RU2330617C1 - Method of biomaterial sampling with endoscope for purpose of microbiological analysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: distal end of sterile endoscope channel is introduced to physiologically acceptable sterile viscous substance in amount required for obstruction of length 2-3 mm. Endoscope is taken to analysis area. Obstruction is pushed out with catheter or biopsy forceps. Biomaterial is sampled.

EFFECT: method enables to prevent associated microflora adhesion to analysed materials.

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Description

The invention relates to medicine, more specifically to endoscopic surgery.

At present, biomaterial is collected from various departments of the gastrointestinal tract for microbiological examination using endoscopic equipment that has previously undergone high-level disinfection, and catheters and manipulators are used for sampling and sterilization (Decree of the Chief State Sanitary Doctor of the Russian Federation of 03.04.03 No. 30 “On the Enactment of the Sanitary and Epidemiological Rules -“ Prevention of Infectious Diseases during Endoscopic Manipulations ”SP 3.1.1275-03, reg. No. 4417 dated 04/14/03; Microbiological methods for the study of biological material in pediatrics / http://www.trimm.ru/php/content.php?group=1&id=2546; Cabinet for endoscopic diagnosis and treatment / http: //www.gutaclinic .ru / cpes_7_35.htm).

For example, after cannulation from the bile duct, bile is taken through an endoscope using a sterile catheter by creating negative pressure in a sterile syringe attached to the catheter. However, when taking biomaterial using an endoscope introduced through non-sterile zones, its channel is contaminated with associated microflora and the true picture of the bacterial landscape in the studied area of the body is disturbed.

A method is proposed for endoscopic sampling of biomaterial for conducting microbiological research, which can be used to take biomaterial using any endoscope - a fibrogastroduodenoscope, a fibrobronchoscope, fibrocolonoscopes, etc.

The proposed method allows to avoid getting into the sterile biopsy channel of the endoscope associated microflora when moving the endoscope through non-sterile areas, such as the oral cavity, pharynx, esophagus, stomach, when it comes to fibrogastroduodenoscope.

Before the biomaterial sampling procedure, a high level endoscope is disinfected; catheters, manipulators - sterilize. A physiologically acceptable sterile viscous substance, such as vasilin, is introduced into the distal end of the sterile canal of the endoscope, in an amount necessary for the formation of a plug 2-3 mm long, an endoscope is inserted to the site of examination, the plug is ejected with a catheter or biopsy forceps and biomaterial is collected.

Each fence is made with a sterile instrument.

The application of the proposed method avoids attaching associated microflora to the test materials and thereby obtain objective results about the state of the microbial landscape in a particular study area.

This method has been successfully applied in a randomized prospective examination of 39 patients with biliary tract diseases, in which bile was taken from the common bile duct using cannulation of this duct by a catheter through a biopsy channel of a fibrogastroduodenoscope. For the bile ducts, the most characteristic microflora are enterobacteria and enterobacteria. Cocci, mushrooms, rods (in particular, Pseudomonas aeruginosa, Escherichia coli) are not characteristic of the bile ducts (for the biliary system). As a result of a conductive study, we obtained objective data on the state of the microbial flora in the bile ducts, not a single case of accession of associated microflora has occurred.

Examples of the method.

1. Patient T-va N.M. (medical history No. 2-601), 69 years old, diagnosed with postcholecystectomy syndrome. The patient performed ERCP. Produced cannulation of BDSK followed by taking bile for bacteriological examination. When collecting bile, the proposed method was used. Before starting the procedure, sterile petroleum jelly was introduced into the distal end of the sterile canal of the endoscope and a tube 2-3 mm long was created, the endoscope was held to the place of investigation, the tube was ejected by a catheter and biomaterial was sampled.

As a result of a bacteriological study of bile, a culture of Enterococcus fecium was obtained. Growth <1 thousand in 1 ml. Associated flora not received.

2. Patient A-va M.F. (medical history No. 2-1361), 48 years old, diagnosis: gallstone disease, choledocholithiasis. For the collection of patient bile for bacteriological examination, the proposed method was used. As a result of bacteriological research, the growth of Pseudomonas aeroginosa was obtained. Growth 10 to 4 degrees. Associated flora not received. Sensitivity to antibiotics was determined: ciprofloxacin 30 mm, amikocin 22 mm and several other antibacterial drugs. As a result of the treatment with ciprofloxacin and amikocin, to which the patient was most sensitive, the patient's condition returned to normal. Discharged with recovery.

3. Patient K-va V.P. (medical history No. 2-1313), 71 years old, diagnosis: PCES, choledocholithiasis. Taken bile for bacteriological studies using the proposed method. As a result of bacteriological research, the growth of Klebsiella pneumonie was obtained. Growth 10 to 3 degrees. Associated flora not received. Sensitivity to antibiotics was determined: ciprofloxacin 34 mm, amoxicillin 32 mm and several other antibacterial drugs. As a result of the treatment with ciprofloxacin and amoxicillin, to which the patient was most sensitive, the patient's condition returned to normal. Discharged with recovery.

Using the method of sampling bacteriological material without isolating the biopsy canal of the endoscope, microbial cultures were obtained with added flora from the overlying sections of the digestive tract. The following is an example.

4. Patient K. in. A. (medical history No. 1-3167), 54 years old, with a diagnosis of: opisthorchiasis. A biopsy of the duodenal mucosa was made for bacteriological examination. When sampling material for bacteriological research, the proposed method was not used. As a result of bacteriological research, the growth of non-pathogenic microflora was obtained. It was not possible to isolate a pure culture due to the large amount of associated microflora.

Claims (1)

The method of endoscopic collection of biomaterial for microbiological research, which consists in the fact that before starting the procedure, a physiologically acceptable sterile viscous substance is introduced into the distal end of the sterile canal of the endoscope in an amount necessary for the formation of a plug 2-3 mm long, an endoscope is held to the study site, the plug is ejected with a catheter or biopsy forceps and produce biomaterial sampling.