomised study carried out at HUCA from May to qualifications; competencies and responsibilities; September 2017. Subjects under study: Representative environment; traceability; validation). sample was obtained from the 6500 gastroscopies Objective: Define a Technical Document for the performed at HUCA endoscopy unit in 2016. Applying the reprocessing of thermolabile endoscopes in order to finite population correction factor, a total of 382 subjects address not only the operational process activity but also were obtained as a representative sample, with 95% of the organizational and management process. confidence level and adjusted to 5% of losses. Inclusion Method: Set up of a multidisciplinary working group criteria: Going to perform an upper GI endoscopy during (technical board UNI/CT 044/SC 12/GL 03 “Sterilization the period of study. Being over 18 years. Accept voluntary Processes”), formed by professionals involved at different participation in the study by signing informed consent. levels (nurses, physicians, association and industry Materials: A hetero-applied questionnaire that included representatives), in the reprocessing process for sociodemographic and clinical variables was applied. A thermolabile endoscopes. The group met regularly on numerical scale of 0 to 10 to assess pain and discomfort monthly basis. For the definition of the document scope a was used, with 0 being no pain and 10 being unbearable thorough analysis of international scientific literature and pain. For the data analysis, Statistical Package for the guidelines was performed. Referral to existing Technical Social Sciences (SPSS) was used. Standards for specific processes was also included. Results: This study involved 382 subjects, of whom 175 Results: After 18 months, in December 2016 the working were men (45.8%) and 207 women (54.2%). Participants’ group drew up a document entitled “Medical Devices mean age was 54.02 years, range of 19 to 89 years old Reprocessing – Guide to the reprocessing of thermolabile and standard deviation of 14.96. Sedation used: None 1 endoscopes”. Following the performed analysis, the (0.3%), topical 11 (2.9%), conscious 113 (29.6%) and both experts decided to define a Technical Report rather than a 257 (67.3%). Experienced perceptions: Nothing (23%), Standard; therefore, the document adopted a more discomfort (70%), pain (5%) and both (2%). Experienced descriptive nature and showed, in a single document, pain was greater in men than in women (Welch's t-test, p- advanced methodologies for the design, development, value = 0.049). Relation between presence of experienced control and evaluation of the efficacy of the single stages pain and previous digestive pathology: Existence of and entire reprocessing procedure for thermolabile previous digestive pathology is related to pain presence endoscopes. This was achieved also considering the (Pearson's chi-square test, p-value = 0.038). Relation objectives to reduce microbial charge for a safe use of the between value of experienced pain and complications aforementioned devices. during the test: Patients who had complications during the Conclusions: The Technical Document, that integrates test had more pain (Wilcoxon signed-rank test, p-value = National Guidelines recommendations, represents for Italy 0). None statistical relation was found with pain for other a growth opportunity for professionals within this sector; it variables. brings to the reader the state-of-the-art information on the Discussion: Existing bibliography is about the tolerance of reprocessing of thermolabile endoscopic instrumentation the test, not specifically about the pain. As limitations, the and brings over talking points for the improvement and use of sedation might influence the perception of pain, achievement of high quality and safety standards within although none statistically significant differences have endoscopic procedures. Only through the implementation been found regarding the type or the amount of sedation. of a scientific methodology, we can derive standards and Conclusion: Only 7% of patients notice pain during recommendations in line with safety and quality objectives. gastroscopy, accompanied by discomfort (2%) or not (5%). Discussion among professionals represents an added Variables that influence in this pain are male sex, previous value in defining a document of great significance digestive pathology and appearance of complications References: during the test. 1. ANOTE-ANIGEA. Linee Guida Pulizia e Disinfezione in Learning outcomes and relevance to nursing practice: Endoscopia. Update 2011 Despite not being an especially painful test, patients do 2. ESGE-ESGENA guideline: cleaning and disinfection in GI report discomfort, so we should try to perform nursing endoscopy. Update 2008. Endoscopy 2008;40:939-957 interventions in order to improve patient's perceptions. In 3. UNI EN 285; 556-1; 868; 13060; 14698-1; 15883; 17664; UNI this way, by reducing discomfort during the test, we would EN ISO 11140-1; 11607-1; 11607-2; 14644-1; 15882; 17665-1; UNI improve the satisfaction with it. CEN/ISO TS 17665-2

ESGENA Abstracts Poster Presentations

eferences: 1.-Abraham NS, Fallone CA, Mayrand S, Huang J, to use in a new situations. Therefore we need to be Wieczorek P, Barkun AN. Sedation versus no sedation in the creative and open minded for new methods. performance of diagnostic upper gastrointestinal endoscopy: a References: canadian randomized controlled cost-outcome study. Am J - Allred HW, Spencer R. Haemangiomas of the colon, rectum, Gastroenterol. 2004; 99(9):1692-9. 2.-Tierney M, Bevan R, Rees and anus. Mayo Clin Proc 1974;49:739-41 CJ, Treble TM. What do patients want from their endoscopy - Sang Heon Lee, Seun Ja Park, [...], and Bo Mi Kim experience? The importance of measuring and understanding Endoscopoic Resection for Rectal Carcinoid Tumors: patient attitudes to their care. Frontline Gastroenterology. 2016; Comparision of Polypectomy and Endoscopic Submucosal 7:197-8. 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 P-11 hemorrhage. Gastrointest Endosc. 2012;75:382-7

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, P-12 Andrea Arany MD 7, Krisztina Tari RN BSc MSc 8,2 Nursing care for patients with bleeding gastric ulcerus 1, Joined Saint Istvan and Saint Laszlo Hospital, Boris Kopić, Croatia Endoscopy, Budapest, Hungary;

2, Semmelweis University, 1st Department of Surgery, Introduction and overview of research: In this final work Budapest, Hungary; shows the need for nursing care patients through the 3, Saint John Hospital, Department of Surgery, Budapest, process of health care with a case, and the categorization Hungary; of the patient suffering from bleeding ulcers in the 4, Semmelweis University, 1st Department of Internal stomach. Bleeding ulcerus can be very dangerous for Medicine, Budapest, Hungary; patient because it can cause death if patient lose a lot of 5, McGill University Health Centre, Montreal General blood. Hospital, Montreal, Quebec; It is very important to recognize that kind of diagnosis and 6, Semmelweis University, 2st Department of Pathology, nurses´ role is very important in health care Budapest, Hungary; Objective: The aims of the research as part of the final 7, Joined Saint Istvan and Saint Laszlo Hospital, work are the patient's nursing care. The aim was also to Radiology, Budapest, Hungary; show the incidence of bleeding ulcers by age, gender, and 8, Semmelweis University, Emergency Department appearances by season. My goal was to show the Endoscopy Unit, Budapest, Hungary performance of endoscopic surgery and treatment in the

rehabilitation of bleeding and categorization of patients Introduction: First application of rubber band ligation for according to the needs for health care. the treatment of internal hemorrhoids was performed by Patients and methods: In the final paper analyzes the Blaisdell in 1958. The method has became widely used available data from 110 patients with bleeding ulcers in the after 1963, since Barron improved the device; This method stomach for a period of two years (2011. and 2012.). is safe to apply and easy to use. Results: The results showed that the bleeding ulcer Case report: In a 19 years old female patient with known occurs more frequently in the male population in aged Crohn's disease, localized to the colon, a polypoid lesion between 45 and 65 years of age. It is also evident that the was found duringroutine colonoscopy. The lesion largest number of patients classified in the fourth category. appeared to be vascularized, purple in color and could be Conclusion: As the results of my research showed that localized 25 cm above the anal sphincter. MSCT despite the quality management of nursing documentation, examination was performed which confirmed it to be highly and thereby classifying patients into categories, still vascularized. Regarding the high risk for severe bleeding, nothing has changed in the improvement of working resection was performed with surgical assistance. conditions and increase the number of staff, can finally At first, two rubber rings was placed around to neck of the conclude that our profession, unfortunately, insufficiently polypoid lesion. Thereafter 1 ml of epinephrine was appreciated by those on whom is to allow us to easier injected into the neck of the lesion above the rubber rings working conditions, and thus improve the overall health which was followed by polypectomy with a standard hook. care. No complications were present throughout the observation Key words: stomach ulcer, gastroscopy, the process of period. Histological examination of the polypoid lesion health care, patient categorization or patiensts with confirmed it to be cavernous hemangioma. bleeding gastric ulcerus. Conclusion: Cavernous hemangioma is a benign, rarely References: found disorder, usually localized in the distal part of the 1. Bajek, S. Bobinac, D., Jerković, R., „et al“ , Sustavna anatomija gastro-intestinal system. Based on previous and present čovjeka, Sveučilište u Rijeci, 2007. finding there might be a connection between inflammatory 2. Fučkar, G. Proces zdravstvene njege. Zagreb: Medicinski bowel disease and the development of cavernous fakultet Sveučilišta u Zagrebu. 1992. 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

ESGENA Abstracts Poster Presentations

P-13 Background & Aims: The video capsule endoscopy (VCE) is an accurate and validated tool to investigate the Colon capsule endoscopy: comparison of clinically entire small bowel. According to current European relevant findings evaluation performed nurses versus guideline, VCE is recommended for investigating patients physicians with obscure gastrointestinal bleeding (OGIB), suspected P. Hnatova1, M. Setnickova1, J. Folttiny1, M. Voska1, T. Crohn’s disease, suspected small-bowel tumours, and Grega1, O. Ngo2, B. Buckova2, O. Majek2, M. Zavoral1, S. inherited polyposis syndromes [1]. Unfortunately, VCE Suchanek1 recordings interpretation by gastroenterologist is time- 1 Department of Internal Medicine, First Faculty of consuming. There are some evidences suggesting that the Medicine, Charles University, Military pre-reading of VCE recordings by an expert nurse is University Hospital, Prague accurate, allowing reducing the time of evaluation without 2 Institute of Biostatistics and Analyses, Faculty of losing relevant lesions [2]. We assessed the concordance Medicine, Masaryk University, Brno, Czech Republic between expert nurses and gastroenterologists in 3 Second Department of Internal Medicine - detecting lesions on VCE examinations. Gastroenterology, Faculty of Medicine in Hradec Kralove, Methods: This was a prospective study enrolling Charles University, University Hospital, Hradec Kralove consecutive patients who underwent VCE in clinical 4 Department of Hepatogastroenterology, Institute for practice. Two specifically trained nurses and 2 expert Clinical and Experimental Medicine in Prague, Czech gastroenterologists participated in the study. At VCE pre- Republic reading, the nurses selected any abnormalities, that were saved as ‘thumbnails’, and classified lesions (vascular, Introduction: The second generation of colon capsule ulcerative, polyp, tumoral masses, and unclassified). Then, endoscopy (CCE2) is a novel non-invasive method which the gastroenterologist evaluated and interpreted the pre- has the potential as the colorectal cancer screening test. selected lesions (quick view) and, successively, reviewed Interpretation of the complete video recording is time- the entire video to searching for potential missed lesions. consuming and can last up to 2 hours. The specialized Time for VCE evaluation was recorded. The PillCam Small nurses can reduce physician workload and rationalize Bowel (Medtronic, Milan, Italy) was used. resource utilization. Results: A total of 95 VCE procedures performed on Aims and methods: The multicenter prospective study consecutive patients (M/F: 47/48; mean age: 63 ± 12 has been running in three tertiary endoscopic centers. The years, range: 27-86 years) were evaluated. Overall, the aim is to evaluate the accuracy of capsule colonoscopy nurses detected at least one lesion in 54 (56.8%) patients. clinically significant lesions analysis between a trained As shown in Table 1, there was a total agreement between endoscopy nurses and a physician. CCE2 videos have nurses and physicians in detecting lesions in the small been viewed independently by 2 nurses and 3 physicians, bowel. Indeed, the second look of the entire VCE recording all blinded to the results of optical colonoscopy (OC). The by the physician failed to find other relevant mucosal total number of 230 individuals are planned to be involved. abnormalities. The overall (median; range) reading time Preliminary results are presented. was 58 (45-79) minutes for nurse, 10 (8-16) and 49 (33-69) Results: Since April 2016, there were 111 individuals minutes for the quick and entire medical view by the enrolled and data of 54 persons have been analyzed. gastroenterologist, respectively. Therefore, the pre-reading Sensitivity of all polyp detection by CCE2 was higher in procedure by nurse allowed a time reduction of medical physicians (97 % vs. 81 %, p=0,0143). However, detection evaluation from 49 (33-69) to only 10 (8-16) minutes of significant polyps (≥10 mm) was better in nurses reading (Difference: -79.6%). No case of VCE retention was (83 % vs. 75 %), although the results were not statistical observed. Conclusions: Data suggest that trained nurse significant (p=0,654). The nurses found 10 of 12 (83%) is able to accurately identify and select the relevant lesions significant lesions detected by colonoscopy, and the in thumbnails, that may be faster reviewed by the gastroenterologists found 9 of 12 (75%) significant lesions gastroenterologist for a final diagnosis. This would seen by the colonoscopy . significantly reduce the cost of VCE procedure. Therefore, Conclusion: The study preliminary results show that specific training program on VCE for nurse, expert on capsule colonoscopy evaluation by endoscopy nurses is gastrointestinal endoscopy, could be advantageously comparable to experienced gastroenterologists. Therefore, implemented. reading or pre-reading of CCE2 videos (i.e. to identify or References select areas of pathology for further medical review by 1. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule physicians) might be effective in daily clinical practice. endoscopy and device-assisted enteroscopy for diagnosis Key words: colon capsule endoscopy; optical and treatment of small-bowel disorders: ESGE Clinical Guideline. Endoscopy 2015;47:352-376. colonoscopy; accuracy; sensitivity 2. Guarini A, De Marinis F, Hassan C, et al. Accuracy of This project has been supported by the Czech Ministry of trained nurses in finding small bowel lesions at video Health Grant No. 16-29614A capsule endoscopy. Gastroenterol Nurs 2015;38:107-110. Table 1. Concordance between nurses and gastroenterologists in finding small bowel lesions at P-14 videocapsule endoscopy. Lesions detected Nurs Gastro- P High concordance between trained nurse and e enterologist value gastroenterologist in evaluating recordings of small No abnormality 41 41 NS bowel Video Capsule Endoscopy (VCE). Angiodysplasia/Lympha 17 17 Alessandra Guarini, Francesca De Marinis, Cesare ngiectasia 20 20 Hassan, Angelo Zullo. Gastroenterology and Digestive Ulcer/erosion 11 11 Endoscopy, ‘Nuovo Regina Margherita’ Hospital, Rome, Polyp 5 5 Italy Tumoral mass 1 1 Unclassified 4/1 4/1 Bleeding (active/recent)

ESGENA Abstracts Poster Presentations

P-15 P-16

Self-reported quality of life in patients with acute Descriptive study of the contribution of the colonic pancreatitis is impaired already on day of admission nurse to the colorectal cancer screening program in a Sisse Rysgaard, Joy Stinne Timmner, Lise Lotte Gluud, tertiary-level hospital Mikkel Werge, Amer Hadi, Palle Nordblad Schmidt, Srdan Alicia Hernández García, Marías del Cristo González Novovic, Department of Gastroenterology and Ramos, Mileidis San Juan Acosta, Silvia Morales Gastrointestinal Surgery, Hvidovre University Hospital, González. Gastrointestinal. Endoscopy Unit. University Copenhagen, Denmark Hospital Nuestra Señora de Candelaria.Tenerife-Spain.

Introduction: The management of acute pancreatitis (AP) Introduction: Colorectal cancer (CRC) is the most has changed over the last decades probably resulting in common cancer in Spain and the second most frequent reduced morbidity and mortality. Few studies have been cause of cancer mortality. The CRC screening program is directed toward the long-term quality of life (QoL) important for ensuring its detection and early treatment. outcomes following an AP attack, but fewer have The phase of patient preparation prior to the colonoscopy addressed this issue on short-term. Whether AP plays an appointment is essential for program success. One of the independent role in the health-related QoL is of clinical quality criteria according to the Spanish clinical guidelines importance so as to better understand the natural history is that preparation of the colon should be excellent-good of AP and counsel patients and families of what to expect “acceptable” in > 90%. during the disease course. Objectives: 1. To describe the contribution to the CRC Objective: To prospectively and longitudinally evaluate the screening program of the appointment with a nurse, who is quality of life (QoL) in patients with acute pancreatitis (AP) responsible for the entire process of preparing the patient both during admission and in out-patient setting. for the colonoscopy appointment on colon cleansing in the Method: We performed a prospective cohort study colonoscopies 2. To describe the results of the consecutively including patients with their first attack of AP colonoscopies into the program. admitted to our department in the period February 2016 to Material and methods: This is a cross-sectional, June 2017. Patients were followed with standardized EQ- observational, descriptive study of basal colonoscopies 5D QoL questionnaire on admission, day 10, and on day performed as part of the CRC screening program in 30 in an out-patient clinic. Patients were asked to rate their intermediate-risk population in the University Hospital life quality by using a visual scale ranging from zero (worst Nuestra Señora de Candelaria compared with possible life quality) to 100 (best possible life quality). Two- colonoscopies performed without CRC screening program sided t-test comparing means was used. and without a nurse intervention at the consulting but with Results: We included 44 patients (52% men; mean age 52 on demand support of nurses by phone in 2015. Process years; gallstone pancreatitis 66% and alcohol related at the appointment with nurse intervention: 1) After a pancreatitis 20%). All patients had elevated plasma levels positive fecal occult blood test, the patient is called to the of CRP, WBC and amylase, and low albumin at admission. CRC screening appointment, where an explanation is Eighteen patients (41%) developed severe AP. Three provided of the importance of performing a colonoscopy, patients died (7%) during admission. the need for follow-up within the program, and possible On admission, the mean QoL score was 51, on day 10 of complications 2) A medical history is taken that includes admission it increased to 67, and reached 81 one month the following information: allergies; smoking and alcohol after discharge. There was a significant increase in QoL use; personal history of respiratory disease, heart disease, from admission to day 10 (p=0.04) and from admission to prior surgery, and other data of interest; current treatment: one month after discharge (p=0.01). antiplatelets, anticoagulants, and sedatives 3) Patient Conclusion: Our study suggests that QoL in patients with follow-up after evaluation by other specialists to assess AP is severely impaired already on admission, but suitability of date of colonoscopy according to patient’s improves throughout admission and is almost at the level medical history 4) Psychosocial assessment of the patient. of premorbid state one month after discharge. Future Study variables: demographic data, degree of colonic studies on this topic should focus on reasons for impaired cleanliness, complete colonoscopy, detection rate of QoL in AP, with focus on pain, anxiety and improved polyps and advanced adenomas. information and counseling. Results: We included 384 colonoscopies [median age 62 Summary: AP does not only affect the physical condition years±5.3 SD (50-69 years), F/M (53.4% / 46.6%)] of patients, but also has an immediate impact on life performed into CRC program with nurse at the consulting quality. (Group 1) and 384 colonoscopies [median age 61 Learning outcomes for audience: Years±15 SD (26-99 years), F/M (42.7% / 57.3%) - Increased focus on QoL and the factors influencing it performed without a nurse at the consulting but with on early in the disease course of AP demand support of nurses by phone (Group 2). All the - Importance of adequate counselling of AP patients procedures were performed under superficial or deep and their families of what to expect sedation. Group 1: Complete colonoscopies 97.1%. References: Excellent-good preparation 90%. Group 2: Complete 1.Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, colonoscopies 90%. Excellent-good preparation 84.1%. Sarr MG, et al. Classification of acute pancreatitis--2012: revision The probability of having an unacceptable colon cleansing of the Atlanta classification and definitions by international in the group without a nurse at the consulting is 15.89%, consensus. Gut 2013;62:102–11; for only 10.65% in the group that received formal training 2. Machicado JD, Gougol A, Stello K, Tang G, Park Y, Slivka A, with nursing (p = 0.0419). This implies an increase in the Whitcomb DC, Yadav D, Papachristou GI. Acute Pancreatitis Has a significant risk of unacceptable colon cleansing (Risk Ratio Long-term Deleterious Effect on Physical Health Related Quality of Life. Clinical Gastroenterology and Hepatology 2017; 15:1435– = 1.49, CI [1.038, 2.21]). 1443 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

ESGENA Abstracts Poster Presentations

neoplasms were detected in 114 colonoscopies (29.7%). telephone calls, and (iii) the feedbacks of endoscopists Complications: 9 (2.3%), 1 case post-polypectomy and nurses. We also developed structural questionnaires. syndrome, 8 cases post-polypectomy bleeding, and no The patients were randomly divided into experimental cases of perforation. Follow-up with colonoscopy was group (n = 134) and control group (n = 134). We asked for decided in 227 patients (64.5%), resumption of the permission from all patients before colonoscopy. We screening program was decided in 121 (34.4%). No guided the control group according to the pre-existing residual adenoma in scar of previous resections or tumor manual. We conducted telephone interviews on the recurrence was observed. experimental group 3 days and 1 day before colonoscopy. Conclusions: The appointment with the specialized nurse The assigned nurses prospectively recorded the data and as part of a CRC screening program contributes to interviewed the patients. All colonoscopy procedures were improve compliance with the percentage of correct colonic performed by gastroenterologists. preparation recommended in clinical guidelines. In Results: In the experimental group, males constituted addition, patients follow the antiplatelet and anticoagulant 63.4% (n = 85) and the mean age was 57.9 ±11.3 years. In substitution protocol correctly. Similarly, the correct colonic the control group, males constituted 64.2% (n = 86) and preparation observed could contributes to the high the mean age was 56.9(±11.3) years. The first outcome detection rate of adenomas into the program. was patient satisfaction on colonoscopy. Satisfaction rate References was 98.5% (n = 132) in the experimental group and 26.9% 1. Ministry of Health. Government of the Canary Islands (n = 36) in the control group (p < 0.005). The second [Internet]. Gran Canaria Action guide in colorectal cancer. outcome was endoscopist and nurse satisfaction of Canarian health service. 2011 [access October 7, 2015]. colonoscopy. Endoscopist Satisfaction rate was 90.4% (n Action guide in colorectal cancer. [129 pages] Available in: = 121) in the experimental group and 66.4% (n = 89) in the http://www3.gobiernodecanarias.org/sanidad/scs/content/c01f b8f7-3d4c-11e3-a0f5-65699e4ff786/Agendacolorrectal.pdf control group (p < 0.001). Nurse satisfaction rate was 2. Hassan C, Quintero E, Dumonceau JM, Regula J, Brandão 85.1% (n = 114) in the experimental group and 50.0% (n = C, Chaussade S, et al. European Society of Gastrointestinal 67) in the control group (p < 0.001). The third outcome was Endoscopy. Post-polypectomy colonoscopy surveillance: Efficiency (colonoscopy duration & failure rate of European Society of Gastrointestinal Endoscopy colonoscopy). The colonoscopy duration was 9.5±3.5(min) (ESGE) Guideline. Endoscopy. 2013 Oct; 45(10): p.842-851. in the experimental group and 14.9±5.4(min) in the control 3. Jover R, Herraiz M, Alarcon O, Brullet E, Bujanda L, group (p < 0.001). The failure rate of colonoscopy was Bustamante M, et al. Clinical practice guidelines: quality of 7.5% (n = 10) in the experimental group and 38.0% (n = colonoscopy in colorectal cancer screening. Endoscopy. 2012; p. 44:444. 51) in the control group (p < 0.001). 4. Lopez-Abente G, Ardanaz E, Torrella-Ramos A, Mateos A, Conclusions: Our newly developed patient education Delgado-Sanz C, Chirlaque MD. Changes in colorectal cancer program significantly improved the satisfaction rates of incidence and mortality trends in Spain. Ann Oncol 2010; patients, endoscopists, and nurses in terms of colonscopy. 21(Suppl 3): p. 76–82. The patient education program also resulted in high 5. Portillo Villares I, Arana-Arri na E, Idigoras Rubio I, Espinás efficiency of colonoscopy. 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). P-18 6. Segnan NPJ, von Karsa L, editores. European guidelines for

quality assurance in colorectal cancer screening and Evaluation bowel preparation in patients hospitalized diagnosis. 1sted. Luxembourg: European Commission, Publications Office of the European Union; 2010. Clavera C, Estepa L, Navarrete A, Milà MA, Maynard A Digestive Endoscopy Service University Hospital Vall d'Hebron Barcelona, Spain

P-17 Introduction: Adequate bowel preparation is a prerequisite for colonoscopy in hospitalized patients, Effects of Patient Education Program however it is often deficient. This can lead to an increase on Colonoscopy Efficiency and Patient Satisfaction in complication rates, procedure cancellation and Ye Lim Song, Jeong-Sik Byeon, Ji Hye Kim, Mi Soon Kim, rebooking, which can possibly extend overall hospital stay. Dong-Hoon Yang, Sang Hyoung Park, Sung Wook Benchmarks for an adequate colonoscopy such as the Hwang, Eun Mi Song, Asan Medical Center, South Korea adenoma detection rate and cecal intubation rate are influenced by the quality of bowel preparation. It has been Objectives: Successful colonoscopy requires careful shown that providing written information increases the preparation and good cooperation by patients. However, overall quality of bowel preparation for outpatients and that some patients do not read and follow the instructions on specific training of dedicated nursing teams leads to taking laxatives, thereby leading to poor bowel preparation improvement in the quality of colonic preparation. and higher rate of colonoscopy failure. Most colonoscopies Objective: Evaluation of the quality of bowel preparation in require good cooperation by the patient as well, such as hospitalised patients who presented to our unit for position change and abdominal pressure, which are not colonoscopy from June 2016 to June 2017. always followed. Also, a main cause of dissatisfaction of Methods: A retrospective descriptive study that included colonoscopy patients is that they are often not aware of the all colonoscopies in hospitalized patients during the study expected discomfort following colonoscopy and report period, excluding those who did not meet the inclusion them as side effects. We thus newly developed a criteria. The quality of the bowel preparation was evaluated colonoscopy patient education program to improve the using the Boston Bowel Preparation Scale (BBPS), a efficiency of colonoscopy and satisfaction of patients, simple reliable and validated tool. The admitting hospital endoscopists, and nurses. service, along with demografica data was obtained for Methods: We prospectively performed a single center descriptive analysis. study on 268 consecutive patients who underwent colonoscopy. A standardized interview form was developed to assess (i) the feedbacks of patients, (ii)

ESGENA Abstracts Poster Presentations

Results: During the study period, a total of 10, 643 these groups (p=0.7). Low and high-volume preparation colonoscopies were performed, for both diagnostic and combined with enemas provided a better cleanout therapeutic reasons, of which a total of 854 (8%) were compared to oral preparation alone (p=0.001 and 0.002 inpatients studies. Of these 126 (14.8 %) where excluded respectively).The overall compliance for SPMC regimen for not meeting the inclusion criteria and thus a total of 728 was excellent(98%), compared to 71% for PEG-4000 patients were included in the final analysis. 459 patients regimen (p=0.03).In 29% of cases the nasogastric tube (63 %) had an adequate preparation defined as a total was used for complete preparation with PEG-4000 due to BBPS between 6-9, with 267 (37%) having inadequate adverse events such as: nausea, abdominal pain, preparations defined as BBPS below 6 score. Of the 267 vomiting.According to the questionnaire answers, we have inadequately prepared patients, 18 % had regular noticed a higher net compliance of those children that preparation (BBPS between 4-5 score) and 19 % had poor didn't get enemas. There was a significant lower regimen preparation (BBPS between 0-3 score). 40 patients in the tolerance in the lot of children that received high volume inadequate group underwent a repeat colonoscopy. preparation and two enemas (37%) compared to high Conclusions: Overall the in hospital bowel preparation in volume regimen alone (67%), p=0.04;Also, there was a our center remain insuficiente. We believe that providing significant lower regimen tolerance in the lot of children written information to hospitalized patients will increase the that received low volume preparation and two enemas overall quality of bowel preparation in these patients. (67%) compared to low volume regimen alone (93%), We hope that developing a training plan designed for p=0.03. Conclusions: Low volume and high-volume nurses in different hospitalization wards together with preparation has similar efficacy in terms of bowel cleansing providing written information will improve the level of in children. There are advantages in terms of tolerance intestinal cleansing. and efficacy for low volume preparation in pediatric References: patients. Despite the better cleanout obtained when adding 1. Coleman LK, Wilson AS. Impact of nursing education on the proportion of enemas, this association induced higher discomfort and appropriately drawn vancomycin trough concentrations. J Pharm Pract 2015; 2 81:665–672. [PubMed] decreased the tolerance among children. 2. Corl DE, McCliment S, Thompson RE, et al. Efficacy of diabetes nurse References: expert team program to improve nursing confidence and expertise in caring for 1.Hassan C, et al. Bowel preparation for colonoscopy: (ESGE) hospitalized patients with diabetes mellitus. J Nurses Prof Dev 2014; 30:134– Guideline. Endoscopy 2013; 45:142–150. 142. [PubMed] 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-19 P-20 Compliance to Different Methods of Preparation for Bowel Cleansing in Pediatric Colonoscopy Endoscopy Nurse Participation during Screening Vulpe Valentina,Kubicz Mirela, Dumitra Livia, Laura Olariu, Colonoscopy Increases the Polyp Detection Rate Oana Belei, Pediatric Gastroenterology Department, Mihaela Caliţa, Liliana Preda, Tatiana Ivan, Adrian Săftoiu Emergency Children Hospital “Louis Turcanu” Timisoara, Research Centre of Gastroenterology and Hepatology, Romania University of Medicine and Pharmacy of Craiova, Romania

Introduction:Numerous studies have evaluated safety Introduction; Colonoscopy is the gold standard procedure and efficacy of different bowel preparation protocols, but used for the detection of colon polyps and colorectal there are not standardized regimens in children.From cancer (CRC). Polyp and adenoma detection rates (PDR, children's perspective, taking a complete bowel and ADR respectively) are important quality indicators for preparation is often the most difficult part of the colonoscopies. The resection of the polyps detected during procedure.Despite the availability of various bowel colonosocopy leads to reduced incidence and mortality preparations, the ideal preparation regimen for pediatric rates of CRC. Polyps detection requires attention from colonoscopy remains elusive, and only few well-controlled both the colonoscopist and the participating endoscopy studies in pediatric population have been published.1 nurse, as well as the use of additional techniques and Methods:We conducted a retrospective study that devices such as: prolonged withdrawal time, the quality of included all children aged between 3 months-18 years that bowel preparation, high resolution imaging techniques, and were submitted to colonoscopy in the last year in our distal attachements placed on the colonoscope (e.g. unit.Fourth methods for bowel cleansing were Endocuff). analyzed.1:high volume regimen with polyethylene glycol Objective. The aim of our study was to evaluate the (PEG-4000) 100 ml/kg; 2:PEG-4000 plus two normal influence over the PDR of the endoscopy nurse, saline enemas 3:low volume regimen with split participating as a second observer during colonoscopy. administration of sodium picosulphate with magnesium Methods. A total of 553 patients undergoing screening citrate (SPMC), 4:SPMC plus two normal saline coloscopies were included from January to December enemas.Boston Bowel Preparation Score was used for 2017. For bowel cleansing all patients received 4 L of evaluation of preparation.The regimens tolerance was polyethylen glycol solution and the quality of the assessed by parents/children using a questionnaire. preparation was assessed by the colonoscopist as poor Results:137 children achieved successful preparation.35 (0), acceptable (1), good (2) and excellent (3). For patient received the first regimen, 47 used the second regimen, 24 comfort all procedures were performed under deep used the third regimen and 31 received the fourth sedation. Patients were randomly assigned to two goups, regimen.Excelent/good bowel preparation was achieved in one with single observation by colonoscopist and the other 19(54%), 41(87%), 14(58%) and 26(84%) of cases in with observation by both the colonoscopist and the PEG, PEG+enemas, SPMC and SPMC+enemas group endoscopy nurse. respectively.The highest effectiveness was observed Results. The patients were aged between 50 to 75 years among children that received regimens based on PEG- old (mean age 62.5 years), including 258 females and 295 4000 or SPMC, associating two enemas one day prior to males. Fortyfive patients with poor and acceptable bowel colonoscopy.There were no statistical differences between preparation were excluded from the study. Consequently

ESGENA Abstracts Poster Presentations

508 patients, which had good and excellent bowel in 26.06% and submucosal suffusion in 3.82% of the cases preparation, were included in the final analysis, 249 in the was found during sigmoidoscopy. Sigmoidoscopic single observation group and 259 in the dual observation examination has a 92.8% specificity and 96.2% sensitivity group, respectively. The mean withdrawal time was 7.3 in cases of bowel endometriosis. minutes for colonoscopies which did not include biopsies Conclusion: Endometriosis is clinically scar tissue. The or polypectomies. The PDR in the single observation group infiltrated intestinal wall loses its elasticity and becomes was 40.5% (101), while in the dual observation group was rigid. The endometrial tissue infiltrate the surrounded 50.% (132). tissue, which fix a part of the circumference of the bowel, Conclusions. Participation of the endoscopy nurse as a and leads -due to the insufflation- a significant kinking and second observer during screening colonoscopies pain for the patient. Larger lesions can cause an hard increases the PDR. This could lead to increased efficiency impression on the bowel, these are the secondary signs. of screening programmes for CRC and further decrease The correct interpretation of these signs makes CRC incidence on the long term. sigmoideoscopy a sensitive examination in evaluation of References. intestinal infiltration of endometriosis. These signs could be 1. Xu L, Zhang Y, Song H, Wang W, Zhang S, Ding X. Nurse detected usually by assistant who lead up the instrument. Participation in Colonoscopy Observation versus the Colonoscopist In several countries of Europe sigmoideoscopy is Alone for Polyp and Adenoma Detection: A Meta-Analysis of performed by nurse endoscopists. Therefore knowing and Randomized, Controlled Trials . Gastroenterol Res Pract. recognizing of these secondary signs are essential not 2016;2016:7631981.doi: 0.1155/2016/7631981. Epub 2015 Dec 29. only for the gastroenterologists but for the nurses, who 2. Kim TS1, Park DI, Lee DY, Yoon JH, Park JH, Kim HJ, Cho YK, lead the intrument, as well. Sohn CI, Jeon WK, Kim BI, Lim JW. Endoscopy Nurse Participation Learning Outcomes: Additionally, sigmoidoscopy is time- May Increase the Polyp Detection Rate by Second-Year Fellows and cost-effective and mean less load for patients than during Screening Colonoscopies. Gut Liver. 2012 Jul;6(3):344-8. total colonoscopy. doi: 10.5009/gnl.2012.6.3.344. Epub 2012 Jul 12. 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 P-21 Orv. Hetil., 2017, 158(7), 264–269.. 2. Simoens, S., Dunselman, G., Dirksen, C., et al.: The burden of The diagnostic sensitivity of sigmoidoscopy endometriosis: costs and quality of life of women with endome- in bowel endometriosis triosis and treated in referral centres. Hum. Reprod., 2012, 27(5), Krisztina Tari; Péter Lukovich2; Attila Bokor3, Noémi Csibi3; 1292–1299. Réka Brubel3; Andrea Ácsné Tóth4 3. Bokor, A., Koszorús, E., Brodszky, V., et al.: The impact of endo- 1. Semmelweis University, Emergency Department, metriosis on quality of life in Hungary. Orv. Hetil., 2013, 154(36), 1426–1434. Emergency Endoscopy Unit, Budapest, Hungary, 2. Saint 4. Murji, A., Sobel, M. L.: Bowel obstruction and pelvic mass. John Hospital, Department of Surgery, Budapest, Hungary; CMAJ, 2011, 183(6), 686–689. [First published December 13, 3. Semmelweis University, 1st Department of Obstetrics 2010] and Gynaecology, Budapest, Hungary; 4. Joined Saint Istvan and Saint Laszlo Hospital, Endoscopy, Budapest, Hungary P-22 Introduction: Endometriosis most commonly found in the lower abdomen involves pelvic and gynecology organs but Quality of Endoscopy Reporting in Patients with can appear and spread anywhere in the abdominal cavity Inflammatory Bowel Disease. also in the urological and gastrointestinal tract. The most Anne Manjalee Liyanage, Vitthal Ramchandra Wadekar , common symptoms are chronic pelvic pain, Edie Myers, Israr UnNabi, Gastroenterology Department, dysnomenorrhoea, dyspareunia, infertility and University Hospital Kerry, Tralee, County Kerry, Ireland. haematochesia. Although the colonoscopy has high sensitivity in the diagnosis of the primary colon diseases, Introduction The exact prevalence of Inflammatory Bowel there are very limited data about the usage in the Disease (IBD) in Ireland is unknown. It is thought that diagnosis bowel endometriosis. nearly 20,000 people are affected from it. 5.9 new cases Patients and method: Between 2009 and 2015, 383 per 100,000 population in Crohn’s Disease (CD) and 14.9 sigmoidoscopies were performed in patients with new cases in Ulcerative Colitis (UC) were reported in 2011 endometriosis. Where mucosal invasion was absent [3]. Establishing a uniform departmental policy of secondary signs (wall rigidity, impression, kinking, pain endoscopy reporting is crucial to identify, evaluate, during the examination, suffusion) were analysed. The manage and follow up these patients. patients' average age was 31,2 years, the youngest 21 Aim To assess the quality of endoscopy reporting from years and the oldest 41 years old. Where mucosal Nov 2016 to Nov 2017 based on following subcategories. invasion was absent secondary signs (wall rigidity, Extent and severity of the disease, global impression of the impression, kinking, pain during the examination, endoscopist (indicating as either CD, UC or indeterminate suffusion) were analysed. colitis), photographic identification, whether the number Results: From All of the 383 examined patients, 224 and site of biopsies that were done are keeping up with patients (58.49%) were found in specific endometriosis recent ECCO guidelines, the treatment (introduction, lesions during sigmoidoscopy. Complete sigmoidoscopy escalation/ step down or termination) and a follow up plan. was performed in 43.47% of the cases. Of the positive Method A retrospective study that was done using Unisoft cases, only 11 patients (4.91%) were found with endoscopy reporting system. We assessed flexible intraluminal endometriosis, namely intraluminal appears sigmoidoscopy and colonoscopy reports from Nov 2016 to nodular soft, bloody tissue growth. Intraluminal endometriosis Nov 2017 in University Hospital Kerry. Indications used in was found in 4.91%, remaining 95% were only secondary searching reports were IBD surveillance, IBD assessment signs as rigidity in 38.39%, impression in 45.54%, kinking and acute or chronic diarrhoea. in 57.14%, pain (in cases of examination without narcosis)

ESGENA Abstracts Poster Presentations

Results Among a total of 87, there were 38 flexible departmental policy is necessary to improve the quality of sigmoidocopies and 49 colonoscopies. In assessing the endoscopy reporting. This policy needs include a detail extent of the disease there were 53 (60.9%), in severity 51 description on how each subcategory should be reported, (58.6%), in global impression of the endoscopist 60 a validated scoring system, a follow up protocol, indicating (68.9%), in photographic identification 83 (96.4%). Though the type of patients with the time frame that need to be biopsies were done in 75 (86.2%) patients, none were used, while referring to a IBD specialist. We will re-audit in keeping up with the guidelines. One patient did not have a a years’ time to review the compliance with the above biopsy due to been on anticoagulation. Treatment was not policy. given in 24(27.6%) reports and no follow up plan in 20 Learning outcomes + Relevance to Nursing (23%) reports. None of the reports used a validated A high-quality endoscopy report covering all the above scoring system. aspects is essential for a IBD specialist to deicide the Discussion Endoscopy plays a crucial role in diagnosis, further management of a referred patient. The right usage assessing disease activity, extent, differentiation of UC of resources and patient safety (by not having to repeat an from CD, in management, prognosis and surveillance of invasive procedure) can be achieved by minimising the IBD. Ileocolonoscopy with biopsies is the preferred number of inconclusive reports. procedure to establish the diagnosis and extent of IBD. References: Minimum of two samples taken from each of the six 1.Vito Annese, Marco Daperno, Matthew D. Rutter, et al. ECCO segments (terminal ileum, ascending, transverse, Guidelines: European evidence based consensus for endoscopy in descending, sigmoid and rectum), and from inflammatory bowel disease. Journal of Crohn’s and Colitis (2013) macroscopically ‘normal appearing’ segment, increases 7, 982-1018. 2.ASGE Guidelines: The role of endoscopy in inflammatory bowel the reliability of the diagnosis [1] Usage of Montreal disease. Volume 81, No.5: 2015 Gastrointestinal Endoscopy. classification for classifying UC and CD extend and http://dx.doi.org/101016/j.gie2014.10.030. Rutgeerts score for identifying the recurrence rate in 3.Irish Society for Colitis and Crohn’s Disease. www.iscc.ie postoperative ileocolonic CD patients are recommended [2]. Conclusion Development of a uniform .

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 RN, Endoskopy, Hvidovre University Hospital, Hvidovre, Denmark, Skovlund [email protected] Cimbro, Monica CBC (Europe) Srl, Medical Devices Division, Nova Milanese (MB), [email protected] Clavera Catalan, RN, Hospital Universitàri Vall d’Hebron. Institut Català de la Salut, Barcelona, Spain, Carolina M. [email protected] Colombo, Bendetta RN, University Campus Bio Medico, Endoscopy Unit. Roma, Italy, Colombo Benedetta, [email protected] De Pater-Godthelp, RN, Academic Medical Centre (AMC), Gastro-enterologie, Amsterdam, NL, [email protected] Marjon Del Mazo Tomé. Pedro Central University Hospital of Asturias, Digestive Endoscopy Unit, Oviedo (Asturias), Spain, Luis [email protected] Dela Cruz, Yulrich Louie Gastroenterology / Endoscopy, Hinchingbrooke Hospital – Northwest Anglia NHS, Foundation Trust, Huntingdon, UK, [email protected]

Addresses of Speakers, Chairs and Tutors

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

Addresses of Speakers, Chairs and Tutors

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

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

ESGENA Annual News

ESGENA Membership Update ESGENA Membership Update ESGENA has over 7500 members in 49 countries in Europe, the Middle East and overseas. ESGENA has launched a new membership area on the ESGENA website. Individual ESGENA members receive National societies and national nursing associations join their individual access codes. Each national group ESGENA as group members. National societies for receives a group code from ESGENA. This national Endoscopy/Gastroenterology nurses and associates can access code allows nurses, who are members of their join as group members. The current ESGENA group national group, free access to the ESGENA membership members come from 27 European countries, representing area. Nurses who are members of their national 31 societies and nursing associations: Endoscopy nurses society, receive the group code from Austria, Belgium, Bosnia Herzegovina, Croatia, Denmark, their national societies. The membership area offers the Estonia, Finland, France, Germany, Hungary, Iceland, following information Ireland, Israel, Italy, Jordan, Macedonia, Montenegro, • Updates on ESGENA activities Norway, Portugal, Romania, Russia, Serbia, Slovenia, • Reports from working groups Spain, Sweden, Switzerland, The Netherlands, United • ESGENA Abstracts Kingdom. • ESGENA E-NEWS • Links of Interest Some countries have 2 groups (societies or nursing • Statutes associations) which are group members of ESGENA. In order to ensure equal rights between countries and to Individual and Group members can administer and update prevent the dominance of any single countries, each their contact data by themselves. ESGENA has also European country with an active group membership has developed an electronic membership application form 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, EEWG group members from non-European countries do not have the right to vote. The ESGENA Education Working Group (EEWG) consists of representatives from every European country holding an In addition to national societies and nursing associations, ESGENA Group Membership. Representatives meet to individual nurses who work in work on educational issues relevant to Gastroenterology/Endoscopy, teach or research in Endoscopy/Gastroenterology nurses (see Table 1). The gastroenterology and endoscopy nursing, can join as group met in October 2017 in Barcelona and in April 2018 ESGENA individual members: There are currently 104 in Budapest. The next meeting will take place during the ESGENA individual members from 38 countries within ESGENA conference in Vienna, Europe, the Middle East and overseas: Albania, Belgium, Bulgaria, Croatia, Denmark, Egypt, Table 1: EEWG national Representatives in 2018 Finland, Germany, Hong Kong, Iceland, India, Iraq, Country National delegate Ireland, Israel, Italy, Japan, Jordan, Luxembourg, Austria Gerlinde Weilguny Malaysia, Malta, Mexico, Oman, Portugal, Republic of Belgium Hilde Willekens Cyprus, Romania, Russia, Saudi Arabia, Slovenia, Spain, Bosnia Herzegovina Daliborka Jelisavac State of Qatar, Switzerland, Sudan, Thailand, The Croatia Jadranka Brljak Netherlands, Turkey, United Kingdom, Ukraine, United Denmark Joan Skovlund Christensen Arab Emirates, USA Estonia Siiri Maasen Individual members have access to all ESGENA services Finland Päivi Muranen (e.g. grants, data bases, etc). France Fanny Durand Germany Ulrike Beilenhoff ESGENA has 2 passive members who are retired nurses Hunhary Krisztina Tari from Norway and the United Kingdom. Iceland Lára Björk Magnúsdótti

Ireland Deirdre Clune ESGENA has 6 honorary members: Israel Yurie Guriel • Dr. Jean Francois Rey, France Italy Patricia Burga • Eric Pflimlin, Switzerland Jordan Lilishor Hijaz • Christine Petersen, The Netherlands Macedonia Maja Ilijevska • Christiane Neumann, United Kingdom Montenegro Tania Sosic • Diane Campbell, United Kingdom Norway Anita Jorgensen • Ulrike Beilenhoff, Germany Portugal Rafael Oliveira • Sylvia Lahey, The Netherlands Romania Daniela Burtea

ESGENA major sponsors are Russia Evgeniia Korovina • OLYMPUS EUROPA SE & CO. KG Slovenia Tatjana Gjerek • Boston Scientific Spain Enriqueta Hernandez-Soto • Pentax Europe Sweden Ingrd Karström • FUJIFILM Europe GmbH Switzerland Michael Ortmann The Netherland Marjon de Pater ESGENA has 16 affiliated members from various United Kingdom Irene Dunkley companies.

ESGENA Annual News

The group work on various position statements on patient Due to legal restrictions, hands-on training may not be care in Endoscopy, staffing level and team time out. 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 ESGENA Endorsed meetings 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 By endorsing national and local events, ESGENA objectives. - 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 ESGENA Training Centres exchange of knowledge and experience in Endoscopy/Gastrointestinal nursing ESGENA has two training centres focused on - underlines the scientific quality of the endorsed events Gastroenterology: the University Hospital of Basel, Switzerland and the University Hospital of Zagreb, Croatia. This category consists of events organised by third In addition to grants, the Endoscopy department at the parties which are endorsed by ESGENA. Third parties are University Hospital in Zagreb also offered workshops with e.g. national societies, hospitals or institutes of higher hands-on training and lectures as part of the ESGENA education. training centre activities.

In 2018 ESGENA endorsed events in Croatia, Serbia and In 2016 the Pneumology Department of the University Italy, Hospital, called “Inselspital”, in Bern, Switzerland became the first ESGENA training centre specialised on Benefits of the ESGENA endorsement Bronchoscopy and thoracic medicine. - ESGENA endorsed events are announced with programme details on the ESGENA website and in the ESGENA aims to establish a European network of training ESGENA e-NEWS centres in European membership countries and invites - The ESGENA endorsement logo can be used for endoscopy departments to submit their applications. The promotional purposes ESGENA Education Working Group (EEWG) has o on meeting material (see format guidelines below) developed quality criteria which give guidance for o in local journals ESGENA Training Centres. o on local websites - Promotional material of the event can be displayed at Quality Criteria the ESGENA booth during the ESGENA conference - Wide range of interventions and other European events - Opportunity to fulfil advanced nursing roles - Clarification of legal restrictions By granting this endorsement, ESGENA undertakes no - Good cooperation with ESGENA financial involvement nor has any obligation to provide any - Highly qualified tutors support services for the event. - Defined aims and learning outcomes for each grantee - Access to learning facilities Application - Team support for training centre Detailed information about the application and the - Accommodation for grantees application form are available on the ESGENA website. In order to apply, detailed information regarding the complete Detailed information and application forms are available on scientific program, including the speakers, is required. An the ESGENA Website www.esgena.org. English version of the programme should be available. The role of Endoscopy and/or Gastroenterology nursing must be prominent among the topics under discussion. Guideline Update Conditions - Application must be made at least three months prior ESGENA initiated the update of the ESGE-ESGENA to the event. guideline on hygiene relevant issues, In November and - The event must last at least one day. December 2017 the following position statements of ESGE - Confirmation that the endorsement applies only to the and ESGENA will be published in ENDOSCOPY: single event. - Prevention of multidrug-resistant infections from - The ESGENA logo should be used in accordance with contaminated duodenoscopes the ESGENA format guidelines (see details on - ESGE-ESGENA-Technical Specification for Process website) 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 ESGENA Clinical Grants gastrointestinal endoscopy -update 2018, online available ESGENA Clinical Grants are being offered to registered - ESGENA curriculum on endoscope reprocessing, European nurses who wish to undertake further clinical online available training in specialised endoscopic or gastroenterological nursing at an ESGENA Training Centre or another specialised centre.

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