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The quality of reprocessing gastroscopes, colonoscopes and duodenoscopes in daily routine of 25 endoscopy departments in hospitals and 30 doctors with their own practices was evaluated by microbiological testing in the HYGEA interventional study. In 2 test periods, endoscopes ready for use in patients were found contaminated at high rates (period 1: 49 % of 152 endoscopes; period 2: 39 % of 154 endoscopes). Culture of bacterial fecal flora (E. coli, coliform enterobacteriaceae, enterococci) was interpreted indicating failure of cleaning procedure and disinfection of endoscopes. Detection of Pseudomonas spp. (especially P. aeruginosa) and other non-fermenting rods ± indicating microbially insufficient final rinsing and incomplete drying of the endoscope or a contaminated flushing equipment for the air/waterchannel ± pointed out endoscope recontamination during reprocessing or afterwards. Cause for complaint was found in more than 50 % of endoscopy facilities tested (period 2: 5 in hospitals, 25 practices). Reprocessing endoscopes in fully automatic chemo-thermally decontaminating washer-disinfectors with disinfection of final rinsing water led to much better results than manual or semi-automatic procedures (failure rate of endoscopy facilities in period 2 : 3 of 28 with fully automatic, 8 of 12 with manual, 9 of 15 with semi-automatic reprocessing). The study results give evidence for the following recommendations: 1. Manual brushing of all accessible endoscope channels has to be performed even before further automatic reprocessing; 2. For Interdisziplinäre Arbeitsgruppe ¹Infektionsprävention in der gastrointestinalen Endoskopieª

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The effect on serum lipoprotein concentrations of chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA) was examined in eight normolipemic patients with radiolucent gallstones during constant liquid formula infusion into the duodenum. Every patient received each bile acid (1000 mg/day) during two consecutive randomized 4-week periods. During treatment with CDCA but not UDCA, the serum triglycerides decreased by an average of 26%. Mean HDL cholesterol decreased by 46% during CDCA therapy and remained unchanged during UDCA administration. Simultaneous measurements of biliary lipid secretion showed a significant negative correlation between HDL cholesterol concentration and hepatic secretion of CDCA (r = -0.652) and a positive correlation between the LDL cholesterol/HDL cholesterol ratio and hepatic secretion of CDCA (r = 0.840). Despite their close chemical relationships and similar effects on biliary lipids, CDCA and UDCA differ markedly in their effects on serum lipoproteins. Because of this and minor side effects, UDCA seems to be a safer agent than CDCA for cholesterol gallstone dissolution.

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