European Society of Gastroenterologyand Endoscopy Nurses and Associates

E.S.G.E.N.A.

September 2008

ESGENA NEWSNo. 22

SponsorsWe would like to express our gratitude to the major sponsorswho continue to provide financial support for ESGENA. Theirsupport has made various activities possible for the Society,including the European conference, and we are most gratefulfor their support:

• Boston Scientific International (Paris)• Cook Europe Ltd. (Limerick, Ireland)• Fujinon Europe Ltd. (Willich, Germany)• Olympus Optical Co., Europe (Hamburg, Germany)• Pentax Europe Ltd. (Hamburg, Germany)

Message from the President 6Ulrike Beilenhoff

In Memoriam 6Christine Petersen

ESGENA Statement on Nurse Endoscopists 7Christiane Neumann, Diane Campbell, Ulrike Beilenhoff, Michael Ortmann and the ESGENA Education Working Group

ESGE–ESGENA Live Demonstration Endoscopy Workshop in Izmir (May 2008) 8Sylvia Lahey

ESGENA Technical Skills Workshops for Endoscopy Nurses — A New Project 9Ulrike Beilenhoff

Report from the First ESGENA Technical Skills Workshop for Endoscopy Nurses, in Reykjavik (May 2008) 10Michael Ortmann

Diagnostic Imaging. i-scan broadens the diagnostic spectrum of high-resolution endoscopy 12Claudia Kagel, Ralf Kiesslich

Hygiene vs. Infection 13Heike Martiny

Abstracts from the 11th ESGENA Conference (Paris, 27–29 October 2007) 15• Invited Presentations 15• ESGENA Workshops 26

Announcements of National Conferences 29

12th Meeting of ESGENA in Association with the Austrian Society of Endoscopy Nurses (IVEPA), in Conjunction with the 16th UEGW, Vienna, Austria, 18–20 October 2008 31• ESGENA Welcome Address 31• ESGENA Workshop Programme 31• ESGENA Scientific Programme, Sunday 19 October 2008 34• ESGENA Scientific Programme, Monday 20 October 2008 38• General Information for the conference 38

Assessment of free papers and posters 40Christiane Neumann

Announcements for GI Nurses 2009 ESGENA/SIGNEA Conference, London 41Call for Abstracts for GI Nurses 2009 ESGENA/SIGNEA Conference 42

News from the Industry 44

CONTENTS

ESGENA NEWS

European Society of Gastroenterology and Endoscopy Nurses and Associates

PRESIDENTUlrike BeilenhoffFerdinand-Sauerbruch-Weg 16 89075 Ulm, GermanyPhone: +49-731-950 39 45Fax: +49-731-950 39 58 E-mail: UK-Beilenhoff@t-online.de

VICE-PRESIDENTMichael OrtmannEndoscopy Department University Hospital of BaselPetersgraben 44031 Basel, SwitzerlandPhone: +41-61-265 51 66 Fax: +41-61-265 24 05 E-mail: MOrtmann@uhbs.ch

GENERAL SECRETARYSylvia LaheyEndoscopy UnitRijnstate HospitalWagnerlaan 556815 AD Arnhem, The NetherlandsPhone: +31-26-3786800Fax: +31-26-3786737E-mail: sylvia.lahey@planet.nl

TREASURERStanka PopovicDept. of Gastroenterological SurgeryUniversity Medical CentreZaloska 71000 Ljubljana, SloveniaFax: +386-1-2316096E-mail: stanka.popovic@kclj.si

COUNCILLOR (Editor of ESGENA News and the ESGENA web site)Mette Asbjørn OlesenHelsingør HospitalEndoscopy UnitEsrumvej 1453000 Helsingør, DenmarkPhone: +45-48295699E-mail: meol@noh.regionh.dk

COUNCILLORJadranka BrljakGastroenterology UnitDept. of Internal MedicineBC Zagreb RebroKispaticeva 1210000 Zagreb, Croatia Phone: +385-1-2388189Fax: +385-1-2420100 E-mail: jadranka.brljak@zg.t-com.hr

COUNCILLORJayne Tillett Diagnostic and Treatment ManagerForest HospitalsGloucestershire PCTLydney HospitalLydneyGloucestershire GL15 5JS,England, UKE-mail: jayne.tillett@fsmail.net

ESGENA - Governing Board

Editorial Office

ESGENA Governing Board (from left to right):Jadranka Brljak, Ulrike Beilenhoff, Stanka Popovic,

Sylvia Lahey, Jayne Tillett, Michael Ortmann

ESGENA NEWS

5

We are grateful to all of the authors for submitting theirarticles. Their contributions have made this issue of theESGENA newsletter possible.Articles published in ESGENA News do not necessarilyreflect the views of ESGENA.

ESGENA Executive SecretariatMedconnect GmbHBruennsteinstr. 1081541 Munich, GermanyPhone: +49-89-4141 9241Fax: +49-89-4141 9245E-mail: mail: info@esgena.orgPlease contact the Editorial Office for any inquiries regarding advertisements or articles.

6

Message from the President

Ulrike BeilenhoffThe 12th ESGENA conference is now approaching. This will be

the second time that we will be meeting in Vienna — the WorldCongresses of Gastroenterology and the seventh internationalmeeting of the Society of International Gastrointestinal Nurses andEndoscopy Associates (SIGNEA) were held there in 1998. Althoughthat was not an official European conference, many membersattended and I am sure they will have warm memories of it, andparticularly of the warm Austrian hospitality, Heurige wine taverns,and the atmosphere of Vienna with its historical sights. It is a greatpleasure for us to be collaborating with the Austrian endoscopynurses’ society (Interessensverband Endoskopiepersonal Austria,IVEPA) in preparing the European conference.

At the Vienna conference this year, we will be continuing withthe traditional format of the European conference. It will be aninteresting combination of state-of-the-art lectures, workshops,free papers, and poster sessions. I hope that many nurses will beable to come to Vienna to share their experience and knowledgewith colleagues and also to enjoy the city of Vienna and its peopleand atmosphere again.

ESGENA is enhancing its professional profile this year byrunning some new projects. By the end of the year, ESGENA e-News will have been published three times (February, May, andOctober 2008). It is hoped that the e-News will improve thecommunications and services we provide for members. It featuresan interesting combination of professional information,announcements, and information about new trends anddevelopments. Like the printed newsletter, e-News depends onreceiving interesting submissions, and I would therefore like toinvite all members and industry representatives to submit anyinformation for publication that may be of interest for endoscopyand gastroenterology nurses in Europe.

The ESGENA Core Curriculum will be available as a CD-ROM atthe ESGENA conference in Vienna. The process of implementationhas already started. New courses are to be established in twoEuropean countries on the basis of the ESGENA Core Curriculum,and in other countries existing courses are to be adapted to it.

The ESGENA Education Working Group (EEGW) has alreadystarted with a new project — developing a handbook on how toorganize workshops. The handbook will provide information onhow to organize, prepare and carry out various types of workshop,such as equipment-skills workshops, workshops on bio simulatorsand workshops with live demonstrations.

The first ESGENA workshop for endoscopy nurses was held inIceland in May 2008. The workshop combined hands-on trainingwith state-of-the-art lectures and was a great success. ESGENA isplanning to organize this type of workshop twice a year, and wewill need the support of experienced ESGENA members who arewilling to act as tutors and speakers to achieve this.

ESGENA has been playing a very active role in the ESGE-ESGENA-Guidelines Committee over the last year. The currentguidelines on hygiene and infection control have been reviewed.Three older guidelines and technical notes have been combinedinto one comprehensive updated guideline, which is to bepublished soon in Endoscopy.

Under the umbrella of the guideline committee, a small workinggroup has already started to develop a core curriculum forcapsule endoscopy reading. ESGENA representatives have playeda key role in all of these projects.

ESGENA and SIGNEA have decided to organize a joint meetingduring the Gastro 2009 conference, together with the BritishSociety of Gastroenterology’s Endoscopy Associates Group (BSG-EAG). This combined conference will be the 10th quadrennialmeeting of SIGNEA and the 13th ESGENA conference.Preparations for the event have already started.

Finally, I would like to thank the industry for its continuedfinancial support, both for the Society and for its conferences.Without this support, the progress that ESGENA has made inrecent years would have been almost impossible.

Let me take this opportunity to invite everyone to join us at the12th ESGENA Conference in Vienna. ESGENA and IVEPA arelooking forward to welcoming you to Vienna.

Ulrike Beilenhoff, Ferdinand-Sauerbruch-Weg 16, D-89075 Ulm, GermanyTel. 0049-731-950 39 45, fax 0049-731-950 39 58

E-mail: UK-Beilenhoff@t-online.de

In Memoriam

Christine Petersen It is with great sadness that we announce the passing of Nadou

Durand from France on the 9 June 2008.

Many of you will know her from ESGENA and SIGNEA meetings.Nadou was one of the early pioneers of endoscopy nursing inFrance. For many years she was very active in the French society ofendoscopy nurses GIFE. She was also one of the early SIGNEAorganizers.

She has been a great colleague and very dear friend and will begreatly missed. Nadou was a very special person and will beremembered by all who met her. She was an extraordinary personand put a lot of energy and commitment into everything she did.She was always willing to help and to give her time.

We express our sincerest sympathies to her husband, Christian,who accompanied her on many of her international trips and is

ESGENA NEWS

7

well-known to many of us, and to her daughter Charlotte. Nadouwas especially proud of her daughter who recently sat for hermedical school entrance examination.

Please join us in remembering Nadou in your prayers.

Nadou Durand

Publication date

ESGENA e-News no. 4

ESGENA News no. 23

ESGENAMembership Pages

no. 11

October2008

February2009

February2009

September 2008

December2008

December 2008

Deadline for submitting articles,

reports and announcements

Deadlines for submitting material for publication

Next ESGENA NEWS and E-NEWS

ESGENA members are invited to report on activities in their owncountries on the ESGENA web site, in ESGENA News and in theESGENA e-News. The various publication dates and deadlines forsubmitting announcements, articles and reports are shown below.

Please send the information to the ESGENA Secretariat:Molly Donohue, Medconnect GmbH, Bruennsteinstr. 10, 81541 Munich, Germany, Phone: +49-89-4141 9241, Fax: +49-89-4141 9245, E-mail: molly.donohue@medc.de

PCN recommendation

Entrance qualification

Basic nurse training

Appropriate specialistnurse training

(nationally recognizedtraining course)

2 years’ post–specialist nurse

training

Minimum qualification

Minimumendoscopy

qualification

Minimum clinicalexperience

E.g., endoscopyspecialist nurse,

stoma care nurse,etc.

Clinical endoscopyexperience is

desirable

Additional ESGENArecommendation

ESGENA Statement on Nurse Endoscopists

Over the last 20 years, nursing practice hasadvanced to include traditional medical roles. In theUK, formalized training has been available for nurseendoscopists for the last 10 years. The professional

motivation for nurses to develop this role was provided by theregulatory body in Britain — the United Kingdom Central Council forNursing, Midwifery and Health Visiting (UKCC; now the Nursing andMidwifery Council, NMC). The need for nurse endoscopists to betrained in order to reduce waiting times for endoscopy procedureswas noted by the British Society of Gastroenterology (BSG).

To date, most other European countries have not had a similarneed, as there have been sufficient medical endoscopistsavailable to cope with the workload. However, with the advent ofcolorectal cancer screening, many health systems in continentalEurope will not be able to implement screening by either sigmoi-doscopy or colonoscopy, due to a shortage of endoscopists.

Opportunities for experienced nurses to undertake endoscopytraining have now arisen in other European countries, wheremedical endoscopists have started to train their local nurses on aninformal basis. However, none of these countries has yetestablished a system to formalize either training or endoscopypractice by nurses in the way that the UK has [1].

The safety of the patient must be paramount, and each patienthas the right to be examined and treated by staff who areappropriately trained and competent to carry out procedures asclinically indicated (EU Convention on Human Rights andBiomedicine, 1997).

Before training for nurses in performing endoscopy can beestablished, the practical and legal risks first have to beaddressed. The practice of a nurse endoscopist needs to beregulated in the relevant national system for registration ofextended practice and advanced training. This can only beachieved in cooperation with the national nursing and registrationauthorities, the national professional societies (medical andnursing) and the relevant ministries of health involved in regulatingpractice.

8

For a nurse endoscopist to be able to be indemnified foradvanced practice, the job descriptions for the position have todefine the limits of practice and specific responsibilities, includingwho will obtain consent, who will prescribe and administer drugsand how patient management before and after procedures will bearranged [1].

A framework for training nurse endoscopists needs to beestablished, with recognized supervisors, mentors and assessorsof practical skills. Trainee nurse endoscopists’ education shouldbe at least at the level and depth necessary to support clinicalpractice during endoscopic procedures, and overall patientmanagement throughout the episode of care [1]. The nurseendoscopist’s practice needs to be within the parameters ofaccountability, as defined nationally.

The European Network of Nurses’ Organizations/PermanentCommittee of Nursing (ENNO/PCN) framework stipulatespostgraduate specialist training for nurses [2]. On this basis,ESGENA makes the following recommendations.

References1 Joint Advisory Group on Gastrointestinal Endoscopy.

http://www.thejag.org.uk.

2. Comité Permanent des Infirmier(e)s de l’UE/Standing Committee of Nurses of the EU (PCN), European Network of Nurses’Organizations (ENNO). Recommendations for a EuropeanFramework for Specialist Nursing Education. http://www.esgena.org/downloads/pdfs/general/enno_framework.pdf.

Christiane Neumann, Diane Campbell, Ulrike Beilenhoff, MichaelOrtmann, and the ESGENA Education Working Group

ESGE–ESGENA Live DemonstrationEndoscopy Workshop in Izmir (May 2008)

Sylvia LaheyAn endoscopy workshop with live demonstrations was held on

2–4 May 2008 at Dokuz Eylül University Medical School in Izmir,Turkey. The workshop was organized jointly by ESGE, ESGENA, theTurkish Gastrointestinal Endoscopy Association, and Dokuz EylülUniversity Medical School’s Gastroenterology Department. It wasattended by a total of 150 participants (120 doctors and 30 nurses)from Turkey, Spain, and Egypt.

The local endoscopy unit had prepared three procedure roomsfor the live sessions, and the ESGENA experts taking part — HertaPomper (Austria), Marjon de Pater (Netherlands), and myself —were each responsible for a room, working along with local nursesin the various procedures.

The workshop featured seven live demonstration sessions inwhich endoscopy experts carried out various techniques inpatients. Participants were able to watch endoscopic andultrasonographic procedures during continuous broadcasting ofthe live demonstrations, and were able to take part in discussionsand learn technical details and tips about the procedures.Between the live demonstrations, Turkish and ESGE expertdoctors gave presentations on current issues. The cases studiedand procedures performed during the two days (17 patients weretreated on the Saturday and 15 on the Sunday) included treatmentof a polyp with high-grade dysplasia in the gastric remnant (EUS);a large sessile polyp in the colon; a colonic mass in a patient withinflammatory bowel disease; gastric and esophageal varices;stenting of benign esophageal strictures; stenting and dilation ofbenign strictures in the common bile duct; common bile ductstones; ERCP for a dilated pancreatic duct; pancreatic pseudocyst(EUS); double-balloon endoscopy in a patient with Peutz–Jegherssyndrome; endoscopic mucosal resection in a patient with long-segment Barrett’s esophagus; and capsule endoscopy in a patientwith iron-deficiency anaemia. Propofol sedation was administeredin all of the procedures.

In parallel, there was also a separate lecture programme(mainly in Turkish) for the nurses. The topics covered includednew technologies and instruments in endoscopy; cleaning and

ENNO frameworkstipulates

Specialist training

Minimum of 12months; minimum of

50% of the totalduration dedicated to

clinical and/orpractice training

In an institute of highereducation (university

or equivalent)

720 hours classroomand study

Length of course

Institution

Education: theory

Education: clinical training

Supervised practiceuntil competency

Documentedcumulativeassessment ofcompetency prior toindependentpractice

A useful model ofstructured trainingcan be found in onthe JAG web site [1]

Additional ESGENArecommendation

ESGENA NEWS

9

disinfection in accordance with the European guidelines;anaesthesiology and endoscopy; the importance of disinfection inendoscopy; and a professional approach to endoscopy nursing.

Co-directors of the workshop were Prof. Ülkü Saritas (Turkey)and Prof. Ibrahim Mostafa (Egypt). The international ESGE expertswere Prof. Aksel Kruse (Denmark), Prof. Ibrahim Mostafa (Egypt),Prof. Jacques Devière (Belgium), Prof. Marc Giovannini (France),and Prof. Thierry Ponchon (France). Representatives of Cook andBoston Scientific exhibited their products at the meeting, and theprocedures were all carried out with Fujinon endoscopes.

Despite the different languages, there was very good

cooperation between the local and ESGENA nurses and betweenthe doctors and nurses. This was the first workshop in Turkey atwhich live demonstrations have been transmitted from threeendoscopy rooms simultaneously. On behalf of the ESGENArepresentatives who took part, I would like to say that theorganisers can be proud of the workshop, which was very wellorganized and ran very smoothly. I would also like to thank Prof.Saritas and Prof. Mostafa for their hard work as co-directors of theworkshop.

Sylvia Lahey, General Secretary, ESGENA Endoscopy Unit, RijnstateHospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands

E-mail: sylvia.lahey@planet.nl

ESGENA Technical Skills Workshops for Endoscopy Nurses — A New Project

Ulrike Beilenhoff In the spring of 2008, ESGENA established a new project, called

ESGENA Technical Skills Workshops. The ESGENA workshops forendoscopy nurses will combine state-of-the-art lectures withhands-on training, focusing on a single topic. The workshops willbe held over 1–3 days and will be organized by the nationalendoscopy nurses’ societies and ESGENA.

The project was initiated by Michael Ortmann from Basel (Vice-President of ESGENA), who has vast experience in organizingworkshops using bio simulators. He had the idea of combininghands-on workshops with lectures that provide the theoreticalbackground to the procedures being learned during the practicalhands-on part. The combination is a very efficient way of learning.

The first workshop was held in Iceland in May 2008 and wasextremely successful (see the detailed report in this issue ofESGENA News).

Aims. The aims of the ESGENA workshops are:• To stimulate and promote endoscopy nursing in the host

countries• To advance the education of endoscopy nurses in the host

countries• To promote an interactive teaching and training model for

gastrointestinal endoscopyThose attending will be able to update their theoretical

knowledge and increase their technical skills in dedicatedendoscopic techniques. The target group will be nurses only.

Location and duration. In principle, the plan is to alternate thelocations of the workshops between countries in western andeastern Europe. The duration of each workshop (1–3 days), willdepend on local requirements and on the workshop’s aims andcontent.

Fig. 1 The live demo team from Izmir.

Fig. 3 Sylvia Lahey, Herta Pomper and Marjon de Pater with Prof. Mostafa(ESGE co-ordinator).

Fig. 2 The nurse participants of the Workshop in Izmir.

10

Content. The content can be chosen by the local organizers incooperation with ESGENA. Depending of the length of theworkshop, it will be possible to cover the theoretical and practicalaspects of one to three main subjects.

Speakers and tutors. ESGENA can provide highly experiencedtutors and speakers. In addition, local nurses will be involved asspeakers, chairpersons, and tutors.

Equipment. In order to provide dry runs, endoscopes andendoscopic accessories should be available for practical training.Usually, manufacturers are keen to help with training equipmentand exhibiting their new products.

Dummies. In order to simulate realistic training scenarios,training on dummies is a very efficient way of learning. However, itis not necessary to use complicated and expensive bio simulatorssuch as pig models for hands-on training. Artificial models caneasily be made using a combination of plastic dolls, meat, fruit, andvegetables. This type of ESGENA workshop will also providespecial training on how to make inexpensive, simple, and veryeffective dummies. In addition, industry-manufactured plasticdolls can be used in the workshops.

The use of dummies for practical training is not only a questionof practicability. It has also ethical and legal aspects, as it meansthat patients do not have to be involved in the training of nurses ordoctors and are not ‘used’ as training objects. Using dummies thusalso protects patients. As they are not alive, situations can berepeated as often as necessary and step-by step-learning can beensured. Dummies are a very effective option for simulatingendoscopic procedures, daily scenarios, and possible compli-cations in a very realistic way.

Applications. National societies that wish to host an ESGENAworkshop are invited to submit a written application to theESGENA Governing Board. Applications should be submitted atleast 6 months before the scheduled workshop. Successfulapplicants will be chosen by the ESGENA Board. The applicationform is available on the ESGENA web site (www.esgena.org).

Ulrike BeilenhoffESGENA President

Report from the First ESGENA TechnicalSkills Workshop for Endoscopy Nurses, inReykjavik (May 2008)

Michael OrtmannSteam from hot springs in the region is supposed to have

inspired Reykjavík's name, as Reykjavík translates to "SmokeyBay". The first permanent settlement in Iceland by Nordic people isbelieved to have been established in Reykjavík by IngólfurArnarson around AD 870. Reykjavik is the capital and largest city ofIceland. It is located in southwestern Iceland, on the southernshore of Faxaflói Bay. With a population of 119,000, it is the heart ofIceland. 37% of the population lives in Reykjavik. Today, Reykjavíkis the centre of the Greater Reykjavík Area which, with apopulation of 200,000, is the only metropolitan area in Iceland. Itslocation, only slightly south of the Arctic Circle, receives only fourhours of daylight on the shortest day in the depth of winter; duringthe summer the nights are almost as bright as the days.(Wikipedia)

The First ESGENA Workshop for Endoscopy Nurses was held inReykjavik from 27 to 29 May 2008. Michael Ortmann and BjörnFehrke from Basel University Hospital in Switzerland travelled toIceland to give the first of these new-format workshops (see theprevious article in this issue). Anja Schuster of Olympus Europeprovided support for the team both in preparing for the workshopand on site.

The Icelandic Society of Endoscopy Nurses (Insight) has beendoing very professional and highly motivated work for many yearsnow. The society has 20 members, and new members joinedduring the workshop. Iceland has around 15 gastroenterologistsand 30 endoscopy nurses (for a total population of around 304,000).

Twenty-eight participants attended the 3-day workshop, whichwas held in the offices of the Olympus distributor in Iceland (theInter hf company). The aims of the workshop were to update theparticipants’ knowledge and skills in endoscopic techniques ingastroenterology and bronchoscopy; to emphasize aspects ofpatient care and assistance; and to provide a forum forexchanging information and experience. The workshop combinedstate-of-the-art lectures with practical training, focusing onintegrated patient care in endoscopy. Training was provided bothfor beginners and for more experienced nurses. The Swiss teamalso demonstrated how to make inexpensive, simple and veryeffective home-made dummies for practicing various endoscopictechniques. The simple dummies will help Icelandic colleagues intraining new staff in everyday routine work and in providingeffective dummies for national workshops and courses.

The first day of the workshop (Tuesday 27 May) began withpresentations by Michael Ortmann on ‘The role of the tutor intraining new staff’ and by Björn Fehrke on ‘The nurse’s role insedation and monitoring of patients in endoscopy’. For the hands-on training session in the afternoon (Fig. 1), the theoreticalbackground was provided by a lecture by Michael Ortmann on themanagement of upper gastrointestinal bleeding (Fig. 2). Training inthe following techniques was provided: injection therapy and

11

ESGENA NEWS

clipping; treatment of varices (band ligation, sclerotherapy,ethoxysclerol, Histoacryl); and bipolar coagulation. Learningoutcomes were assessed with a quiz at the end of the day, whichclosed with a presentation by AstraZeneca.

The second day of the workshop also started with lectures —Michael Ortmann on reprocessing endoscopic equipment, AnnaSoffía Guómundsdóttir and Sólrún Hulda Pálsdóttir on the use ofhigh-frequency surgery in endoscopy, and a presentation by theInter ehf Island. The hands-on training session in the afternoon(Fig. 3) was preceded by a talk by Michael Ortmann onbronchoscopy and associated methods, and training wasprovided in the following techniques: bronchoscopy,bronchoalveolar lavage, biopsy and cytology, argon plasmacoagulation, foreign-body removal, and transbronchial biopsy andneedle aspiration. The day again closed with a quiz.

Fig. 1 Michael Ortmann and Icelandic participants during a hands-on-training session.

Fig. 2 Participants listening during one of the theoretical parts of the workshop.

Fig. 3 Björn Fehrke and Icelandic participants during a hands-on training session.

The final day of the workshop (Thursday 29 May) opened withpresentations on nursing documentation in endoscopy (MichaelOrtmann); the ERCP-V system (Anja Schuster, Olympus); and theactivities of the Icelandic society Insight (Herdis Astradsdóttir).The hands-on training session in the afternoon was introduced bya presentation by Michael Ortmann about ERCP. For beginners,training was provided in following techniques: cannulation andguide wire techniques; endoscopic sphincterotomy; biopsy withforceps and brushes; stone extraction with a balloon; stenting(with plastic stents); stent removal. Experienced nurses receivedtraining in endoscopic sphincterotomy; stone extraction with abasket and lithotripsy; biliary bougienage and dilation; biopsy withforceps and brushes; plastic and metal stenting; and stentremoval. The day closed with a quiz again, and with feedback fromthe participants.

The participants all had an opportunity for networking withfriends and colleagues and for continuing the day’s discussions ata barbecue held afterwards on the last day. Very special thanks aredue to the local organizers, whose work and enthusiasm broughtthe project to life — Herdis Astradsdóttir, the President of Insight,and the Islandic board and to Mr. Thorvaldur Sigurdsson, localdistributor for Olympus in Iceland, who made his company’s officesavailable for the meeting and also provided a great deal ofbackground support before and during the workshop. Our thanksgo to all of our Icelandic colleagues for their warm hospitality, andin particular to Sólrún Hulda Pálsdóttir and Lara Magnusdóttir forextra support for the tutor’s team on the final day.

We are also grateful to the various companies (in addition toInter ehf Island) whose support made this educational workshoppossible: Olympus Europe, Cook, Boston Scientific, AstraZeneca,and Jansen-Cilag. Thanks also go to the ESGENA governing boardfor their confidence in the organizing team.

This new ESGENA project proved to be a successful way ofproviding continuing training in endoscopy. The feedback from theparticipants was very positive, and the effort involved in terms oftime, materials, and human resources was certainly worthwhile.This type of workshop has the advantage that training in complexnew techniques can be provided in an efficient way with a limitednumber of participants. The workshops also provide useful timefor discussions and for exchanging experience. Furtherworkshops in other European countries are being planned.

Michael Ortmann, ESGENA Vice-President, Endoscopy Department,Basel University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland;

E-mail: Ortmannm@uhbs.ch

12

Diagnostic Imaging. i-scan broadensthe diagnostic spectrum of high-resolutionendoscopy.

Claudia Kagel, Ralf Kiesslich

The article has been submitted by PENTAX

Introduction. Colorectal carcinoma is the second most frequentmalignant tumour among both women and men; it is responsiblefor about 15% of all cancer deaths in Germany. Early identificationof adenomas as precursors of cancer during colonoscopy offersan opportunity not only for the early detection of cancer, but alsofor cancer prevention, since the adenomas can be removed evenduring ongoing endoscopy via polypectomy or mucosal resection.

Colonoscopy is considered to be the gold standard for the earlydetection of colon cancer, but even this method is not (or not yet)perfect. Until now, flat adenomas in particular represent asignificant clinical problem, since these can be easily overlookedin conventional video endoscopy. Flat adenomas with depressedsurfaces have a high potential for malignancy. Even at a size of 0.5cm, 50% of the lesions show an infiltration into the submucosallayer, which is associated with an increased risk for lymph nodemetastases. The aims of modern endoscopy should, therefore, bedefined as “detecting” and “characterizing”. All neoplasticchanges to the colon mucosa must first be recognized. Then in asecond step – based on the type of the lesion, the vascularchanges, and the surface tissue architecture – an unambiguouscharacterization should be undertaken as to whether thisinvolves a true pre-cancerous stage (adenoma) or harmlesschanges (hyperplasia).

The advantages of HD+ endoscopy and i-scan. The newgeneration of high-resolution endoscopes gives a resolution thatsurpasses even the HDTV format. Thanks to this high resolution,even small and flat tissue changes in the colon mucosa can beeasily detected. The new i-scan technology combines what isknown as HD+ resolution with the use of digital filters, whichprovide post processing colour filters that are easy to use. Asingle press of a button allows the physician conducting theexamination to choose between the v (vessel), p (pattern), and SE(surface) settings during the ongoing endoscopy. The SE modecreates increased contrast of the colon mucosa, which closelycorresponds to chromoendoscopy using acetic acid.

The blood vessels are emphasized with i-scan v, and with i-scan p the surface architecture of individual crypts (pit pattern)can be clearly visualized and assessed (see figures). Thiselectronic chromo endoscopy can be simply faded in or out; inthis way i-scan SE is suitable for the recognition of lesions, andthe v and p modes are suitable for the characterization of lesions.A quick decision is possible based on the newly availableinformation whether targeted biopsy or endoscopic resection isneeded (prediction of neoplastic changes) or no furtherintervention is required (prediction of non-neoplastic changes).

Methods. The effectiveness of the i-scan is just as reliable as

that of chromoendoscopy, in which the dyes are applied to thecolon mucosa using a spray catheter, as an initial study by theMainz University has proved. A total of 54 patients withindications for colon cancer screening were included in thestudy. All the patients were examined using HD+ colonoscopy.The sigmoid colon and the rectum were again re-inspected usingi-scan and lastly chromo endoscopy with methylene blue wasperformed.

Results. The use of i-scan and chromoendoscopy as comparedto the normal mode led to a significant increase in the number ofcolorectal lesions discovered (normal mode – 154 changes; i-scan – 282; chromoendoscopy – 555). The differences werestatistically significant. Interestingly, no difference was found inthe identification of small flat adenomas (< 5 mm) by i-scan or bychromoendoscopy. In both groups, 7 adenomas were correctlyidentified, and thus i-scan and chromo-endoscopy showed equaleffectiveness in the identification of small and flat adenomas.

Conclusion. Based on these results, which will be presented atthis year’s Digestive Disease Week in San Diego as an oralpresentation, it follows that high-resolution endoscopy willestablish itself as the new standard in the early recognition ofcancer, and i-scan as an electronic filter will supersedechromoendoscopy in the early recognition of sporadic adenoma.

References. A. Hoffman, C. Kagel, M. Goetz, S. Biesterfeld, Peter R. Galle,

M.F. Neurath, R. Kiesslich. High-definition colonoscopy (HD+)with i-scan function allows doctors to recognize and characterizeflat neoplastic changes as precisely as chromoendoscopy.Presented at DDW 2008

Claudia Kagel, Prof. Dr. Ralf KiesslichInterdisciplinary Endoscopic Unit at the 1. Med. Department,

Johannes Gutenberg, University Mainz, Germany

13

ESGENA NEWS

Results.The study has proven that the design of the WDsrepresent a decisive influence on the efficacy of reprocessing. Itwas found that the WDs with single-channel connection andchannel separation led to clearly better efficacy and morereproducible results compared with the other systems.

Outcome. Taking older studies into consideration, it could beshown here that one can determine the efficacy of processes inWDs with the German method of EN ISO/TS 15883-5 and thuscomparisons are possible. Therefore, when WDs are purchased,the requirements named in the standard ISO15883-4 should beobserved. The information of the WD manufacturers must betaken into account absolutely in reprocessing.

Moreover it should be noted that the staff should also betrained correspondingly with regard to the handling andoperation of the WD. Knowledge about hygienic standards isurgently necessary to ensure protection against infections and toguarantee correct reprocessing

Source. [1] Kircheis U., Martiny H.: Comparison of the cleaningand disinfecting efficacy of four washer-disinfectors for flexibleendoscopes. J Hosp Infect (2007) 66, 255-261.

Prof. Dr. rer. nat. Heike MartinyCharité - Universitätsmedizin Berlin

Campus Benjamin Franklin, Technical HygieneHindenburgdamm 27, 12203 Berlin, Germany

Hygiene vs. Infection

Prof. Dr. rer. nat. Heike Martiny

The article has been submitted by PENTAX

Last year a study was published in the "Journal of HospitalInfection" [1], in which different washing and disinfectingprocesses (cleaning as well as overall process) in four washer-disinfectors for cleaning and disinfecting flexible endoscopes(WDs) were examined comparatively with regard to theirreprocessing efficacy.

Introduction. Flexible endoscopes are medical devices aboutwhich the most has been published in the scientific literature inconnection with the transmission of infectious pathogens.Because of their complex design, they represent a greatchallenge to reprocessing systems. It is therefore all the moreimportant to have available suitable systems for reprocessing,apart from well trained assistant staff.

The use of washer-disinfectors for reprocessing flexibleendoscopes (WDs) has significant advantages compared withmanual methods. WDs facilitate the standardisation of theprocess parameters that are indispensable for the effectivenessof a process (e.g. compliance with action times or concentrationdata). At the same time the direct exposure of the staff toinfectious pathogens is reduced and exposure to disinfectantsavoided. But blind faith in WDs is also not advisable, for WDscontaminated by Pseudomonas aeruginosa or Mycobacteriumchelonae have been reported on several times in the literature.Consistent implementation of the requirements and testingmethods of washer-disinfectors is therefore of elementaryimportance.

Method. The variety of the available WDs makes a comparisonfor users very difficult. Thus the WDs normally available on themarket vary among other things in terms of channel connection,alarm of blocked channels, flow rates as well as monitoring timeand temperature. Therefore four WDs differing in design wereselected for this study. One WD with pressure chamber system,one WD with single-channel connection without channelseparation and a further two with single-channel connection andchannel separation were compared with one another.

The following procedure was adopted for testing. The ISO EN15883 series of standards has been the subject of intensive workfor 10 years. Various test contaminations and test methods fordemonstrating cleaning efficacy are listed in Part 5 of this series.The German method of ISO EN / TS 15883-5 was adopted fortesting. In this case transparent PTFE test pieces two metres inlength, which simulate the biopsy channel of endoscopes, werecontaminated with a mixture of blood and Enterococcus faecium.After the cleaning or overall process had been performed, theoptical cleanliness of the test pieces and the microbiologicalreduction factor of the test organisms used were evaluated.

ENDOSCOPY

15

Abstracts from the 11th ESGENA Conference(Paris, 27–29 October 2007)

Invited Presentations

From endoscopic mucosal resection (EMR) to endoscopicsubmucosal dissection (ESD), from ESD to natural orificetranlumenal surgery (notes): training on live tissueDimitri Coumaros, IRCAD/EITS, University Hospital, Strasbourg,France

Introduction. A primary aim of training programs is to ensure thatfellows can perform specific procedures safely. However, theconstant development of new techniques generates the need foreffective training, even for experts. Different models weredeveloped for training so that potential injuries and discomfort topatients can be avoided.

Aims. The aim of this presentation is to demonstrate the utilityof the anaesthetised mini-pig model for training in ESD andNOTES.

Results. This model is particularly appropriate for the training inESD since this technique entails the use of new cutting andcautery devices ensuring en-bloc resection of large superficialneoplastic lesions and accurate histologic assessment. ESD toolsrequired are the Triangle Tip-, Flex-, Hook-, Insulated Tip-, Safe-and Flush-knives, the ST Hood and haemostatic forcepsCoagrasper, Hot Claw and Hot Bite. The anatomy, the submucosalinjection of fluids, the intensities and types of currents used arethe same as in humans. Furthermore this model is suitable forendosonography and other procedures (Stretta, Esophy’x,Zenker’s myotomy). This model is also appropriate for NOTESdevelopment and training. After passage through the gastric wall,exploration of the abdominal cavity is possible. New endoscopesand devices will be used for both diagnostic and therapeuticpurposes. NOTES and particularly transgastric surgery can bechallenging because of exposure, endoscope stability issues andlimitations in control of dissection tools. When performingtransgastric cholecystectomy a recurring issue is the upsidedown view obtained by endoscope retroflexion. In addition, weshow other methods such as tele-training, tele-mentoring, the useof pocket computers and podcasting which contribute to learning.

Discussion. Other training models are available. Two computerbased simulators, the Immersion Medical simulator and theSimbionix GI Mentor simulator, can be used for training in upperand lower gastrointestinal endoscopy, polypectomy, endoscopicretrograde cholangio-pancreatography (ERCP) and endoscopicsphincterotomy. In addition, Simbionics developed a trainingmodel of endosonography. Although appealing all these modelsare expensive and time consuming. Whether the improvement inthe learning curve seen in trainees when using such simulators isclinically important and worth the expense and time investmentremains unclear. On the contrary, the efficacy of the ErlagenActive Simulator for Interventional Endoscopy (EASIE) usinganimal organs has already been demonstrated for various

haemostatic procedures. Presently this model is used to train forpolypectomy, endoscopic mucosal resection, ERCP, stenting andmore recently double balloon endoscopy. Unfortunately in thismodel, cautery settings are not the same as in live animal models.

Conclusion. It is essential to match the type of procedure withthe appropriate training model for effective teaching according tothe level of the operator. Live animal models have a definiteadvantage allowing a realistic learning experience in advancedendoscopic procedures. The occurrence of bleeding orperforation gives the opportunity to learn how to prevent andmanage these complications.

Quality assurance in screening colonoscopyRoger J Leicester OBE FRCS, Director of Endoscopy, St. George’sHospital National Training Centre & SW London Bowel CancerScreening Centre; UK

Colorectal cancer accounts for more than 200,000 deaths inEurope each year. As a result, many countries are embarking onscreening programmes, some organised nationally and others ona regional basis. Methods vary from occult blood testing regularcolonoscopy. Whichever method is chosen, the final pathway ininvestigation is invariably colonoscopy, for both diagnostic andtherapeutic purposes.

It is vitally important for any screening programme to besuccessful that compliance for screening is as high as possible. Itis therefore the responsibility of endoscopy professionals toensure that colonoscopy is safe, comfortable, dignified and aboveall accurate. It is also important that units in the screeningprogramme must be able to absorb the extra workload withoutimpacting on providing a diagnostic service or symptomaticpatients

In the UK, strict quality criteria are required for both screeningendoscopy units and the colonoscopists performing theprocedure. Prior to a unit being accredited for screeningcolonoscopy, data on safety, quality, patient comfort and dignity,decontamination standards, together with details of training forendoscopists and endoscopy assistants must be submitted. This isfollowed by a formal inspection to verify the standards.

If the endoscopy unit is accredited for screening, then colono-scopists must submit audits of there caecal intubation rates,complications and diagnostic accuracy before sitting anexamination on principles of safe colonoscopy and lesionrecognition and management. This is followed by a practicalassessment of colonoscopy by two independent experts.

Following a successful application by units and endoscopists,quality control is monitored regularly using the same indicatorswhich are recorded for each colonoscopy.

16

Endoscopy is a relatively young specialty within the history ofmedicine, because of its invasive nature and wide variation inquality, it is perhaps timely that the introduction of screening, withthe necessity to avoid missed lesions and potential seriouscomplications in asymptomatic people, that this is likely to providethe catalyst for quality assurance of all endoscopic procedures.

National bowel cancer programme in England – experience and resultsLynn Coleman, Sheffield, UK

The presentation will describe the background to the NHSBowel Cancer Screening Programme: the research evidence ofFOBt effectiveness; the UK Colorectal Cancer Screening Pilot inEngland and Scotland; the implementation of the nationalprogramme which commenced in July 2006 and the currentposition of roll out. It will also include the organisational structureof the NHS Bowel Cancer Screening Programme and describe theroles of the Programme Hubs and the Screening Centres, and theirrelationships with PCTs and Primary Care in developing the BCSPlocally.

Information on the screening pathway will be given, the role ofthe Specialist Screening Practitioner and a brief summary of thenational Bowel Cancer Screening IT system. An overview of thefirst year of the NHS Bowel Cancer Screening Programme andinitial results will be included

References, per-session and further reading1 NHS Bowel Cancer Screening Programme - Advice to the NHS

- July 20052 BCSP Implementation Guide No 1 – Advice for SHAs - July

2005 NHS Bowel Cancer Screening Guide Book – Version 1 July 2006 and Version 2 March 2007

3 BCSP Implementation Guide No 5 – Education and Training Requirements for Specialist Screening Practitioners – March 2007

All available for the BCSP website for NHS Staff:www.bcsp.nhs.ukFor all cancer screening programmes information: www.cancerscreening.nhs.uk

Teaching new staff and medical assistants – the role of theendoscopy tutorRoger J Leicester OBE FRCS, Director of Endoscopy, St. George’sHospital

Introduction. With the development and increased use offiberoptic endoscopy, the need for structured training andeducation among endoscopy personnel is increased.

• 1975 The first professional society for endoscopy personnel wasfounded.

• Since 1980, special professional societies for certified nursing staff (AKP) and nursing assistants (MPA) have become established.

• 1980 - 1990 First courses were held in ‘continuing professional education in the functional area of endoscopy,’ including practical courses at external endoscopy departments

• 1998, the ‘European Endoscopy Nurses Forum (EENF)’ was founded by ESGENA (European Society of Gastroenterology and Endoscopy Nurses and Associates).

• Since 2000, there has been a ‘gastroenterological endoscopy’ continuing education module for nursing assistants (MPA) in Germany and Austria.

• Since End of 2007, there has been a ‘continuing professionaleducation in the functional area of Endoscopy Model’ from the ESGENA together with the European Endoscopy Working Group

Aims & Methods. During the initial period, the new employeewill be introduced by the endoscopy tutor to the organization andthe basics of the endoscopy unit including the skills andknowledge in the field of gastroenterology/hepatology as well aspneumology.

This program specifically contains theoretical and practicalinstruction, a ‘learn and teach’ situation, active participation in therespective examinations and subsequent discussion with a mentor.

The basis of the one year skill adaptation and job training is anofficial checklist of our department, which should serve as a guideto the new employee. This checklist summarizes and controls thetheoretical and practical knowledge of the new employee with aspecial focus on the hands-on skills.

Conclusion. The endoscopical job-training of new employees isan essential phase, which often is not taken seriously in the every-day routine of a tertiary hospital. The main reasons for this are alack of time during the routine workload, lack of allotted trainingtime and non-existent guidelines and recommendations for theendoscopic education. This is especially unfortunate, since it isthe early phase of training which will influence professionalbehaviour in the endoscopy nurses careers. A training adjusted tothe needs of the trainee and which will not overwhelm him is keyto a successful intergration into an endoscopy team.

Accreditation for teaching centres – an instrument of qualityassuranceDiane Campbell, Torquay, UK

Introduction. Endoscopy services in the UK have faced a numberof challenges in recent years, largely due to the unstructureddevelopment of the specialty and enormous growth in demand. Theresulting variable standards of clinical practice coupled with

17

Department of Health targets to reduce waiting times for diagnosticprocedures has lead to an urgent need to improve service delivery,facilities and training of endoscopists.

Recognition of the need for resources to address these issues inpreparation for the introduction of the NHS National Bowel CancerScreening Programme (BCSP) resulted in the formation of theNational Endoscopy Team and the commissioning of the NationalEndoscopy Training Programme. These initiatives have beensuccessful, service and training have improved and Bowel CancerScreening is established and will roll-out across the country overthe next two years.

Effective quality assurance is essential to sustainability of theimprovements already made and to the credibility of the BCSP. Inthis context quality assurance is the agreement, achievement anddemonstration of standards. Development of a quality frameworkhas been led by the National Endoscopy Team with support from theBCSP and the Joint Advisory Group (JAG).The training andassessment of endoscopists and the environment in which thistakes place has been the concern of the JAG since the late 90’s andsince 2004 accreditation visits have been part of the JAG planirrespective of whether units are acting as teaching centres orundertake in house teaching of trainee endoscopists. The JAG peerreview accreditation visit has become the accepted tool for qualityassuring an endoscopy unit.

This presentation will outline:• The required standards• The assessing team• The visit process• The resulting report proceduresThe overarching aim of this initiative is to ensure that all endoscopicprocedures are carried out in a safe environment, are acceptable tothe patient and effective as a diagnostic or therapeutic tool.

Although only introduced in 2006 the accreditation process isproving to be beneficial in achieving this aim and in making a majorcontribution to the improvement in endoscopy services in the UK.

Useful websiteswww.grs.nhs.ukwww.executive.modern.nhs.ukwww.cancerscreening.nhs.ukwww.thejag.org.uk

The ESGENA core curriculum for endoscopy nurses and itsimplementation on the national levelUlrike Beilenhoff, Ferdinand-Sauerbruch-Weg 16, D-89075 Ulm,Germany; Email: UK-Beilenhoff@t-online.de

Since the eighties specialist education courses forendoscopy nursing have been established in many Europeancountries. Specialist education for endoscopy nurses have beenestablished in 20 European countries. Courses vary in length,content, academic level and official recognition.

ESGENA developed a European Core Curriculum forEndoscopy Nurses which will be published at the end of 2007.

Structure of Core Curriculum. The ESGENA Core Curriculumis based on the ESGENA job profile which describes the tasksand responsibilities of endoscopy nurses (1). It is also based onthe European Network of Nursing Organizations (ENNO)framework for post-basic nurse education, which states thatspecialist nursing education (2):• Takes place in institutes of higher education (university or

equivalent)• Is continued from year to year• Is recognized by an appropriate authority• Has full-time teaching staff or faculty including nurses

qualified by education and experience (master’s degree,doctorate)

• Involves 720 theoretical hours (classroom and study) per year• And 50% of its total duration should consist of clinical and/or

practice training

The ESGENA Core Curriculum consists of three obligatorymodules (3):• One basic module on the fundamentals of endoscopy nursing,

consisting of 2 x 90 hours• One clinical module on upper and lower gastrointestinal

endoscopy, consisting of 2 x 90 hours• One advanced module including nursing and management

considerations, consisting of 2 x 90 hours

Another optional clinical module consisting of 2 x 90 hourscan be adapted to each national system.

Key persons. ESGENA key members are nominated to supportthe process of implementation in their respective countries. Theyhave been involved in the development of the European CoreCurriculum and have contacts to national groups and bodiesrelevant for endoscopy education. They give advice in theprocess of establishing a new course or evaluating alreadyexisting courses. The list of ESGENA key members are publishedon the ESGENA website: www.esgena.org

Process of implementation. National multidisciplinaryworking groups of experts, educators and representatives of

19

ESGENA NEWS

relevant official bodies develop and update national guidelinesand the national core curriculum for endoscopy nursing.National guidelines only describe the focal points, duration andstructure of the courses.

The local implementation group consists of experts from theclinical area, educators and tutors from the respectiveeducational institutes or universities. This group transmits thenational guidelines and the national core curriculum into a localcourse concept. The local group plans, organises, delivers andevaluates the local course. Even though the content and numberof hours are fixed by the national curriculum, there is enoughflexibility to establish different structured courses in eachcountry.

References1 European Network of Nursing Organisations (ENNO):

Framework for post basic nurse education, 11/20002 ESGENA: Beilenhoff U, Neumann CS, Campbell D: European

Job Profile for Endoscopy Nurses, Endoscopy 2004; 36 (11):1025-1030

3 ESGENA Core Curriculum for Endoscopy Nurses (to be published at the end of 2007) www.esgena.org

Introduction to ethical philosophyChristiane S. Neumann, Birmingham, UK

Introduction. Formal guidelines for ethical medical practicewere introduced after the 2nd World War as a consequence ofthe Nazi Medical experiments. A person’s behaviours should bebased on personal and societal ethics (from Greek Ethos) andmorals (from Latin Moralis) – both meaning the same.

Deontology versus Utilitarianism. Different societies orgroups within society have two overall ethical approaches. Thedeontological approach values the individual above the good forsociety and states that no person can be used as a mean to anend. This often represents the ethics of Western societies. Theutilitarian / consequentialist approach values the best forsociety, achieving the most happiness for the most people, evenif this disadvantages individuals. Many Eastern societies arebased on this principle. Neither theoretical approaches are goodor bad as each has advantages and disadvantages. And mostsocieties have a mix of both. What is important that theseprinciples apply at all times and to all people.

Problems can arise even within society or institution whendifferent people’s practice is based on different philosophies. Forexample, doctors and nurses are required to do the best for thepatient they see at that very moment (Deontology) while hospitalmanagement and the health ministries try to use the availableresources for the good of the whole population – giving each anequal share (Utilitarianism), even if this share is small.

4 ethical principles• Individual ethical practice is based on four principles:• Non-maleficence – meaning = doing no harm• Beneficence – meaning = doing good• Justice – meaning = the same/equal share for everybody

Autonomy – meaning = non-paternalism, allowing patientsself determination/decision making

The four principles practiced appropriately should ensuretreatment of patients which is based on respect of the individual.

Summary. There are no ultimate right or wrong approaches inethics outside those laid out in the general Human & Patient RightsDeclarations and the Declaration of Helsinki. Each society has todefine its own values. However, once these been established theyhave to be universally applicable to all people and at all times.

Case reflection: how to deal with ethical dilemmasMarijke Smits RN, Gastroenterology, Pediatrics, Flevohospital,Almere, The Netherlands

During this presentation I would like to offer some tools andguidelines to my fellow endoscopy-nurses, to provide the patienta better quality of care.

By examining a specific case we will see that many differentethical aspects appear. Ethical principles such as whether to actor not, to do no harm, to avoid evil, show respect for autonomyand to deal with the patient in a just and fair manner will bediscussed.

During this case study you will be made aware of yourcompetences as a provider of care and to participate indiscussions as an advocate of the patient’s rights, a role that thepatient may not always be able to deal with himself. Patients arenot always as independent and outspoken as they are whenbuying bread at the local baker.

During this presentation there will be an interactive discussion,with the audience and my colleagues, about the real meaning ofautonomy, informed consent, rules, personal preferences andactions in a moral dilemma. How could we have avoided this sortof situation? It is ethical to be excellent in your profession.

20

Intercultural models in nursing for developing culturalcompetence – experience from franceEllen Hervé, Hôpital Foch, Suresnes, France. ellenrv@lycos.com

Introduction. Transcultural nursing is developed worldwide,each country needs to adapt nursing models to suit its specificpopulations regarding different cultural factors influencingindividualised care to patients.

Aims of this study. To analyse a transcultural nursing modeland test its’ use in the training of nurses and appropriateness ofcare.

Aims of the presentation. To initiate the participants to somemodels of transcultural nursing. To reflect upon our practice ofteaching and nursing using these nursing tools

Summary. Over the past 6 years training of nursing studentsand professionals has been developed regarding the transculturalnursing approach. Models have been used in theoretical andclinical courses. Trainees in France usually express a need ofknowledge of different cultures around the world. Universitycourses are available in anthropology and sociology aaplied tohealthcare. What type of training program is most appropriate?

Results. The study shows that expectancies of student nursesand professionals regarding training in transcultural nursing varyaccording to different factors that will be developed in the presen-tation.The existing official training programs are moredeveloppend in training for psychiatric medical staff, but there stillis a need for nurses.

Conclusion. Transcultural nursing in France is now developing.Anthropological and sociological factors must be integrated in theassessment of patients’ needs. However carers and patientscannot be summarized to these factors.

References1 ‘Soins et Cultures’ by B.Tison and E.Hervé-Desirat

Editor: Elsevier Masson, Paris 20072 ‘Transcultural Communication in Nursing’ by Cora Munoz and

Joan LuckmannEditor: Thomson Delmar Learning 2005

Emotional experiences and the influence of brain biochemistryon the gastrointestinal tractMette Karoliussen, Porsgrunn, Norway

The traditional paradigm of natural science has considered thehuman body as a physiological entity of separate organs andorgan systems. Both in clinical specialities and in medicalresearch, the knowledge is often limited to reductionism. A deeperunderstanding of the organ system tends to investigate the

separate subsystems and ignore the relationship between thedifferent systems. The diseases in the GI system have often beenstudied in a structural and molecular manner, quite separatedfrom the life experiences and psychological reactions of theperson having the disease. But a human being is not composed ofseparate systems, but is a complex entity of intertwined communi-cating network of systems, responding to the person’s lifesituation, his reactions and believes.

Recent research in human ecology, psychoneuroimmunologyand brain research are presenting a new base for understandingdiseases of the GI tract. The research provides new knowledge ofhow perception, thought and emotions give rise to brainbiochemistry that not only affect the persons psyche but has adirect influence on the GI tract on a cellular level.

By combining knowledge from related human research areas,professional personnel can provide better healthcare for patientswith GI tract disease. A human ecological approach demonstratesthat the person’s subjective experience has a significant influenceon the regulation of the GI tract’s mobility and secretion, thoughthe neurological and hormonal control.

Anxieties in patients undergoing investigationsGerlinde Weilguny, RN, University of Vienna, Vienna GeneralHospital, Division of Internal Medicine Ill, Waehringer Guertel 18-20, A-1090 Vienna, Austria

Patients undergoing investigations are often concerned, notonly about pain and the investigation itself but also about theresults and how sickness or treatment will affect their lives. Howpatients deal with anxieties and problems is sometimes a questionof ethnicity, gender, family affair and socioeconomic status.Doctors and nurses underestimate the level of anxiety andprocedure acceptance, even if the patient is from the samecultural background as the medical staff. Patients’ reaction maybe repressive – they resist against information and promote anavoidant behaviour - or vigilant – they claim for more information.Anxiety and distress are accompanied by an increased blood levelof norepinephrine and cortisol.

Anxiety is accompanied by somatic symptoms like sweating,tremor, increased muscle tension, paresthesia, tachycardia,hypertension, tachypnoea, diarrhea and other vegetativesymptoms. Anxiety level can be assessed by a psychologicalexploration or by questionnaires. The most commonly usedquestionnaire is the STAI state and trait anxiety scale. Visualanalogue scales (VAS) are used to assess patients’ expectationsand levels of pre-procedure nervousness.

Previous studies identified patients’ concerns related togastrointestinal endoscopy. In one study 60% of patients reportedpre-procedure concerns, such as finding out what might be wrong

21

ESGENA NEWS

(18%), pain (12%) and finding cancer (4%). Particularly youngpatients, women and patients having had no precedingprocedures were more anxious about undergoing endoscopy.Others identified nervousness, chronic alcohol or drug abuse aspredictors of adverse experiences.

Patients’ anxiety might have negative influences on theprocedure itself. Because of increased muscle tone and loweredpain threshold the investigation might be more difficult and lastlonger or the patient might report more pain.

To deal with this issue, patients receive sedation medication,but possible complications should be outweighed againstbenefits. In fact, complications during gastrointstinal endoscopymay result from intravenous sedation. The medical literaturedescribes a variety of alternative treatments for replacement orreduction of anxiolytic medication, like more detailed information,relaxation techniques, hypnosis or music.

For the trained endoscopy staff it is important to recognizepatients’ fears and provide proper counteractions. Generalnursing schools commonly fail to teach such abilities. As this issuealso relates to other medical scenarios (such as surgery)compulsory training in general nursing education warranted, atleast for special programs such as endoscopy.

Literature1 Bräutigam W, Zettl S (1988) Wie Angst entsteht; Angst in

meinem Leben. In: Schultz H.J. (Hrsg): Angst. Kreuz Verlag, S 20-44

2 Conlong P, Wynne R (1999) The use of hypnosis ingastroscopy: a comparison with intravenous sedation. Postgrad Med J 75: 223-226

3 Drossman DA, Brandt L, Sears C, Li Z, Nat J, Bozymski EM (1996) A preliminary study of patients` concerns related to GI Endoscopy. Am J Gastroenterol 91(2): 287-292

4 Elkins G, White J, Patel P, Marcus J, Perfect MM, Montgomery GH (2006) Hypnosis to manage anxiety and pain associated with colonoscopy for colorectal cancerscreening: case studies and possible benefits. Int J Clin ExpHypn 54(4): 416-431

5 Gebbensleben B, Rohde H (1990) Anxiety before gastroin-testinal endoscopy – a significant problem? Dtsch Med Wochenschr 115(41): 1539-1544

6 Gould D (2001) Visual Analogue Scale. J Clin Nurs 10: 697-7067 Lee D, Chan A, Wong H, Fung T, Li A, Chan S, Mui L, Chung E

(2004) Can visual distraction decrease the dose of patient controlled sedation required during coloscopy? Endoscopy 36:197-201

8 Maguire D, Walsh JC, Little CL (2004) The effect of informationand behavioral training on endoscopy patients’ clinical outcome. Patient Educ Couns 54(1): 61-65

10 Morgan J, Roufeil L, Kaushik S, Bassett M (1998) Influence ofcoping style and precolonoscopy information on pain and

anxiety of colonoscopy. Gastrointest Endosc 48 (2): 19-2711 Pena LR, Mardini HE, Nickl NJ (2005) Development of an

instrument to assess and predict satisfaction and poor tolerance among patients undergoing endoscopic procedures. Dig Dis Sci 50(10): 1860-1871

12 Spielberger CD (1995) Test Anxiety. 1st Ed., Taylor and Francis,Philadelphia

13 Tonnesen H, Puggaard L, Braagaard J, Ovesen H, RasmussenV, Rosenberg J (1999) Stress response to endoscopy. Scand J Gastroenterol 34 (6): 629-631

14 Uedo N, Ishikawa H, Morimoto K, Ishihara R, Narahara H, Akedo I, Ioka T, Kaji I, Fukuda S (2004) Reduction in salivarycortisol level by music therapy during colonoscopic examination. Hepatogastroenterology 51(56): 451-453

15 Weilguny G (2005) Kann Hypnose oder Musik Patientenängste bei endoskopischen Eingriffen reduzieren? Abschlussarbeitder 18. Weiterbildung für „Basales und Mittleres Pflegeman-agement’ des AKH Wien

Management of an endoscopy centerMarie-Ange Bibollet. Hôpital Edouard Herriot – Lyon (marie-ange.bibollet@chu-lyon.fr)

Introduction. The organisation of an endoscopy unit answers tothe following requirements:- reception of out an in-patients -quality standard of the care given during the procedure by a wellstaffed group - planning of an adequate equipment -availability ofsedation and anaesthesiology - efficacy of the digital equipmentfor the communication network. Flow of patients, staff andequipment are highly dependant of the architecture of the rooms,which must be distributed according to their specific function andtake in account constraints linked to hygiene and disinfection.

Objectives. The endoscopy unit is acting as a provider service,answering to emergency calls for procedures, and to theincreased demand of admissions in the ‘day hospital’ required bythe socio-economic background. The quest for safety and qualityin the management of patients submitted to endoscopy is also anobjective.

Management. The operation charter provided by the distinctconcerned teams describes the distribution of the operatingrooms, the respective schedules of activity, numbers and distinctcategories of staffs, their role in each workstation. A provisionalprogramming of the procedures and the planning board isestablished daily; in addition emergency procedures may beadded during the day and also at night and during the week end.Management also concerns control of hazard factors anddysfunction with determination of manpower required in faulttolerant function; maintenance of the endoscopes and equipmentin each room, quality control of the procedures and prescriptionsof hygiene,.relationships with other units in the hospital.

22

Nurses at workstations. Each endoscopy room is managed by2 nurses acting alternatively as instrumentalist (assistance to theoperator and processing of the endoscopes after use) and as acircuit agent ensuring reception of the patient, preparation of theroom and the required material, traceability and transfer ofinformation. The panel board for the day and the listing ofprocedures are ensured by a ‘programming’ nurse in cooperationwith the nurse in care of admission in the day-hospital. Theopening and closure of the intervention rooms, the end of thedisinfection programs, selection of persons on call at night orduring the week-end are determined by the nurse planningwhich displays the distinct schedules at each workstation.

Training of endoscopy nurses. This is under the care of theendoscopy unit according to a pre-determined agenda. The firststep is the reception of the new nurse and checking of the pre-requistes by the chief nurse. Then, a tutorial system by thesupervisory staff is prolonged for 8 months. Technical work-sessions for practice are organised by the staff. In additioncontinuing education sessions are held in the hospital (operatingtheatre, hygiene, control of risks) and by the GIFE (GroupementInfirmier pour la Formation en Endoscopie). A documentationcenter (techniques and protocols) is available in the endoscopyunit. The staff proceeds to an evaluation of the new nurse at 1, 3and 6 months and after 1 year, using a qualification referentialelaborated in 1998

Conclusion. The organisation of an endoscopy unit is basedon the hospital policy, and the medical project of the unitobserving the strategy of care and the coherence of a multidisci-plinary team. Multi-annual balance sheets are establishedduring sessions of the governing board of the endoscopy unit.The incentive and increasing professional skill of the staffdepends on the care given to organisation and training; itsobjective is to promote safety and quality in the management ofpatients.

The changing role of endoscopy nursesTon Mestrom, University Hospital Maastricht, the Netherlands

Over the last decade we have seen a lot of changes within thefield of gastrointestinal endoscopy. From a predominantlydiagnostic field endoscopy has evolved into a full grown andbroad ranged diagnostic and therapeutic specialism. However, inmany countries training and specialisation of nurses still fallsshort of that of endoscopists. So how do we cope with thesechanges and organise the necessary training while stillmaintaining our core business which is care.

The author will present a training structure which is based onequality of all members of the endoscopy team.

Independent nurse consultations in an outpatient clinic – whyand how?Tina Weien Kristensen, Hvidovre University Hospital, Denmark

In November 2005 the outpatient clinic of medical gastroen-terology at Hvidovre Hospital implemented independent nurseconsultations. The reason why was both a wish from the nursesthemselves and a request from the board of directors. Therewere a number of unanswered questions before this form ofconsultation could be offered to our patients.

• What is an independent nurse consultation?• Which services could we offer?• How could we document our work?• How could we ensure that patients get the same treatment?• Who prescribes the nursing consultation?

We choose to define an independent nurse consultation as: ‘acheck up/an examination/a treatment which is prescribed by aphysician and is carried out independently by a nurse along morespecified guidelines’.

We selected the services we found suitable for the nursing-consultations, and together with one of our physicians weformulated guidelines for each check up/examination/treatment.These guidelines would be the tool for the nurses at each visit,and would be a part of the patient’s case record. Also theseguidelines would ensure that the patients would be offered the same treatment, no matter who the nurse was, or howexperienced she/he was. Only a physician could prescribe thenurse consultation due to our choice of suitable services.

Two years have now passed and we have learned thefollowing:• A high level of information is necessary to everybody involved• On-going education of nurses is important• Introduction of new procedures takes time• Independent nurse consultations are here to stay• This is a process in continuing development

Endoscopic ultrasonography with fine-needle aspiration anddrainageStephane Bois, Unité Fonctionnelle d’endoscopie, Hôpitald’instruction des Armées St Anne, Boulevard St Anne BP 600,83800 Toulon Armées, Email: stephanebois83@neuf.fr, Fax:0494099963

Definition of the puncture under echoendoscopie. The echo-endoscopy is an exploration which combines an echographicapproach and an endoscopic approach. It makes it possible tospecify the parietal and ganglionic extension gastro-intestinal andpancreatic tumors. It can affirm the malignant or benign characterof an adenopathy or a digestive mass perished. The development

23

ESGENA NEWS

of the sectoral and linear echoendoscopy allowed cytologicalobtaining material and or histological of lesions will intra or extraparietal digestive with an endoscopic guidance echo.

Indications• To define the nature of a mass• To specify the evaluation of a cancer• Masses médiastinales or pancreatic of unspecified nature• Nature of an adenopathy• Extrinsic compressions of the digestive tract• Suspicion of anastomotic repetition under mucous membrane• Nature of a tumor under mucous membrane• A biopsy guided under echo-endoscopy is less aggressive:• That a mediastinoscopy or exploring thoracotomy• That an exploring laparotomy

Nurse role at the time of the puncture under echoendoscopie.Preparation of the patient. The patient will have to be with jeunstrict 6 hours before the beginning of the examination. Not tosmoke if not increase in gastric secretion. To have had a consul-tation of anaesthesia before the intervention. To have seen thedoctor who will carry out the examination and informed being ofthe complications. To check the totality of its file before theexamination (file of anaesthesia, biological assessment...)

Preparation of the equipment. The echo endoscope, Theneedle, Cytolite or blades, Small equipment

Nurse role. The puncture is carried out at the end of thediagnostic examination of echoendoscopy. The nurse preparesthe needle on a clean table of examination. There are several sizesof different needles, generally of 19 to 25 Gauges. Positioning ofthe lesion on the way of exit of the needle by the doctor. Instal-lation of the needle on the echo-endoscope by the nurse. Thedoctor leaves the needle the channel operator then introduced theneedle into the tumor (the visualization of ‘the echo-tip’ of theneedle makes it possible to check its good positioning in thelesion). The nurse withdraws the stylet completely and adapts anair space syringe of 20 milliliters. The doctor carries outmovements of comings and goings of the needle in the tumor. Thenurse recovers the whole of the taking away contained inside theneedle with the stylet foams for an analysis on blades or byinjecting cytolite for a recovery in this one. The sample will allowcytological and histological examination.

Conclusion. The technique of puncture under echo-endoscopy is a delicate procedure requiring a good drive and aperfect complicity with the operator

Reference1 M. Giovannini, recommandation de la SFED « ponction

guidée par écho-endoscopie »

Long term efficacy of endoscopic treatment of biliary compli-cations (BC) after orthotopic liver transplantation (OLT)Sanae Mejdoubi, Hopital Purpan, Toulouse, France; FaizaChermak, Hopital St Eloi, Montpellier, France; Jean-Louis Payen,Hopital de Montauban, Montauban, France; Paul Bauret, HopitalSt Eloi, Montpellier, France; Claire Bregeon, Hopital Purpan,Toulouse, France; Nadine Railhac, Hopital Purpan, Toulouse,France; Fabrice Muscari, Hopital Rangueil, Toulouse, France;Bertrand Suc, Hopital Rangueil, Toulouse, France; Nassim Kamar,Hopital Rangueil, Toulouse, France; Lionel Rostaing, HopitalRangueil, Toulouse, France; Laurent Alric, Hopital Purpan,Toulouse, France; Jean-Pierre Vinel, Hopital Purpan, Toulouse,France; Georges-Philippe Pageaux, Hopital St Eloi, Montpellier,France; Karl Barange, Hopital Purpan, Toulouse, France.

Background. BC after OLT are the most frequent compli-cations. They still a cause of morbidity with a high risk of graftfailure. Most of transplantation centers use endoscopicretrograde cholangiography (ERCP) for diagnostic and treatmentof those complications (Vallera, Liver Transplant Surg 1995).

Aims. To evaluate long term efficacy and safety of theendoscopic therapy in the management of BC after OLT.Endoscopic efficacy criteria was non surgical treatment withbilio-digestive anastomosis.

Patients and Methods. Two hundred four patients wereretrospectively screened for the presence of biliary compli-cations. All of them had a choledochocholedochostomy asend-to-end without T tube. Exclusion criteria was ischemicbiliary complications. BC were first detected by MRI in most ofcases. ERCP procedures were performed by experiencedendoscopists. Maximal number of treatment sessions per patientwas 2 to 3 (prothesis insertion and/or balloon dilatation). Follow-up after the last ERCP was one year (range 1-6).

Results. ERCP showed biliary complication in 66 patients (43male, median age 52 years). The liver disease was alcoholiccirrhosis (n=37), chronic hepatitis C (n= 23) and other (n=6). 74%of BC occurred after the first month of OLT. ERCP wassuccessfully performed in 61 patients (92%) and detected 53anastomotic strictures. A total of 184 procedures was performed,(median per patient=3). The median time interval between theprocedures was 3 months. Endoscopic procedure was:combination of balloon dilatation and endoprothesis insertion, orendoprothesis alone or ballon dilatation alone. Technical compli-cation rate (5 of 184, 2.7%) was: mild pancreatitis (4 patients) andminor bleeding after sphinterotomy (one patient). Symptomaticprothesis obstruction occurred in 13 patients during the follow-up. Endoscopic treatment was successful in 45 of 61 patients(73%).There was no difference in survival between patients whodid and did not undergo ERCP.

Conclusion. ERCP should be the first intention for diagnosis

24

and treatment of BC after OLT. Endoscopic therapy is safe andeffective for the majority of BC.

Disclosures. The following authors have indicated they havenon relationships to disclosure: Sanae Mejdoubi, Faiza Chermak,Jean Louis Payen, Paul Bauret, Claire Bregeon, Nadine Railhac,fabrice Muscari, Bertrand Suc, Nassim Kamar, Lionel Rostaing,Laurent Alric, Jean Pierre Vinel, Georges Philippe Pageaux, KarlBarange.

Carbon dioxide insufflation in gastrointestinal endoscopyMichael Bretthauer, MD, PhD, Department of Gastroenterology,Rikshospitalet University Hospital, Oslo, Norway

In any endoscopic procedure, it is mandatory to insufflate gasinto the bowel to ensure good visualisation. Currently, air is usedfor this purpose in the vast majority of centres throughout theworld. However, significant amounts of air are usually retained inthe GI tract during endoscopy. Therefore, many patients sufferfrom pain and discomfort during and after the examination (1-4).Carbon dioxide (CO2), unlike air, is rapidly absorbed from thebowel. Thus, the use of CO2 has been shown to significantlyreduce discomfort after colonoscopy, flexible sigmoidoscopyand ERCP in randomized trials (1-4).

The first trials investigating the effect of CO2 were incolonoscopy. Investigators from both Canada and Norwayshowed in randomised trials that CO2 insufflation almostcompletely reduced post-procedural pain after colonoscopy(1,2,4). More than 50% of patients examined with air hadabdominal pain for several hours after colonoscopy, while inpatients examined with CO2, more than 90% reported no pain atall after the colonoscopy (2). Similar results have also beenshown for flexible sigmoidoscopy (3). Recently, it has beenshown in a randomised controlled trial on 100 patients, that CO2insufflation also reduces significantly post-procedural pain inERCP (5). At this years’ UEGW, data from a randomised study onCO2 versus air insufflation in double-balloon enteroscopy ispresented, showing remarkably improved small bowel intubationdepth when using CO2 compared to air (6)

During endoscopic polypectomy using standard airinsufflation, gas explosions have been reported, the latest onlysome weeks ago (7). The reason for this is that air containsoxygen, which can lead to combustion of gas present in the colon(mainly methane and H2). The risk for explosion is obviously verysmall. However, as most patients suffer from severe damage ofthe abdominal cavity and many die, this complication is veryserious. CO2 insufflation eliminates the risk of explosion, as CO2does not contain any oxygen.

Conclusions. CO2 insufflation significantly reducesdiscomfort in GI endoscopy, improves small bowel intubation

depth during enteroscopy, and prevents gas explosion duringpolypectomy. CO2 should be the standard gas used forinsufflation in gastrointestinal endoscopy.

Literature1. Stevensen GW et al. Pain following colonoscopy: elimination

with carbon dioxide. Gastrointest Endosc 1992;38:564-5672. Bretthauer M, Thiis-Evensen E, Hoff G, et al. A randomized

controlled trial to assess the safety and efficacy of carbondioxide insufflation in colonoscopy. Gut 2002; 50:604-607

3. Bretthauer M, Hoff G, Thiis-Evensen E, et al. Carbon dioxide insufflation reduces discomfort due to flexible sigmoidoscopyin colorectal cancer screening. Scand J Gastroenterol 2002,37:1103-8

4. Sumanac K, Zealley I, Fox B, et al. Minimizing post-colonoscopy abdominal pain by using CO2 insufflation: a prospective, randomized, double blind, controlled trialevaluating a new commercially available CO2 deliverysystem. Gastrointest Endosc 2002;56:190-4

5. Bretthauer M, Seip B, Aasen S, et al. Carbon dioxideinsufflation for more comfortable ERCP. A randomizedcontrolled double-blind trial. Endoscopy 2007,39:58-64

6. Domagk D, Bretthauer M, Lenz P, et al. Carbon Dioxide insufflation improves small bowel intubation depth during double balloon enteroscopy- a double-blind randomizedcontrolled trial. Abstract OP-E-360, UEGW Paris 2007

7. Hofstad B. Explosion in the rectum. Tidsskr Nor Laegeforen. 2007;127:1789-90.

HDTV, NBI, autofluorescence: impact and indicationsJacques J.G.H.M. Bergman, Department of Gastroenterology andHepatology, Academic Medical Center, Amsterdam, theNetherlands.

Introduction. Barrett’s esophagus is defined as an endoscop-ically visible columnar-lined distal esophageal segment withspecialized intestinal metaplasia in biopsy specimens taken fromthis segment. Barrett’s esophagus is a recognized pre-malignantcondition that predisposes to esophageal adenocarcinoma. Inorder to improve the detection rate of neoplasia in Barrett’sesophagus patients, high resolution endoscopy, autofluo-rescence endoscopy and narrow band imaging have beeninvestigated and are promising.

Autofluorescence endoscopy. Excitation of tissues with light of ashort wavelength (i.e., ultraviolet or short-wavelength visiblelight) gives rise to emission of light of a longer wavelength, i.e.autofluorescence. Two different characteristics are important forin vivo autofluorescence imaging endoscopic technique in thegastrointestinal tract: measuring the total autofluorescence andthe use of light reflectance to correct for tissue architectural andabsorptive properties. In the autofluorescence imaging (AFI)system produced by Olympus (Tokyo, Japan), total autofluo-

ESGENA NEWS

25

rescence plus specific green and/or red reflectance spectrawere included in the image algorithm. The most interestingfeature of this technique however is the incorporation of the AFImodule in a high-resolution video endoscope with a separatecharge-coupled device for AFI. This is an important technologicaladvancement since the white light image is by itself superior tostandard video endoscopes. With the AFI mode, normal gastroin-testinal epithelium and non-dysplastic Barrett’s epitheliumappear green while areas with dysplasia/cancer may display apurplish color. In an uncontrolled feasibility study in 60 Barrett’sesophagus patients, we have used the first prototype AFI andhave shown that AFI may potentially improve the detection rate ofHGIN in Barrett’s esophagus. In this study, all patients wereexamined with the high-resolution white light mode first followedby the AFI mode. Twenty two patients were diagnosed with HGIN;in seven patients HGIN was detected with AFI after high-resolution endoscopy has not shown any suspicious lesions. In 14patients HGIN was detected with both high-resolution endoscopyand AFI; in three of these patients, additional lesions containingHGIN were detected with AFI only. In the same study, we foundthat the positive predictive value of AFI-detected lesions to bemoderate. Only half of the total number of detected lesions wasproven to contain HGIN on histology.

Narrow Band Imaging (NBI): Traditionally, staining agents suchindigo carmine have been used in order to enhance the contrast ofthe mucosal surface when using magnifying endoscopy. Narrow-band imaging is a novel technique that increases the mucosalcontrast without the use of dye spraying and may be useful inBarrett’s esophagus. NBI is based on the phenomenon that thedepth of light penetration depends on its wavelength; the longerthe wavelength the deeper the penetration. Blue light penetratesonly superficially, whereas red light penetrates into deeper layers.Evidence has shown that three factors are important in differen-tiating HGIN from non-dysplastic tissues: 1) irregular mucosalpatterns, 2) irregular vascular patterns, and 3) the presence ofabnormal blood vessels. In conclusion, NBI enhances the mucosaland vascular patterns without the need for chromoendoscopy andmay be a useful clinical tool for the endoscopic diagnosis ofintraepithelial neoplasia based on the detection and classificationof the mucosal morphology.

Combining HRE, AFI and NBI: The combination of HRE, AFI andNBI is attractive since these modalities compliment each other ifused back-to-back. In this context, HRE and AFI are used todetect suspicious areas and NBI for close inspection of theseareas. It has been shown that combining these techniquesreduces the false positive rate from 40% (19/47) to only 2% (1/47)for all grades of neoplasia and to 10% (5/47) for HGIN.

A recent development is the release of a multi-modal systemthat incorporates high resolution white light imaging, videoautofluorescence imaging, narrow band imaging and magnifyingendoscopy in one prototype. Therefore, all state-of-the-art

advanced endoscopic imaging techniques relevant to thedetection of early neoplasia in Barrett’s esophagus are currentlyavailable in a single endoscope. This technological advancementmakes using these techniques in a complimentary fashionpractical involving only a touch of a button to switch to anytechnique at any time during an ongoing procedure.

Single balloon enteroscopy and other good news from OlympusR. Tamm, Olympus Medical Systems Europa (GmbH), Hamburg,Germany

Although the technique of Double Ballon Enteroscopy (DBE) isstill new to many Gastroenterologists and only commerciallyavailable since 4 years, the DBE instrument has undergoneexcessive study assessment and is supposed to be suggested fora lot of exciting applications. These include first of all haemostasisof Mid Gi bleeding, but the portfolio of indications has beenextended to general diagnostic of the small intestine, assessmentof inflammatory diseases, dilatation of stenosis, placement ofstents, polypecetomy, EMR etc. etc. The instrument is also in usefor PEG or ERCP in patients that have undergone Roux-en-Ybypass surgery and has even been reported to be able toapproach the Colon from the ante-grade direction.

In the meantime Olympus has worked on simplifying theapproach of balloon enteroscopy to make its usage easier andreduce overall examination time. The new Olympus systemconsists of a balloon control unit (OBCU) that is supporting a singleuse, hydrophilic overtube, featuring one integrated balloon. Thenewly developed SIF-Q180 enteroscope (2m working length,2,8mm working channel and 9,2mm outer diameter) has nosecondary balloon. Therefore the whole system is also referred toas Single Balloon Enteroscope (SBE). The scopes ‘Q-type’ CCD iscompatible with Videosystems down to EVIS 140 generation and incombination with CV-180 / CLV-180, Narrow Band Imaging (NBI) isavailable.

When using the new Olympus SBE system, three major simpli-fications become evident:• Time saving preparation: No extra time needed to prepare the

secondary balloon at the tip of the endoscope• Simplified fixation of the scope’s distal tip. Instead of fixing

the distal tip of the scope by inflating a secondary balloon the scopes angulations are used for this.

• Combined push (of scope) and pull (of overtube) is possible. Shortening the bowel by withdrawing the inflated overtube can be accompanied by continuously inserting the scope into the lumen. This combined manoeuvre is supposed to save examination time.

Besides the new Single Balloon Entersocope the Olympus‘EnteroPro’ line-up for the small bowel also includes the capsuleendoscope and a range of EndoTherapy instruments. Together

26

with the documentation system ENDOBASE, this will contribute tothe improvement of reliability quality and efficiency in thediagnosis and treatment of small bowel conditions.

ESGENA Workshops

Capsule endoscopy: - the role of capsule endoscopy indiagnosing small bowel diseases (1) - video reading by a nurse (2)Herdes, Erik, VU University medical center, Amsterdam, The Netherlands

The aim of the first workshop is to provide an overview of thepossibilities that a video capsule (VCE) has as a diagnostic tool toaid the gastroenterologist to diagnose possible small intestinediseases.

In the past, there was no endoscopy technique available tovisualize the mucosa of the small intestine. With the use of theVCE technique, determination of the mucosal lesions responsiblefor the clinical presentation is possible. In both adults andchildren the VCE can be used to make successful diagnosis likeobscure gastrointestinal bleeding (OGIB), anemia, iron deficientanemia, Crohn’s disease and colitis ulcerosa (IBD), cancers,severe protein depletion, celiac disease, polyps or tumors,polyposis and Peutz-Jeghers syndrome. Moreover, the preciselocation of small bowel lesion can be estimated with VCE. Thisacquired information gives us an opportunity to plan furtherendoscopic or medicinal treatment. At our site, where doubleballoon enteroscopy is available, the VCE results can be used inguiding the approach (lower or upper) and planning intervention.The second workshop aims to provide information about thetasks and the important role of the nurse in video capsuleendoscopy. The nurse provides the patient with informationabout the examination and explains the importance and methodof bowel preparation. The VCE investigation is done entirely bythe nurse who also instructs the patient with further information.The nurse downloads the information from the data recorder anddoes the initial review of the data. He / she makes thumbnails ofthe found disorders and makes the initial report. The gastroen-terologist reviews the findings and the report of the nurse, and isresponsible to make the final report and possible diagnosis.

Investigations after a problem on a washer disinfectorMarie-Ange Bibollet, Jean Alain Chayvialle, Thierry Ponchon, ServiceEndoscopie Digestive Hôpital Edouard Herriot Lyon; Christine Chemorin,Philippe Vanhems, Claude Bernet, Angèle Gayet, Léone Morandat,Unité d’Epidémiologie et d’Hygiène Hospitalière Hôpital Edouard HerriotLyon (marie-ange.bibollet@chu-lyon.fr)

Introduction. In 2002, March 29, a nurse in the endoscopy unit,when opening the door of the automatic disinfector, noticed the

absence of water vapour in the machine. There was no alert sign,no leakage of water and the consumption of detergent anddisinfectant agents was normal. A dysfunction of the pumpirrigating detergents and disinfectants in the channels ofendoscopes was detected by the responsible technician.

Objective. Identify those patients who were submitted to aprocedure using an endoscope processed with the defectivemachine; to call them for the search of a possible contaminationand a surveillance program.

Methods. The automatic disinfector was stopped, adysfunction report was sent to the medical staff and to theHospital Hygiene Unit. The control concerned all the patients(n=236) submitted to a procedure using an incompletelydisinfected endoscope, since the date March 29. Thesurveillance program included a questionnaire on symptoms anda search for Hepatitis viruses and AIDS. The surveillance beganon the nearest day of March 29 (day 0) and was resumed atmonthly intervals up to 6 months. In addition, media informationand medical answering service were established forreassurance of the patients.

Results. 69 distinct circulation loops were identified for those236 patients. A circulation loop corresponds to a series ofpatients who were submitted to an endoscopy with aninadequate procedure of disinfection and were considered aspotentially contaminated and contaminant; the loop ends whenthe endoscope has been completely disinfected. Out of the 236patients, 207 (87%) could be controlled at Day 0: no serocon-version to hepatitis viruses or AIDS occurred during the followup. Out of these 207 patients, 136 were followed up to 4 months,56 up to 5 months, 15 up to 6 months. Out of the 236 patients 10could not be contacted and were considered as lost to follow-up.Out of the 236 patients 13 died from a severe disease unrelated toany contamination or complication from endoscopy.

Conclusion. The analysis has shown that no patient wasinfected by the most injurious viruses. This comforting resultconfirms the importance of a first cleansing step of theendoscope prior to introduction in the automatic disinfector. Thecleansing step includes the use of detergents and passing aswab in the channel of the fibroscope. The traceability and thesystematic individual control of the sequence ‘patient,endoscope, machine’ allows to identify any failure in the processof disinfection. In the surveillance of patients after anendoscopic procedure the respect of the precautionary principleis essential to ensure a high standard of care for the surveillanceof patients. Incidentally, the global cost of the control after anepisodic disfunction of the disinfector was high for the hospital.

27

ESGENA NEWS

Cleaning & disinfection of endoscopes: why still bother?Ton Mestrom, University Hospital Maastricht, the Netherlands

Although it seems things are changing somewhat, most nursesstill clean and disinfect their endoscopes, and more importantstill, feel it’s an important part of their job profile. The author hasbeen responsible for centralising the cleaning and disinfection intwo consecutive hospitals and will show the benefits forpatientcare and nurses in centralising the process. The presen-tation will consist of overall organisation, training of personnel,benefits, drawbacks and possible pitfalls.

How to perform microbiological testing of endoscopes andautomated washer desinfectors?Ulrike Beilenhoff, Ferdinand-Sauerbruch-Weg 16, D-89075 Ulm,Germany; Email: UK-Beilenhoff@t-online.de

Introduction. Microbiological surveillance is an importantinstrument of quality assurance in gastrointestinal endoscopywhether endoscopic procedures are performed in hospitals, inprivate clinic or in doctors’ offices.

The aims of regular microbiological surveillance are (1,2):• To control the quality of the whole reprocessing cycle• To identify and redress mistakes and weaknesses during the

reprocessing procedure and• To prevent the transmission of infectious material and

diseases through Endoscopy.

Responsibilities. Microbiological surveillance is the responsi-bility of the service provider. In order to show evidence of thecomplete reprocessing cycle, routine microbiologicalsurveillance includes testing of endoscopes, automated washerdisinfectors (AWD), water systems (especially the last rinsingwater) and filtration systems used in endoscopy units.

Frequency. Routine testing of endoscopes, AWDs and watersystems should be performed every 3 months (1). In case ofcontamination, short-term repeat tests are necessary until theproblems have been resolved. In case of clinical suspicion ofcross-infection or epidemiological evidence suggestive oftransmission of infection related to endoscopy, microbiologicaltests should be performed immediately.

Performance of tests. Microbiological tests of endoscopesmust include Swabs from the outer surfaces and liquid samplesfrom all channels and the water bottle system. Each channel isflushed with 20 ml sterile saline. Because of the small lumen, theelevator channel of duodenoscopes is flushed with 5ml sterilesaline only. The liquid of each channel is collected in a separatesterile container. A used water bottle is tested at the end of thedaily list, by taking liquid samples from the water bottle.

Depending on the design of the AWD, the options of collectingsamples may vary. A sample of 2x 100ml should be taken from thefinal rinse water.

Water samples should also be taken from tap water (accordingto national recommendations. The ESGE-ESGENA Guidelinegives detailed recommendations on the culturing of samples (1).

Interpretation of results and outbreak management. In case ofregular microbiological surveillance, a number of organisms canbe used as indicators of weaknesses or mistakes in thereprocessing procedure:• E. coli, enterococcus as indicator for insufficient cleaning and

disinfection, defects of AWDs• Pseudomonas aeruginosa as indicator for insufficient rinsing,

drying and contaminated filter systems• Staph. aureus and epidermidis as indicator for insufficient

staff hygiene, insufficient transport or storage of endoscopes

A quantification of bacterial growth is recommended. Acriterion for acceptability is the absence of growth of vegetativebacteria. If clinical or epidemiological data suggests thetransmission of infection, the test methods should be focused onthe suspicious organism, additionally to the routine test methods.If any contamination is found, it is the responsibility of the serviceprovider to take the suspected piece of equipment out of service(e.g. endoscopes, AWD, etc), until a satisfactory biological testhas been performed.

References1. ESGE-ESGENA Guideline for quality assurance in

reprocessing: Microbiological surveillance testing in endoscopy. Endoscopy 2007; 39; 175-181.

2. ESGE-ESGENA- guideline for process validation and routine testing for endoscope reprocessing in washer-disinfectors, according to the European Standard prEN ISO 15883 parts 1, 4and 5. Endoscopy 2007; 39: 85-94

3. Leiss O, Beilenhoff U, Bader L, Jung M, Exner M. Reprocessingof flexible Endoscopes and Endoscopic Accessories - anInternational Comparison of Guidelines. Z Gastroenterol 2002;40; 531-542

Hemostatic procedures (clips, sclerosis, bindings)Agnès LICHERE Hospital Avignon, GIFE, falichere@tele2.fr.; Dr. Stéphane KOCH CHU Besançon (France) skoch@chu-besancon.fr

Injection. ADRENALIN 1/10000: short duration vasoconstrictor(30mn). INDICATIONS: bleeding Ulcers, post polypectomy andsphinctéroctomy, before thermic procedure. PREPARATION ofequipment: Switch with sclerosis of single use. 1ml of adrenalin1mg more 9ml of physiological salt solution; Syringe 10ml withend luer-lock. TECHNIQUE: Location of the zone of bleeding.Introduction of the needle in the operating- channel. Injection of

28

the hemostatic product, with the circumference of the zone, mlper ml. To return the needle in its sheath between each operationand with the shrinking of the endoscope. Obtaining an edema ora bleaching of the mucous membrane testifies of effectiveness ofthe treatment. Usually associated electro coagulation.CONCLUSION: Easy realization, low cost.

Thermic procedure. INDICATIONS: bleeding Ulcers, postpolypectomy and sphinctéroctomy, after adrenalin injection.TECHNIQUE: Before procedure test the probe by touching 1 to 2ml drop of saline water and observe the bubbles. The visual fieldneeds to be washed with repeated irrigations. Then, advance theprobe until tangential contact. Press firmly and activate thecoagulator generator for 10 seconds.

Banding of the esophageal or hemorrhoidal varices.INDICATIONS: Treatment or prevention of rupture of esophagealvarices. MECHANISM Of ACTION: Set rubber bands on theesophageal varices. MATERIAL: SAEED MULTIBAND LIGATOR ofWilson Cook or SUPERVIEW of Boston Scientific TECHNIQUE:Routine endoscopic examination is necessary to confirm thediagnosis requiring. System preparation. Reintroduction of theendoscope and visualize the selected varix and aspirate,maintain suction and deploy the band. CONCLUSION: 2 to 4explorations can be necessary. Soft food, 6 hours after thegesture in the absence of complication.

Hemoclip. (Boston Sc, Cook, Olympus). DESCRIPTION:Catheter of introduction out of Teflon. Stainless steel clip.INDICATION: endoscopic marking, hemostasis. TECHNIQUE:Installation clip by opening and pressing the handle completely.After inserting the device into the endoscope, pull the slidergently towards you to open the clips completely and pull it.CONCLUSION: Easy installation, falls between 4 and 10 days.

Endoloop. Allows a control of the subsequent bleeding withthe ablation of large polyps pedicles. (Olympus). DESCRIPTION:Catheter of introduction out of Teflon, sheath interns out of steel,binding out of nylon, handle of order. INDICATION: Prevention ofa hemorrhage during an endoscopic polypectomy. INSTAL-LATION OF THE ENDOLOOP: Tighten prudently the lasso using thehandle for strangle the foot: the polyp becomes purplish,enlargen the endoloop by pushing back the handle. Resection ofthe polyp to the diathermy snare above the endoloop. It will fallbetween 3 and 10 days by ischemia with the residual part of thefoot located downstream. CONCLUSION: Take care of tighteningsufficiently without to dividing the polyp. Have a good control ofthe gesture.

How to improve your communication - fear of speaking andappearing in front of the publicZdravko Zupanãiã in Ana Aleksandra Zupanãiã, ·ola retorike, TrÏa‰ka2, Ljubljana, Slovenija, Email: zdravko©sola-retorike.si;aleksandra@sola-retorike.si

The paper shall rest upon the following topics:• Origin of fear of appearing and speaking in front of the public• Types of fear of appearing in front of the public• The most frequent signs of fear of speaking and appearing in

front of the public• How can we alleviate the fear of appearing in front of the

public• Difficulties related to fear and other disinclinations when

speaking and appearing in front of the public• Discussion on particular cases

Endoscopic mucosal resection (EMR) and endoscopicsubmucosal disection (ESD): modalities and nurse’ rolesC Michel (nurse) and Pr D Heresbach (MD-PhD). Gastroenterologicaldepartment and endoscopy’s unit. University hospital Rennes – France

EMR and ESD are new endoscopic procedures like mini-invasive surgery aimed to remove early digestive neoplasia withlow morbidity without mortality. The aims of EMR are to treatsuperficial lesion involving mucosae whereas ESD shouldremove larger neoplasia invading superficial submucosae. Infact, following surgery should be done either in case ofimmediate complication, ie hemorrhage (3 to 10%) or perforation(1p1000 to 5%) despite some of them should be treated perendoscopic procedures or in case of incomplete resection ordeeper invasion suggesting future lymph nodes involvement.Purpose of EMR or ESD is to remove the lesion in one time (or onepiece) as it is done according to the carcinologic treatment rules.These techniques are divided in several steps which must beestablished and well known by both endoscopic physicians andendoscopic nurses. At present EMR are widely performed foroesophageal, gastric or colonic and rectal high grade dysplasiaor early cancer. However each site needs precise tools andmaterial of endotherapy which must be currently used by thenurses especially to treat endoscopically adverse effect ashemorrhage or minimal perforation avoiding curative surgery.Most recently, ESD is widespreading among western teamsespecially in UK, Germany and France. This procedure needsfirst to be positioned compared to EMR in term of lesion size anddepth of invasion the ultimate aim being to remove the lesion inone time excluding as long as possible piecemeal EMR.Secondly, ESD needs to be performed on animal models (trainingprogram for referral centers) to perform fluently each step andimprove their reproductibility. Finally, in Japanese teams ESDprocedures as other interventional endoscopies are performedby two GI physicians assisted by an endoscopic nurse.Effectively, the movement of the endoscope needs actually to be

ESGENA NEWS

29

done by a physician because it belongs to the endoscopictreatment, the nurse’s roles being to check and give to thephysician all different tools of endotherapy step by step and tocheck the power’s level of the electrosurgical unit. Effectively,during ESD and sometimes in EMR, tools and electrosurgical unitsetup must be often modified according to the site or size of thelesion and amount of solution injected below the lesion in orderto maintain the lifting sign during each step of the ESDprocedure. So, after EMR and ESD, during the post-proceduresteps, nurses must be more involved in the description andcorrespondance with the pathologist as it is more important to becertain that the process of the specimen removed will give all therelevant data to choose between conservative and endoscopicfollow-up or adjuvant surgery.

Announcements of National and EuropeanConferences

Belgium• EURO-NOTES 2007: 2nd Joint European NOTES meeting in

Belgium, 2008, organized by ESGE in cooperation with EAES25–27 September 2008, Brussels, BelgiumInformation: EURO-NOTES 2008 Conference Secretariat, European Society of Gastrointestinal Endoscopy (ESGE), HG Editorial & Management Services, Mauerkircher Strasse 29, 81679 Munich, Germany. Tel. 0049-89-9077936-15, fax 0049-89-9077936-20, e-mail: en2008@euro-notes.orgwww.esge.com and www.euro-notes.org/workshop

Bulgaria• ESGE–ESGENA Live Demonstration Workshop 2008

21–22 November 2008, Sofia, BulgariaInformation: Scientific Secretariat, Associate Professor Krum Katzarov, Military Medical Academy, Gastroenterology Department, Sofia, Bulgaria. Tel. 00359-887-303779; fax: 00359-2-9225760, e-mail: gastrovma@yahoo.comwww.esge.com

Czech Republic• National Conference of Endoscopy Nurses

25 November 2008, Congress Hall Homolka, Prague 5, Czech RepublicConference language: CzechInformation: Hana Kubu, Tel. +420-2-24076, e-mail: Hana.kubu@seznam.cz

Denmark• National Meeting 2008

Fagligt Selskab for Gastroenterologiske Sygeplejersker7–8 November 2008 Kolding, DenmarkLanguage: Danish

Germany• 11th International Symposium: Diagnostic and Therapeutic

Endoscopy6–7 February 2009, Düsseldorf, CCD-Süd, GermanyConference languages: German, EnglishInformation: COCS — Congress Organisation C. Schäfer, Franz-Joseph-Strasse 38, 80801 Munich, Germany. Tel. 0049-89-3071011, fax: 0049-89-3071021, e-mail: martina.wiederkrantz@cocs.dewww.esge.com and www.cocs.de

• Spring Conference of the German Society of Endoscopy Nurses and Associates (DEGEA) and 39th Conference of the German Society of Endoscopy and Imaging (DGE-BV)19–21 March 2009, ArabellaSheraton Grand Hotel, Munich, Germany

30

Conference language: GermanInformation: COCS — Congress Organisation C. Schäfer, Franz-Joseph-Strasse 38, 80801 Munich, Germany. Tel. 0049-89-3071011, fax: 0049-89-3071021, e-mail: martina.wiederkrantz@cocs.dewww.cocs.de, www.dge-bv.de, www.degea.de

• International Symposium on Complications in GastrointestinalEndoscopy: How to Diagnose, How to Treat, and How to Prevent!25–26 June 2009, Hanover, GermanyInformation: Gabriele Krupp, Diakoniekrankenhaus Henriet-tenstiftung GmbH, Medizinische Klinik II, Schwemannstr. 17, 30559 Hanover, Germany. e-mail: gabriele.krupp@henriettenstiftung.dewww.esge.com and www.gastro-henriettenstiftung.de

Hungary• 11th World Congress of the International Society for the

Diseases of the Esophagus (ISDE)10–13 September 2008, BudapestInformation: Mr. Zsombor Papp, e-mail: zspapp@convention.hu, convention@convention.hu.www.esge.com and www.isdecongress2008.com

Luxembourg• Annual conference of the Luxembourg Association of

Endoscopy Staff (Association Luxembourgeoise du Personnel en Endoscopie, ALPE)28 March 2009Information: Lorenz Rudkin, ALPE international contact, e-mail: alpe@chl.lu

Norway • 26. SADE congress

(Scandinavian Association for Digestive Endoscopy)22–23 January 2009Oslo, NorwayInformation: www:sade.noCongress language: Norwegian, Swedish and Danish

• THE XL NORDIC MEETING of Gastroenterology(Scandinavian Association for Digestive Endoscopy)3–6 June 2009Stavanger, NowayLanguage: Skandinavian

The Netherlands• Amsterdam Live Endoscopy 2008 conference

15–16 December 2008, Amsterdam, The NetherlandsInformation: European Postgraduate Gastrosurgical School, Ms Joy Goedkoop, EPGS-AMC, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands. E-mail: epgs@amc.uva.nlwww.esge.com and www.amsterdamendoscopy.com

Slovenia• 2nd Gastroenterological Congress, Section of Endoscopy

Nurses of Slovenia3–4 October 2008, Bled, SloveniaThe main topics will be: colorectal cancer, GERDInformation: Stanka Popovic, e-mail: sm.popovic@siol.net

Switzerland• Neurogastroenterology & Motility. Joint International Meeting

of the European Society for Neurogastroenterology and Motility (ESNM), International Neurogastroenterology and Motility Group (INMG), Functional Brain–Gut Research Group (FBG) and American Neurogastroenterology and Motility Society (ANMS)6–9 November 2008, Lucerne, SwitzerlandConference language: EnglishInformation: www.ngm2008.com

United Kingdom• Annual Conference of the British Society of Gastroenterology

23–26 March 2009, Scottish Exhibition & Conference Centre, GlasgowInformation: www.bsg.org.uk

Forthcoming UEGW/ESGENA conferences• ESGENA/SIGNEA Conference during Gastro 2009,

UEGW/WCOG20–25 November 2009, London, United Kingdomwww.gastro2009.org

• 14th ESGENA Conference during the 18th UEGW, Barcelona, 201023–27 October 2010, Centre Convencions Internacional Barcelona, Spainwww.uegf.org

31

12th Meeting of ESGENA in Association with the Austrian Society of Endoscopy Nurses(IVEPA), in Conjunction with the 16th UEGW, Vienna, Austria, 18–20 October 2008

ESGENA Welcoming AddressOn behalf of ESGENA and the Austrian Society of Endoscopy

Nurses (IVEPA), it is a great pleasure for us to invite you to the 12thESGENA Conference, which will be held during the 16th UnitedEuropean Gastroenterology Week (UEGW) meeting in October2008 in Vienna.

As in previous years, we are hoping to provide a full and variedprogramme — to stimulate you into meeting and holdingdiscussions with colleagues from all over Europe and furtherafield. We are continuing with the format used in previousconferences, as this has encouraged networking and communi-cation between the delegates — both between individual nursesand national groups.

On the Saturday, there will be an opportunity to attend a choiceof eight workshops organized in four parallel rooms. Theworkshops will have a more practical focus and will be held insmaller groups — up to 50 — to encourage discussion, questions,and exchanges of ideas. Nurses will also have access to the UEGWlive demonstrations, which are planned for Saturday all day.

Following success at previous conferences, it is planned tooffer hands-on training using bio simulators for nurses on theSaturday and Sunday. These workshops will be organized in closecooperation with the ESGE.

The conference will open officially with the ESGENA WelcomingReception on the Saturday evening. In the past, this has been amost enjoyable and informal evening, with an opportunity to meetcolleagues and friends from all over Europe and overseas.

On the Sunday, the scientific programme, which includes twofree paper sessions and a nurses’ poster session, will offer mainlynursing-oriented lectures in two parallel halls.

On the Monday morning, we will have the ESGENA PlenarySession — with lectures in just one hall — to bring together all thedelegates, and the meeting will close with the prize-giving for thebest free paper and the best poster, followed by the invitation tothe next ESGENA conference.

The trade exhibition will open on Monday lunchtime, and thereshould be enough time to browse the stands if the medicalscientific programme does not tempt you back into the lecturehalls. Nurses are invited to visit the Learning Corner in particular,which will be offering a wide variety of ‘state-of-the-art’ videos.We look forward to welcoming you to the 12th ESGENAConference in October 2008 in Vienna, Austria.

Ulrike Beilenhoff (President of ESGENA)Herta Pomper (President of IVEPA)

Language: English

ESGE Learning Centre, level 1

08.30–18.00UEGW postgraduate

training programme withlive demos

15.00–15.30 Coffee

Language: English

UEGW postgraduatetraining programme

with live demos

ESGENA Workshop Programme, Saturday 18 October 2008

SATURDAY 18 OCTOBER 2008

Language: English

Hall H on level U2

13.30–15.00Workshop 3

Given Imaging: Managing CapsuleEndoscopy Program - Best Practices forNurses and Allied

Healthcare Professionals

15.00–15.30 Coffee

Language: English

15.30–17.30Workshop 7

HF –Surgery in Endoscopy

Language: English

Hall I on level U2

13.30–15.00Workshop 4

Total Quality assurance in endoscopy - the

English model

15.00–15.30 Coffee

Language: English

15.30–17.30Workshop 8

Practical training withmodels - How to make

dummies

Language: English

ESGE Learning Centre, level 1

13.30–15.00Workshop 1

Hands-on-training on biosimulators

ODG Colonoscopy

ERCP

15.00–15.30 Coffee

Language: English

15.30–17.30Workshop 5

Hands-on training on biosimulators

ODG Colonoscopy

ERCP

Language: English

Hall G on level U2

13.30–15.00Workshop 2

Olympus: Hygiene surveillance

and hygiene assurance in endoscopy: potential

for improvement

15.00–15.30 Coffee

Language: English

15.30–17.30Workshop 6

COOK Medical: Technological

Advancements in Balloon Dilation

32

UEGW postgraduate training programme09.00–10.30Plenary 1The management of acute pancreatitis11.00–17.00Parallel Session 1Endoscopy live demonstrations via satelliteParallel Session 2Viral hepatitis: challenges and perspectives in treatmentParallel Session 3Personalized medicine in IBD

Workshop 1: Hands-on training on bio simulatorsThis workshop is organised by ESGENA and ESGE 13.30–15.00ESGE Learning Centre on level 1Coordinators: Michael Ortmann, Basel, Switzerland, Eric Pflimlin,Basel, SwitzerlandLanguage: EnglishHands-on training on bio simulators (pig models) under thesupervision of highly experienced tutors. Participants will have theopportunity to perform endoscopic techniques on the topics ofcolonoscopy with therapeutic procedures and ERCP with stoneextraction and stenting. As participation will be limited,registration will be treated on a first-come, first-served basis.

Workshop 2: Hygiene surveillance and hygiene assurance in endoscopy:potential for improvement?!This workshop is organised by Olympus Medical Systems EuropeGmbH, Hamburg, Germany.13.30–15.00Hall G on level U2 Chair: Annette Rittich, Olympus Medical Systems Europe GmbH,GermanyAim: The approach to hygiene surveillance in endoscopy differsnot only from continent to continent, but even between Europeancountries. Some countries focus on the regular control of the finalrinse water quality in endoscope WD, while others also sampleand supervise the microbiologic status of endoscopes afterreprocessing. The aim of this workshop is • To present the approach to hygiene surveillance in different

European countries• To review official guidelines • To discuss advantages and shortcomings of current practice• To identify potential for improvementSpeakers: Dr. Lionel Pineau, Biotech Germande, Marseille,France, Dr. Tillo Miorini, Institute for Applied Hygiene, Austria

Workshop 3: Managing Capsule Endoscopy Program - Best Practices for Nurses and Allied Healthcare ProfessionalsThis workshop is organised by Given Imaging 13.30–15.00Hall H on level U2 13.30 -13.50 Indications, Clinical Application and

Contraindication 13.50 -14.05 Video Case Presentations14.05 -14.20 Efficient Patient Management

(Procedure, Equipment, Study Management)14.20 -14.35 Latest Innovation 14.35 -14.50 PillCam® COLON Capsule Endoscopy 14.50 -15.00 RAPID® Help Centre and Other Resources

Workshop 4: Total Quality Assurance in Endoscopy - the English modelThis workshop is organised by ESGENA 13.30–15.00Hall I on level U2Chair: Diane Campbell, Torquay, UK; Christiane Neumann,Birmingham, UKAim of workshop: To introduce the participants to aspects ofendoscopy that can be quality controlled and how this is achievedin England.Aim of workshop: Interactive workshop looking at various aspectsin endoscopy that can be quality managed such as e.g.• Clinical Quality• Quality of the Patient Experience• Workforce• Training• Unit design and layout• Decontamination• etc, The workshop will also inform on how the national QualityAssurance programme is organised, and how the endoscopydepartments and staff – and ultimately the patients- havebenefited from the process.

33

ESGENA NEWS

Workshop 5: Hands-on-Training on bio simulators This workshop is organised by ESGENA and ESGE15.30–17.00ESGE Learning Centre on level 1 Chair: Michael Ortmann, Basel, Switzerland, Eric Pflimlin, Basel,Switzerland Hands-on training on bio simulators (pig models) under thesupervision of high experienced tutors. Participants will have theopportunity to perform endoscopic techniques on the followingtopics: • Colonoscopy with therapeutic procedures • ERCP with stone extraction and stenting As participation will be limited, registration will be treated on afirst-come-first-served basis.

Workshop 6: Technological Advancements in Balloon Dilation This workshop is organised by Cook Medical15.30–17.00Hall G on level U2 Chair: Theo Pordon, Amsterdam, NLContent: The workshop will include a presentation on Manage-ment of oesophageal strictures and new balloon dilationtechnology by Theo Pordon and hands-on-training on products

Workshop 7: HF-Surgery in EndoscopyThis workshop is organised by ESGENA 15.30–17.00Hall H on level U2 Chair: Mette Olesen, Copenhagen, Denmark, Christine Petersen,Amsterdam, NLPresentations: • Principles of HF surgery and APC & Preventions of complications

Jürgen Raiser, Tübingen, Germany • Quality management in HF surgery as a process between

endoscopy nursing and medical device maintenance Christian Kluth, Basel, Switzerland

• Practical Demonstrations

Workshop 8 Practical training with models - How to make dummiesThis workshop is organised by ESGENA 15.30–17.00Hall I on level U2 Chair: Michael Ortmann, Basel, Switzerland, Ulrike Beilenhoff,Ulm, Germany Aims: In order to simulate realistic training scenarios, training ondummies is a very effective and efficient way of learning. However, itis not necessary to use complicated and expensive bio simulators likepig dummies for daily hands-on-training or smaller workshops;artificial models and dummies can easily been ”built” locally.The attendees will get information • about commercially available dummies and • how to produce cheap, simple and very effective self-madedummies for practical training in their own practice by acombination of plastic dolls, meat, fruit and vegetables.

ESGENA and the Austrian Endoscopy Nurses’ Society (IVEPA)have great pleasure inviting all conference participants to the

ESGENA-IVEPA Welcoming Receptionon 18 October 2008

ESGENA-IVEPA Welcoming Reception

34

Hall G on level U2 Language: English

8.30-10.00SESSION 1Sedation

10.00-11.00 Coffee & Poster Session I

11.00-12.30 SESSION 3

Free paper session

12.30-14.00 Lunch & Poster session II

14.00-15.30 SESSION 5

Free paper session

15.30-16.00 Coffee

16.00-17.30 SESSION 7Education

17.30-18.30 ESGENA General Assembly

(Members only)

ESGENA Scientific Programme, Sunday 19 October 2008 and Monday 20 October 2008

SUNDAY 19 OCTOBER 2008 MONDAY 20 OCTOBER 2008

Hall F1 on Level OELanguage: English

8.30-10.30PLENARY SESSION

New techniques anddevelopments in endoscopy

Best Free Paper and Best Poster AwardInvitation to London

10.30-11.00 Coffee

Visit to exhibitionESGE Learning Area

UEGW sessions

Lunch at UEGW Catering Areas

Visit to exhibitionESGE Learning Area

UEGW sessions

15.30-16.00 Coffeeat UEGW Catering Area

Visit to exhibitionESGE Learning Area

UEGW sessions

Hall H on level U2Language: English

8.30-10.00SESSION 2

Paediatric patients inendoscopy

10.00-11.00 Coffee & Poster Session I

11.00-12.30 SESSION 4

GE-Patient care

12.30-14.00 Lunch & Poster Session II

14.00-15.30 SESSION 6Psychology

15.30-16.00 Coffee

16.00-17.30 SESSION 8

Management

ESGE Learning CentreLanguage: English

10.00-11.00 Coffee & Poster Session I

13.30-15.00 WORKSHOP 9

Hands-on-training on bio simulators

15.30-17.00 WORKSHOP 10

Hands-on-training on bio simulators

35

ESGENA NEWS

ESGENA Scientific Programme, Sunday 19 October 2008

Session 1: Sedation08.30–10.00Hall G on level U2Language: EnglishChair: Michael Ortmann (Basel, Switzerland), Gerlinde Weilguny(Vienna, Austria)08.30–08.40 Welcome (Ulrike Beilenhoff, Ulm, Germany)08.40–09.05 Application of propofol (bolus, pump, TCI, PCI,

CAPS) (Ulrich Rosien, Hamburg, Germany)09.05–09.30 NAPS — quality assurance and prevention of

complications (Ludwig Heuss, Zurich, Switzerland)09.30–09.55 Hypnotherapy: an overview — is there a place for it

in gastroenterology? (Irene Dunkley, Huntingdon, UK)

Session 2: Paediatric patients in endoscopy08.30–10.00Hall H on level U2Language: EnglishChair: Jadranka Brljak (Zagreb, Croatia), Theresia Schober(Vienna, Austria)08.30–08.40 Welcome (Herta Pomper, Vienna, Austria)08.40–09.05 Guidelines for paediatric endoscopy

(Paraic McGrogan, UK) 09.05–09.30 Paediatric bronchoscopy (Iolo Doull, Cardiff, UK)09.30–09.55 Liver transplantation in children: outcome seven

years after first transplantation (Marina ‘CicakNovak, Zagreb, Croatia)

ESGENA Poster Round I (Preparation, Sedation & Discharge) 10.00–11.00In front of Halls G-H on level U2 Assessors: Jayne Tillett (Lydney, UK), Anita Jorgensen (Skien,Norway), Lorenz Rudkin (Luxembourg)1. Patients’ perceptions on the use of name wrist band in

outpatient services at NKC Institute of Gastroenterology and Hepatology(Siriporn Ratanalert RN, Sopa Boonviriya RN, WarapornJarupan RN, Sulee Sangnil RN, Reonkhun Chotirat RN, NKCInstitute of Gastroenterology and Hepatology, Songklanagarind Hospital, Thailand)

2. The use of ethyl chloride spray and professional nursing approach in pain and anxiety control in endoscopy (N. Tüzomay, D.Sabuncular, B.Aç›l, B.fiengül, E.Tankurt, Izmir Kent Hospital Turkey)

3. A Model for an Early Detection of Prostate Cancer in theGastroeneterology Unit, Hadassah Ein- Kerem Medical Center(Shafran-Tikva Sigal 1, 2 Lysy Yosef 1, Goldin Eran1, GreenbergDan2; 1.Gastroenterology Unit, Hadassah University MedicalCenter Ein Kerem, Jerusalem, Israel; 2 Department of HealthSystems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel)

4. Polyethylene Glycol solution for colon cleansing: 3 or 4 liters? (Valentina Lapina, Daiga Muceniece, Paula Stradina ClinicalUniversity Hospital, Riga, Latvia)

5. Changing practice of sedation during endoscopic ultrasound: Propofol versus Midazolam(Daniela Burtea, Monica Busoi, Mihaela Calita, Malos Anca,Gabi Fedak, Research Center of Gastroenterology andHepatology, University of Medicine and Pharmacy Craiova,Romania)

6. Propofol: patients best friend during endoscopy (Lydia Singels EA, Henk Pelt EA, Department of Gastroen-terologie, Academic Medical Center, Meibergdreef 9, 1100 DDAmsterdam, the Netherlands)

7. Clinical efficacy of Dexmedetomidine alone is less than Propofol for conscious sedation during ERCP (Suzana Muller, MsS, RN, Silvia M. Borowics, Elaine A. F. Fortis,MD, PhD, Luciana C. Stefani, MD,Gabriela Soares, IsmaelMaguilnik, MD, MsH, Helenice P. Breyer, MD, MsH, Maria Paz L.Hidalgo, MD, PhD,Wolnei Caumo, MD, PhD, Hospital de Clínicasde Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduation Course in Gastroenterology Sciences, PortoAlegre, Brazil)

8. Nursing care and instructions to outpatients discharge after endoscopy exams under sedation(Suzana Müller, PhD, RN; Ane Isabel Linden, Ms, RN, Hospitalde Clínicas de Porto Alegre, RS, Brazil)

9. Recommendations after an upper gastrointestinal endoscopy (Granados-Martín Mónica, Díaz-Rodríguez Dania-Rocío, Hospital de Fuenlabrada, Madrid, Spain)

Session 3: Free Papers11.00–12.30Hall G on level U2Chair: Diane Campbell (Torquay, UK), Stanka Popovic (Ljubljana,Slovenia), Herta Pomper (Vienna, Austria)11.00–11.15 Nutrition to patients suffering from severe

alcoholism – An interdisciplinary success story (Dorthe Melgaard, Marianne Toppenberg, Regionshospital Viborg, Viborg, Denmark)

11.15–11.30 Implementation of new technology in hepatic nursing through development of standard nursing care plan for Prometheus liver support treatment (Gitte Kastberg Andersen; Department of MedicineV, Aarhus University Hospital, Denmark)

11.30–11.45 Implementation of a gastroenterological semi-intensive observation unit improves the quality ofnursing in patients with Hepatic coma (1Astrid Reher-Langberg, 1Jens Noppenau,1Christian Homann, 1 Department of Internal Medicine I, Division of Gastroenterology, Bispebjerg Hospital, University of Copenhagen, Denmark)

11.45–12.00 A prospective multicentre study on short and long-

‘

36

term complications of Percutaneous Endoscopic Gastrostomy (PEG) in Italy (Maurizio Giacomini (*), Giorgio Benedetti (+), Francesca Valent(+^), S. Maria degli Angeli Hospital– Gastroenterology and Endoscopic Digestive Ward, Via Montereale 24, 433170 Pordenone, Italy)

12.00–12.15 The Education of patients with home parenteralnutrition (Chantal Bakhuysen RN, Gwenda Veenboer RN,Ward F7Zuid; gastrointestinal and hepatologydiseases. Academic Medical Centre, Amsterdam,The Netherlands)

12.15–12.30 Job stress and coping strategies in patients with subjective food hypersensitivity(1,2Ragna Lind, 1,2Kristine Lillestøl, 3Hege RandiEriksen, 4,5Tone Tangen, 1,2Arnold Berstad, and1,2Gülen Arslan Lied, 1Institute of Medicine,University of Bergen, 2Division of Gastroenterology, Department of Medicine, Haukeland University Hospital, 3Department of Biological and MedicalPsychology, University of Bergen, Norway, 4Institute of Clinical Medicine, University of Bergen,Norway, 5Department of Psychiatry, HaukelandUniversity Hospital, Bergen, Norway)

Session 4: Patient Care in Gastroenterology11.00–12.30Hall H on level U2Language: EnglishChair: Sylvia Lahey (Arnhem, The Netherlands), Elke Freidhager(Linz, Austria)11.00–11.20 Nutritional risk factors among hospitalized

gastroenterological patients (Mette Holst, Aalborg, Denmark)

11.20–11.40 Nursing and quality-of-life studies: what is therelevance to the clinic? (Lars-Petter Jelsness-Jørgensen, Ostfold, Norway)

11.40–12.00 Self-help intervention as a neglected treatment alternative for functional GI disorders (Michael Kamm, Harrow, UK)

12.00–12.20 The problem of colon preparation in elderly patients(Patricia Burga, Padua, Italy)

12.20–12.30 Discussion

ESGENA Poster Round II – Treatment and Patient Care 12.30–14.00in front of Halls G–H on level U2Assessors: Jayne Tillett (Lydney, UK), Anita Jorgensen (Skien,Norway), Lorenz Rudkin (Luxembourg)11. Minimal invasive endoscopic treatment for oesophageal

stenosis (Krisztina Tari RN (1), Peter Lukovich MD (1), Szabolcs Farkas

MD (2), Gabor Varadi MD (1), Peter Kupcsulik MD (1), (1)Endoscopy, 1st Department of Surgery, (2)Department of Diagnostic Radiology and Oncotherapy, SemmelweisUniversity, Budapest, Hungary)

12. Starting a new endoscopic technique: Endoscopic RetrogradeCholangio-Pancreaticography (ERCP)(Díaz-Rodríguez Dania-Rocío, Granados-Martín Mónica, Hospital de Fuenlabrada, Madrid, Spain.)

13. Influence of Simeticone and Metoclopramide administration for Capsule Endoscopy preparation: preliminary results (I.A. Ibáñez Zafón, B. González Suárez, J. Muñoz Galitó, X. Bessa, A. Castells, S. Delgado-Aros, B. Gras, L. Marquez, M. Andreu and F. Bory, Endoscopy Unit, Hospital del Mar.,Barcelona)

14. Influence factors for nurse preformed endoscopy (Chapman, Warren1, Cooper Brian1, Inman Chris2. 1.CityHospital, Birmingham, Birmingham, B18 7QH, 2.Birmingam CityUniversity)

15. Nurse Information Guideline for patients with chronic hepatitis C(Caballero, Iolanda (2), Giménez, MDolors (1), Márquez, MCarmen (1), Fontanet, Angels (3), Bernal, Rosso (2),Mangues, Pepita (4), Guixé, Queralt (5), Varoucha, Cristina (6), Ariño, JLuis (4), Salas, Ana (7), Taulé, Rosa (8), Feijoo, María (9),Vargas, Montserrat (10), (1)Hospital del Mar (Barcelona), (2) Hospital Terrassa, (3) Hospital Sant Pau (Barcelona), (4) CP Brians (Sant Esteve Sesrovires), (5) CP Modelo (Barcelona), (6)Centro Penitenciario (CP) Quatre Camins (La Roca del Vallès), (7) Hospital Germans Trias i Pujol (Badalona), (8) Hospital Sant Joan de Déu (Manresa), (9) Hospital Vall d’Hebron (Barcelona), (10) Hospital Juan XXIII (Tarragona), Spain)

16. Nurse led rehabilitation clinic for patients with chronic hepatic insufficiency (Iben Asmussen Lisbjerg, Steen Vadstrup and WinnieSoegaard, Department of gastroenterology, Holbaek Hospital,Holbaek, Denmark)

17. Net information and web information (Palle Bager, Bodil Meyer and Gunhild Andersen; Department of Medicine V, Aarhus University Hospital, Denmark)

18. Functional status, health-related quality of life and symptom severity in patients with chronic intestinal pseudo-obstructionand enteric dysmotility(Marie Iwarzon1,2 RN., BNSc. PhD-student, and Greger Lindberg1 M.D., PhD. 1Department of Medicine, Division of Gastroenterology and Hepatology, Karolinska Institutet atKarolinska University Hospital, 2Department of Neurobiology, Care Sciences and Society, Division of Nursing, KarolinskaInstitutet Stockholm, Sweden)

19. Nursing quality and postoperative monitoring of patients undergoing surgery for perforated peptic ulcer in Denmark –results and perspectives (Ann-Sophie Nielsen, Ellen-Margrethe Jacobsen, Hanne Christiansen, Ulla Bachmann, Anne Nakano, RN in the DanishNational Indicator Group re perforated peptic ulcer, Denmark)

ESGENA NEWS

37

Workshop 9: Hands-on-Training on bio simulators 13.00–15.00ESGE Learning Centre on level 1 Chair: Björn Fehrke (Basel, Switzerland), Eric Pflimlin (Basel,Switzerland)Hands-on training on bio simulators (pig models) under thesupervision of high experienced tutors. Participants will have the opportunity to perform endoscopictechniques on the following topics: • Management of upper GI Bleeding • ERCP with stone extraction and stenting As participation will be limited, registration will be treated on afirst-come-first-served basis.

SESSION 5: Free Paper 14.00–15.30Hall G on level U2Chair: Diane Campbell (Torquay, UK), Stanka Popovic (Ljubljana,Slovenia), Herta Pomper (Vienna, Austria)14.00–14.15 Preparation for colonoscopy in hospitalized

patients (Nehama Horev RN, BSc, Bracha Chadad, RN, Negba Segal, RN, Ilana Shemesh RN, MSc, Meli Mor, RN, Shlomit Plaut, RN, Gerald Fraser, MD, Alex Geller, MD, Eyal Gal, MD, Yaron Niv, MD, FACG, AGAF, Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva & Sackler Faculty of Medicine, Tel Aviv University, Israel)

14.15–14.30 Total quality management in Gastrointestinal endoscopy nursing assessment of patient’s appropriateness for sedation-free colonoscopy (Jadranka Brljak, Division of Gastroenterology, Department of Medicine, Zagreb University Hospital Centre, Kispatiçeva 12, Zagreb 10000, Croatia)

14.30–14.45 Targeted intervention for education patients in the gastroenterology unit (Sigal Shafran-Tikva1, Luba Lutzky1, Dimitry Lavrov1, Dafna Levian1, Yael Dotan-Veeder1, Halad Lafi1, Sara Marcus1, Racheli Horvitz1, Anna Surin1, FelixMeyerson1, Nurit Porat2 1Gastroenterology Unit, 2Coordinator, Clinical Quality in Nursing, Hadassah University Medical Center Ein Kerem)

14.45–15.00 Hepatitic C – Knowledge assessment amongnursing hospital staff (Kalnizki Osnat RN, BA, Institute of gastroen-terology, Assuta Medical Center, Tel-Aviv, Israel, Sufugo Henia RN, BA, Institute of gastroenterology, Sheba Medical Center, Ramat-Gan)

15.00–15.15 Ergonomics in digestive endoscopy (Linden, Ane I., Baptista, Márcia E., Muller, Suzana, Hospital de Clinicas de Porto Alegre, Brazil,linden@sinos.net)

15.15–15.30 Reprocessing of endoscopic equipment – a survey in European countries Ulrike Beilenhoff (Ulm, Germany)

Session 6: Psychology14.00–15.30Hall G on level U2Language: EnglishAssessors: Christiane Neumann (Birmingham, UK), Clara Kratzik(Vienna, Austria)14.00–14.20 Psychology in the city of Sigmund Freud (George

Brownstone, Vienna, Austria)14.20–14.40 Stress management in endoscopy (George

Brownstone, Vienna, Austria)14.40–15.00 New modalities to explore the central nervous

system (Johann Hammer, Vienna, Austria)15.00–15.20 Antidepressants: only acting on the brain? (Guy

Boeckxstaens, Amsterdam, Netherlands)15.20–15.30 Discussion

Workshop 10: Hands-on-Training on bio simulators15.30–17.00ESGE Learning Centre on level 1 Language: EnglishChair: Björn Fehrke (Basel, Switzerland), Eric Pflimlin (Basel,Switzerland)Hands-on training on bio simulators (pig models) under thesupervision of high experienced tutors. Participants will have the opportunity to perform endoscopictechniques on the following topics: • Management of upper GI Bleeding • ERCP with stone extraction and stenting As participation will be limited, registration will be treated on afirst-come-first-served basis.

Session 7: Education16.00–17.30Hall G on level U2Language: EnglishChair: Pilar Perez-Rojo (Pamplona, Spain), Gerlinde Wiesinger(Salzburg, Austria)16.00–16.20 Experience with the European accreditation

system of UEMS (Michael Jung, Mainz, Germany)16.20–16.40 Inflammatory bowel disease — the value of nurse

education (Irene Dunkley, Huntingdon, UK)16.40–17.30 Nurse endoscopists in different European countries.16.40–16.50 Nurse endoscopists in the UK

(Pauline Hutson, Sheffield, UK)16.50–17.00 Nurse endoscopist in Sweden – education and

prospects (Gunilla Strand-Nystrom, Stockholm, Sweden)

38

ESGENA Scientific ProgrammeMonday 20 October 2008

Plenary session:New techniques and developments in endoscopy8.30–10.30Hall F1 on Level OEChair: Ulrike Beilenhoff (Ulm, Germany), Herta Pomper (Vienna,Austria)Language: English8.30–9.30 Presentations by the industry:8.30–8.45 OLYMPUS MEDICAL SYSTEMS EUROPA

Optimisation of endoscope workflow in betweenpatient examinations (Reinhard Blum, Hamburg, Germany)

8.45–9.00 PENTAXInnovative approaches in modern endoscopy(Martin Götz, Mainz, Germany)

9.00–9.15 BOSTON SCIENTIFIC Biliary Stricture Therapy - the Platinum Standard(Thomas Carter, UK)

9.15–9.30 COOK MEDICAL Ergonomic Solutions(Simon Brouwers, Ireland)

09.30–09.50 Complications of EMR and ESD and their prevention(Sören Meissner, Copenhagen, Denmark)

09.50–10.10 Endoscopic treatment of Barrett — a critical analysis (J.J. Bergman, Amsterdam, Netherlands)

10.10–10.20 Best Free Paper and Best Poster Awards (sponsored by Pentax)Ulrike Beilenhoff (Ulm, Germany), Herta Pomper

17.00–17.10 ESGENA statement of nurse endoscopists(Christiane Neumann, Birmingham, UK)

17.10–17.30 Discussion

Session 8: Management16.00–17.30Hall H on level U2Language: EnglishChair: Pilar Perez-Rojo (Pamplona, Spain), Gerlinde Wiesinger (Salzburg, Austria)16.00–16.30 Perception of violence on workplace between

nurses in endoscopy (Stanka Popovic, Ljubljana, Slovenia)

16.30–17.00 Global rating andits to measure quality and audits of the organisation (Jayne Tillett, Lydney, UK)

17.00–17.30 Intelligent light — an option for improving working conditions in endoscopy (Jesper Durup, Odense,Denmark)

(Vienna, Austria)Close of meetingUlrike Beilenhoff (Ulm, Germany)

10.20–10.30 Invitation to gastroenterology nurses for 2009Pauline Hutson (Sheffield, UK)

General Information for the Conference

ESGENA Scientific Secretariat• European Society of Gastroenterology and Endoscopy Nurses

and Associates (ESGENA)Ulrike Beilenhoff, Ferdinand-Sauerbruch-Weg 16, 89075 Ulm, Germany. Tel. 0049-(0)731-950 39 45, fax: 0049-(0)731-950 39 58. E-mail: uk-beilenhoff@t-online.deSee also www.uegf.org and www.esgena.org

UEGF Congress Office• UEGF Congress Secretariat and Exhibition/Sponsor Office,

Hollandstrasse 14/Mezzanine, 1020 Vienna, Austria. Tel. 0043-(0)1-212 36 91, fax: +43-(0)1-212 36 91-29. E-mail: uegw@vereint.com

Congress Venue• Austria Center Vienna, Bruno-Kreisky-Platz 1, 1220 Vienna,

Austriawww.acv.at

ESGENA Annual General Meeting• The ESGENA Annual General Meeting will be held on Sunday 19

October 2008. Admission is for ESGENA members only.

UEGW Core Programme• Nurses are welcome to attend the medical lectures in the

UEGW core programme at no extra charge.

Technical Exhibition• ESGENA-registered participants have access to the technical

exhibition from Monday 20 October 2008 until Wednesday 22October 2008.

ESGENA Coffee and Lunch• Coffee will be served for all ESGENA-registered participants

from Saturday afternoon until Monday lunchtime.Lunches will be served for all ESGENA-registered participants on Sunday and Monday.

ESGENA Social Events• ESGENA-registered participants are invited to attend the

ESGENA Welcoming Reception on Saturday 18 October 2008.

ESGENA NEWS

39

The venue will be announced in the final programme.

ESGENA Conference Language• The official language of the ESGENA Conference is English.

Translation will not be provided.

ESGENA RegistrationESGENA conference registration deadlines and registration

fees (€, incl. 20% VAT):• Registration and payment received by 16 May 2008: € 185,00

• Registration and payment received by 19 September 2008: € 200,00

• Registration and payment received after 19 September 2008: € 250,00A copy of the nurse’s professional standing or similar identifi-

cation is indispensable for proof of status (confirmation byemployer, proof of education, or registration as nurse in English orGerman). Please fax to: dm&c, fax: +43-(0)1-4095631-22.

Please register online for the ESGENA Conference. Simply fillout the registration form available at: www.uegf.org.

The registration fee for ESGENA conference includes:• Admission to all ESGENA scientific sessions and workshops• Admission to the ESGENA Welcoming Reception on Saturday

18 October 2008• Admission to the UEGW scientific sessions, including the

UEGW postgraduate live transmission• Admission to posters and the technical exhibition• Admission to the ESGE Learning Area• Admission to the Ultrasound Learning Area• Unlimited use of the public transport system, valid for 3 days• Congress materials (delegate bag, final programme, ESGENA

abstract book, etc.)• Coffee breaks and lunches (Saturday–Monday)

On-site registration (after 19 September 2008) Participants who want to register on site are advised to arrive

early. On-site registration does not necessarily entitle the partic-ipants to receive a delegate bag. On-site registration will behandled on a first-come, first-served basis; priority will be given topre-registered delegates.

Opening hours• Friday 17 October 2008: 14.00–18.00• Saturday 18 October 2008: 07.30–18.00• Sunday 19 October 2008: 07.30–18.00• Monday 20 October 2008: 07.00–18.00• Tuesday 21 October 2008: 07.30–18.00• Wednesday 22 October 2008: 07.30–14.00

PaymentWhen registering for the ESGENA Conference, please arrange

for payment of the registration fee and any other costs relating tothe supporting programme. Payments can be made by credit card(Visa, Eurocard/Mastercard, Diners Club, American Express) or bybank giro transfer. Please transfer the registration fee free ofcharge to the beneficiary to:• Volksbank für den Bezirk Weiz,

Florianiplatz 1, 8200 Gleisdorf, AustriaAccount number: 305 1034 0003Account name: UEGW 08Account holder: dm&c – Destination Management & ConsultingGesmbhBIC code/Swift address: VBOEATWWWEIIBAN: AT39 4232 0305 1034 0003

• Please remember to indicate your name on the transfer order.

ConfirmationFollowing successful online registration, you will receive a

confirmation via e-mail. In view of the increasing security measuresand firewalls, it is best to ensure that the e-mails can reach you byadjusting your spam filter accordingly. If you do not receive confir-mation, please contact dm&c at uegw08@dm-and-c.at.

CancellationAny cancellation must be notified in writing to dm&c. No

refunds will be granted for cancellation later than 1 July 2008.

ContactFor any questions regarding registration, please do not hesitate

to contact Destination Management & Consulting Europe, dm&c,Gilgegasse 11/14, 1090 Vienna, tel. 0043-(0)1-409 56 31-0, fax 0043-(0)1-409 56 31-22. E-mail: uegw08@dm-and-c.at

ESGENA Scientific InformationESGENA Poster Session

ESGENA scientific posters will be displayed from Saturday 18October to Sunday 19 October 2008. Authors will receive detailedinformation about their poster session. ESGENA will have twoposter sessions: Sunday 19 October 2008, 10.00–11.00 and12.30–14.00.

40

Assessment of Free Papers and Posters

Participants were invited to submit original scientific abstractsfor oral or poster presentation. The deadline for submission was 30June 2008. The abstracts submitted were anonymized (names andaddresses removed) and assessed by five reviewers fromdifferent European countries in accordance with the followingreview criteria (content, originality, structure, etc.).Evaluation criteria:• Relevant: is the paper relevant to nursing (directly or

indirectly)?• Accurate: is the information up-to-date and are its sources of

evidence stated?• Evidence-based: ‘evidence-based’ means that the information

is based on reliable evidence, which in turn is based on high quality research.

• Clear: is the information clearly communicated?• Educational value: e.g., will it improve practice/services for

patients, knowledge, etc.• General interest: is the abstract of general interest to a wide

audience (important for oral presentation)?• Originality: e.g., presenting new information or a new approach

to an old problem, etc. — not just a repetition of something well known.

• Presentation: e.g., logical, with aims/objectives, method, results, summary and conclusion, etc. Statements such as ‘results will be discussed’ or ‘data will be presented’ are not acceptable.

• Research vs. clinical: research abstracts need to have the appropriate format — describing an audit, intervention tested, etc., with evaluation of effectiveness. Clinical papers describe a change of practice (should also be evaluated for effectiveness or compliance with guidelines).

• Compliance with the abstract submission guidelines: Does the abstract comply with the instructions given (including aims, methods, results, conclusion, references, learning outcomes,etc.)?

For oral presentations additional criteria were used• Does the paper describe something which will be done in the

future or has already been done and evaluated by the author?• Is the paper just descriptive, or has there been some evaluation?• Does the paper duplicate or overlap with another oral

presentation (especially if it is written by one of the invitedspeakers)?

• Is the paper of interest to more than a small local group?

The judges on the basis of the quality and general interest of theabstract make the decision if accepted for Poster or Oral Presen-tation. Authors cannot request specifically “for oral presentation”;however, an author can specifically request “for Poster presen-tation”. The reason for honouring this request is that authors mayfeel unable to give an English oral presentation.

After the assessment of the reviewers the scientific committeecompiled the free paper and poster sessions.

Notification of acceptance (for oral or poster presentation) orrejection by the Scientific Programme Committee was e-mailed tothe presenting author in July 2008. .

The presenting authors of oral presentations and posters willreceive one free registration to the ESGENA conference.

Christiane Neumann, Birminghgam, UK

ESGENA NEWS

41

Announcements for GI Nurses 2009 ESGENA/SIGNEA Conference, London

The United European Gastroenterology Federation (UEGF) andWorld Gastroenterology Organization (WGO), together with theWorld Organization of Digestive Endoscopy (OMED) and the BritishSociety of Gastroenterology (BSG), are jointly organizing the Gastro2009 conference in London on 21–25 November 2009.

In conjunction with Gastro 2009, the European Society ofGastroenterology and Endoscopy Nurses and Associates (ESGENA)and the Society of International Gastroenterological Nurses andEndoscopy Associates (SIGNEA) have decided to organize a jointmeeting, which will be hosted by the Endoscopy Associates Groupof the British Society of Gastroenterology (BSG-EAG).

A balanced 3-day programme will offer state-of-the-art lectures,free papers and posters, and several workshops featuring hands-ontraining and live transmissions. Interesting topics in gastroen-terology and endoscopy will ensure truly global relevance. Themeeting is to be held at the ExCel centre in the east of London, and adetailed programme will be available later. Further information isavailable on the official conference site (www.gastro2009.org) andon the societies’ web sites:

• www.esgena.org• www.signea.org• www.bsg.org.uk

Hosted by the Endoscopy Associates Group of the British Society ofGastroenterology (BSG-EAG)

London21 – 25 November 2009

www.gastro2009.org

Call for Abstracts for GI Nurses 2009ESGENA/SIGNEA, London

Participants wishing to submit abstracts for the GI Nurses 2009conference can do so only in electronic format, by sending aMicrosoft Word document containing the abstract by e-mail toUlrike Beilenhoff:• UK-Beilenhoff@t-online.de

The deadline for submitting abstracts for the ESGENAConference is 30 May 2009.

General Information on Submitting AbstractsParticipants are invited to submit original scientific abstracts for

oral or poster presentation. Authors must observe the followingguidelines for abstract submission. Abstracts that do not conformto the guidelines will not be considered for review.

• Abstracts must be submitted in English (with British spelling) and must be presented in English.

• Use a font that is easy to read, such as Times Roman, Helvetica, or Courier fonts.

• The abstract must not be more than 500 words long or must not fill more than one A4 page, using type in a 12-point font.

• The abstracts will be reviewed by a panel of experts and may beselected for oral or poster presentations, or may be rejected. The time allotted for each oral presentation will be 10 minutes, followed by 5 minutes of question time.

• Notification of acceptance (for oral or poster presentation) or rejection by the Scientific Programme Committee will be e-mailed to the submitting author by 30 June 2009.

• Detailed information, guidelines and recommendations for oral or poster presentation, as well as the day, time and room of the presentation, will be sent in due time to duly registeredpresenting authors.

• The author presenting an accepted free paper will receive free registration for the GI Nurses 2009 conference.

• Accepted abstracts will be published in the Abstracts Book forthe GI Nurses 2009 meeting, in ESGENA News, in the SIGNEA Newsletter, and on the web sites of ESGENA and SIGNEA.

The abstract should be typed as follows:• A brief title, which clearly states the nature of the investigation,

with the entire title in capital letters.• Abbreviations should, if possible, be avoided in the title, but may

be used in the text if they are defined on the first usage.• The authors’ names (full first name, surname) and the institution

(hospital, university, organization, city and country, e-mail and fax number) at which the research was carried out, with the name of the presenting author underlined.

• Type the title of the paper in capital letters in the top section ofthe abstract.

• Use single line spacing.• Indent three spaces on the first line of each paragraph.• Include tables if necessary.• The abstract should be as informative as possible:

— State the specific objective of the study.— State the method used, if pertinent.

— Summarize the results obtained.— State the conclusions reached.— Statements such as ‘results will be discussed’ or ‘data/

information will be presented’ are not acceptable.• Please ensure that the abstracts do not contain any spelling

errors, grammatical errors, or scientific errors, as the abstractwill be reproduced exactly as submitted.

• The abstract should have content relevant to nursing and should add to existing knowledge.

• The abstract should have a minimum of two relevant references.

• The abstract should state two things that nurses attending theconference can learn from the presentation.

42

CheckedABSTRACT SECTIONS

Title, clearly stating the nature of the investigation

Authors’ names (full first name, surname)

Presenting Author (name of the presenting authorunderlined)

Institution (hospital, university, organization, cityand country, e-mail and fax number)

Introduction (what is already known, what needsfurther study)

Aim/Objective

Method used

Results / findings

Summary of results/findings

Conclusion(s) reached (what has been learned)

References (minimum of two)

Learning outcomes (two things you would like thereader to learn from your presentation)

Formatting etc.

Title in CAPITAL LETTERS

Abbreviations should, if possible, be avoided in thetitle if possible, but may be used in the text if theyare defined when first usage

Presenting author underlined

Single line spacing

Abstracts must be submitted in English (British spelling) and checked for spelling errors

Use a 12-point font — e.g., Times Roman

500 words — max. one A4 page

The abstract should have nursing-relevant contentand should add to existing knowledge.

38

News from the Industry

Fujinon Breakfast Meeting, UEGW 2008

State-of-the-art technology for diagnosis and therapy.

Date: Monday, October 20, 2008Time: from 7.00 to 8.00 a.m.Breakfast: 6.30 -7.00 a.m.Venue: Austria Center Vienna, Red Level (2nd Floor), Hall B

GI endoscopy has profited from new technologies and methodsfor diagnosis and therapy. DBE and using the FICE method (FlexibleSpectral Image Color Enhancement) have already become astandard in Endoscopy. New Methods such as ESD and transnasalEndoscopy have just started to have more influence in the GIEndoscopy field. All of the aforementioned methods are beingpresented by experts from Europe and Japan along with theirexperiences and the international results. We invite you to join us

the discuss these breakthroughs and are looking forward to yourparticipation.

For further information regarding DBE, FICE, TNE and ESD pleasecontact:Fujinon (Europe) GmbHHalskestrasse 447877 Willich, GermanyTel.: +49(0)2154/924-0Fax: +49(0)2154/924-290fujinon@fujinon.dewww.fujinon.de

Booth 162, Hall X at UEGW in Vienna

ESGENA NEWS

45

For further information please contact:PENTAX Europe GmbHLIFE CAREJulius-Vosseler-Str. 10422527 Hamburg / GermanyE-mail: medical@pentax.dewww.pentaxeurope.com

TRAINING FOR YOU: HYGIENIC REPROCESSING OF FLEXIBLEENDOSCOPES

The role of hygiene in medicine is clearly defined. It describesall sanitary measures which serve to maintain a patient’s health.The problem concerning the hygienic reconditioning of flexibleendoscopes is an increasingly discussed topic in the medicalpress.

In an age of growing public awareness of health, manufacturersof endoscopes must also pay due regard to the question ofhygiene. Their task is to provide medical practitioners withinstruments which allow endoscopy to be performed comfortablyand under absolutely hygienic conditions. Hygienic endoscopy isthus more than just a trend; it is now a vital element in endoscopicpractice.

PENTAX has stayed abreast of these changes in various ways –not only by product innovations but also by having installed a teamof experts who would like to support you with regard toreprocessing issues.

PENTAX would like to offer a special service, thus serving as a"catalyst" for the exchange of information, to provide youpersonally, as a doctor or assistant practicing endoscopy, witheven greater assurance when it comes to reprocessing yourendoscopes. PENTAX Hygiene training for you and your team willoffer you comprehensive knowledge on reprocessing andhygiene. For one whole day you’ll have the opportunity of spendingtime with hygiene and endoscopy specialists together withmanufacturers and distributors of endoscopes, washer-disinfectors (WDs) and cleaning/disinfection agents to profit fromtheir knowledge.

Here we have summarized for you the upcoming local dates inyour country. All courses are free of charge and held in the locallanguage. If you cannot find dates for your country please contactyour local PENTAX office (visit www.pentaxeurope.com) fordetails as well as for the registration.

We look forward to your participation!

GermanyVenue: Frankfurt/OderDates: 13th November 2008

Venue: LeipzigDates: 12th November 2008

The NetherlandsVenue: BredaDates: 9th December 2008

3rd March 2009

United KingdomVenue: LangleyDates: 18th September 2008

8th October 200820th November 200821st January 2009 12th February 2009 22nd April 2009 14th May 2009 16th June 2009

46

PILLCAM® VIDEO CAPSULE ENDOSCOPY BY GIVEN IMAGING

OverviewGiven Imaging develops, manufactures and markets patient-

friendly, innovative solutions for screening and detectingdisorders of the gastrointestinal (GI) tract. At the core of GivenImaging’s product line is its flagship platform for PillCam capsuleendoscopy, the PillCam Platform. PillCam video capsules areingestible capsules that enable physicians to visualize distinctportions of the GI tract. The PillCam Platform is designed for useon an outpatient basis and consists of multiple componentsincluding disposable PillCam video capsules, the Given®

Workstation and RAPID® software.

Given Imaging’s PillCam Video Capsule Product Line

PillCam SBCleared by the U.S. Food and Drug Administration in 2001,

PillCam SB is used by the physician to visualize the small intestinewhen diagnosing disorders such as Crohn’s disease, small boweltumors, malabsorption disorders (such as Celiac disease), GIinjuries induced by extended NSAID use and suspected GIbleeding of the small bowel.

PillCam SB measures 11 mm by 26 mm and transmits images ata rate of two images per second for approximately eight hours,resulting in more than 50,000 pictures. To date, more than 500,000patients worldwide have benefited from this innovative procedure.

PillCam ESO Cleared by the U.S. Food and Drug Administration in November

2004, PillCam ESO was developed for patients suffering fromesophageal disorders, such as Barrett’s esophagus, which is anearly indication for esophageal cancer, and esophageal varices,which may result in fatal bleeding. It provides a patient-friendlyalternative to esophageal endoscopy and the associated sedationand discomfort.

PillCam ESO measures 11 mm by 26 mm and contains an imagingdevice and light source at both ends of the capsule. The capsuletakes up to 14 images per second, a total of 2,600 color images asit passes down the esophagus.

PillCam COLON*The PillCam COLON video capsule to visualize the colon was

cleared for marketing in the European Union. PillCam COLON is thethird video capsule to be developed and manufactured by GivenImaging, Ltd. The capsule measures 11 mm by 31 mm and containsimaging devices at each end that capture 4 images per second

during the procedure. Each camera contains automatic lightingcontrols, frame rates and depths of field which have beenspecially adapted for the wider lumen and high degree of compart-mentalization that characterizes colon physiology.

*PillCam COLON is not cleared for marketing or available forcommercial distribution in the USA.

For further information please visit:http://www.givenimaging.com or http://www.capsuleendoscopy.org

Order Form for Additional Copiesof ESGENA NEWS

ESGENA offers additional Copies of ESGENA NEWS to ESGENAmembers and non-members.

Subscription Costs

For ESGENA Members 15 € per copy

Reduced rate for orders > 100 copies 10 € per copy

For Non-Members 20 € per copy

ADDRESS DETAILS:NAME (Person / Group)

HOSPITAL DEPARTMENT

COMPANY DEPARTMENT

STREET

POSTCODE CITY

TELEPHONE FAX

E-MAIL

Order Form for Additional Copies of ESGENA NEWS

To order additional copies please send this reply slip to: ESGENA SecretariatMedconnect GmbH, Bruennsteinstr. 10, 81541 Munich, Germany, Fax +49-(0)89-4141 9245

I would like to order the following number of additional copies of ESGENA NEWS:

I am a member of ESGENA:

Group Membership Individual Membership Passive Membership Affiliated Membership

Our national society is Group Membership

Please add you ESGENA Membership Number: Please note that we can only fulfill orders for the current issue

ESGENA NEWS

43

Group Membership Individual Membership Passive Membership Affiliated Membership

I would like to receive information about ESGENA membership, including the constitution of the Society, membership application forms, and information regarding payment of fees.

ADDRESS DETAILS:NAME (Person / Group)

DEPARTMENT HOSPITAL

STREET

POSTCODE CITY

COUNTRY

TELEPHONE FAX

E-MAIL

ESGENA Membership

GROUP MEMBERSHIPGroup membership is open to national societies, groups orfederations that represent the interests of gastroenterology and/orendoscopy nurses and endoscopy associates. The fees for groupmembership depend on the number of members in the organi-zation:

Members Fee

< 50 30 €

51 - 100 55 €

101 - 250 105 €

251 - 500 205 €

501 - 750 405 €

751 - 1000 605 €

> 1000 755 €

Membership Application

Tick the desired membership level:

Please send this reply slip to: Medconnect GmbHBruennsteinstr. 10, 81541 Munich, Germany, Tel.: +49-(0)89-4141 9240, Fax +49-(0)89-4141 9245, E-mail: info@esgena.org

INDIVIDUAL MEMBERSHIPIndividuals practising, managing, teaching, or researching ingastroenterology and/or endoscopy nursing:Membership fee 15 €

PASSIVE MEMBERSHIPIndividuals who have formerly practised, managed, taught, orresearched in gastroenterology and/or endoscopy nursing andwho have maintained an interest in the field:Membership fee 10 €

AFFILIATE MEMBERSHIPMembers from the industry may join the society as affiliatedmembers: Membership fee 55 €

European Core Curriculum for Endoscopy Nurses

The ESGENA Education Working Group has developed a CoreCurriculum for endoscopy nurses. In addition to theoreticalinformation about the structure and content of modules, it alsocontains practical information about how to implement andstructure national courses.

The Core Curriculum will be available as a PDF on the ESGENAweb site (www.esgena.org) and as a CD-Rom.

ADDRESS DETAILS:NAME (Person / Group)

HOSPITAL DEPARTMENT

COMPANY DEPARTMENT

STREET

POSTCODE CITY

COUNTRY E-MAIL

Order Form for ESGENA Core Curriculum

The CD-Rom can be ordered by sending this reply slip to:ESGENA SecretariatMedconnect GmbH, Bruennsteinstr. 10, 81541 Munich, Germany, Fax +49-(0)89-4141 9245

The first 1000 copies are free of charge

I would like to order the following number of copies

ESGENA Core Curriculum

Number of copies