Hanson J M, Plusa S M, Bennett M K, Browell D A, Cunliffe W J
Department of Surgery, Queen Elizabeth Hospital, Gateshead, UK.
Br J Surg. 1998 Oct;85(10):1385-7. doi: 10.1046/j.1365-2168.1998.00955.x.
An outbreak of proctitis at the start of a colorectal cancer screening programme utilizing flexible sigmoidoscopy prompted scrutiny of the incidence of this complication and the role of glutaraldehyde in its aetiology.
Questionnaires completed 1 day and 3 months after sigmoidoscopy were reviewed for 388 patients, and glutaraldehyde levels in the recycled rinse water of the endoscope washing machine were measured. The incidence of symptoms in the subsequent 612 patients after installation of a washer that does not recycle rinse water was examined.
Five patients (1.3 per cent) presented to hospital with bloody diarrhoea occurring immediately after a normal flexible sigmoidoscopy. Repeat examination confirmed the presence of proctitis. Symptoms subsided rapidly with either no treatment or steroid enemas. Eight additional patients (2.1 per cent) recorded similar problems but received no treatment and the symptoms settled spontaneously. Glutaraldehyde levels rose progressively in the rinse water after each wash cycle with 2 per cent glutaraldehyde solution. Only one possible case of proctitis (0.2 per cent) was identified from the questionnaires completed by 612 patients after changing to a washer that did not recycle the rinse water.
These observations should prompt the careful assessment of cleaning techniques. The use of washing machines that do not recycle rinse water may avoid this complication.
在一项使用乙状结肠镜进行结直肠癌筛查项目开始时，发生了直肠炎疫情，促使人们对这种并发症的发生率以及戊二醛在其病因中的作用进行审查。
对388例患者在乙状结肠镜检查后1天和3个月填写的问卷进行了回顾，并测量了内镜清洗机循环冲洗水中的戊二醛水平。对安装了不循环冲洗水的清洗机后随后的612例患者的症状发生率进行了检查。
5例患者（1.3%）在正常乙状结肠镜检查后立即出现血性腹泻并入院。再次检查证实存在直肠炎。症状在未治疗或使用类固醇灌肠剂后迅速缓解。另外8例患者（2.1%）记录了类似问题，但未接受治疗，症状自行缓解。使用2%戊二醛溶液进行每次清洗循环后，冲洗水中的戊二醛水平逐渐升高。在更换为不循环冲洗水的清洗机后，从612例患者填写的问卷中仅发现1例可能的直肠炎病例（0.2%）。
这些观察结果应促使对清洗技术进行仔细评估。使用不循环冲洗水的清洗机可能避免这种并发症。
