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Endoscope disinfection

George W Meyer, MD, MACP, MACG
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Although endoscopic equipment has been implicated in transmitting infection, it appears as if virtually all transmissions have been due to errors in the process of cleaning and disinfecting the equipment or in breakdown of general infection control practices with the exception of newer duodenoscopes [1-3]. This topic review will discuss infectious agents that can potentially be transmitted during gastrointestinal endoscopy and outline the recommendations from various societies for the cleaning and disinfection of gastrointestinal endoscopes.


Hepatitis B — Hepatitis B virus has been transmitted to a single person following endoscopy [1]. A woman, who had an endoscopy one day after a patient with known chronic hepatitis B, developed hepatitis B infection 96 days following the procedure and recovered uneventfully. Other patients who underwent endoscopy with the same endoscope three, four, and five days after the initial endoscopy did not develop hepatitis B. At the time (1980), endoscopes could not be totally immersed in fluid, and the air/water channel was not specifically treated with glutaraldehyde [4]. Scopes have been engineered to be less complicated and are easier to clean since the 1980s. Several reports before and after 1980 suggest that with proper cleaning and disinfection, hepatitis B is adequately removed from endoscopes [2,5,6].

Hepatitis C — Transmission of hepatitis C, an RNA virus, during endoscopy has been demonstrated in case reports [7-9]. Transmission occurred following colonoscopy in two patients [7] and after ERCP in another [9]. The endoscope responsible for transmitting infection in the two patients infected following colonoscopy had not undergone the recommended duration of disinfection, and the biopsy forceps, the likely source of the infection, had been cleaned but not sterilized [8]. An increased prevalence of hepatitis C transmission in patients who had undergone endoscopic biopsies has also been described [10].

Proper disinfection of endoscopes contaminated with hepatitis C virus can effectively eliminate the risk of transmission [11,12]. In one report, there were no cases of proven transmission of hepatitis C when endoscopes were processed using current American Society for Gastrointestinal Endoscopy (ASGE) guidelines [13].

HIV — No case of human immunodeficiency virus (HIV) transmission by endoscopy has been published [14]. Exposure to 2 percent solution of glutaraldehyde for two minutes completely inactivates the HIV virus [15-17]. Other approved agents also kill the HIV virus.

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Literature review current through: Nov 2017. | This topic last updated: Nov 06, 2017.
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