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Prevention of Duodenoscope-Associated Infections

  • Endoscopy (P Siersema, Section Editor)
  • Published:
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Abstract

Purpose of Review

Over the last decade, several outbreaks of transmission of infection have been linked to endoscopic retrograde cholangiopancreatography, despite adherence to reprocessing protocols. This review evaluates enhanced reprocessing measures recommended by the US Food and Drug Administration (FDA) as well as newly available duodenoscopes with disposable components and single-use duodenoscopes.

Recent Findings

Current data indicate that none of the FDA suggested enhancements in reprocessing completely eliminate duodenoscope culture positivity. Nevertheless, these enhancements may be beneficial, as evidenced by a decrease in reports of duodenoscope related infections and deaths over recent years. Initial microbiological data on disposable endcaps and on a distal duodenoscope barrier device are encouraging, as are functionality and safety data on disposable duodenoscopes.

Summary

More data on the efficacy, safety, and relative cost-effectiveness of duodenoscopes with disposable components and disposable duodenoscopes will help facilitate their adoption. In the interim transition period, endoscopy units should diligently follow manufacturer instructions for duodenoscope reprocessing and maintenance, pay attention to the human component of reprocessing, and adopt one or more enhanced reprocessing measures.

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Abbreviations

AER:

Automated endoscopic reprocessing

ATP:

Adenosine triphosphate

CRE:

Carbapenim-resistant Enterobacteriaceae

ERCP:

Endoscopic retrograde cholangiopancreatography

EtO:

Ethylene oxide

HLD:

High level disinfection

LCS:

Liquid chemical sterilization

MAUDE:

Manufacturer and user facility device experience

MDR:

Medical Device Report

MDRO:

Multi-drug resistant organisms

FDA:

Food and Drug Administration

US:

United States

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA

    Andrew Ofosu MD, MPH & Subhas Banerjee MD

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  1. Andrew Ofosu MD, MPH
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Both authors contributed equally to the writing of this manuscript. Both authors read and approved the final manuscript.

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Correspondence to Subhas Banerjee MD.

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Competing Interests

Subhas Banerjee has received consultant honoraria and research support from Boston Scientific Corporation. Andrew Ofosu has no relevant financial or non-financial interests to disclose.

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Ofosu, A., Banerjee, S. Prevention of Duodenoscope-Associated Infections. Curr Treat Options Gastro 20, 205–219 (2022). https://doi.org/10.1007/s11938-022-00378-x

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