Endoscopic retrograde cholangiopancreatography is one of the main methods for the diagnosis and treatment of biliary tract and pancreatic diseases. Compared with other digestive endoscopes, duodenoscopy has a special structure. Since the outbreaks of nosocomial infections caused by the transmission of multidrug-resistant organism through duodenoscopy in 2010, the reprocessing and design of digestive endoscopes represented by duodenoscopy have faced new challenges. This article reviews the international advances in duodenoscopy reprocessing in the past 10 years including the structural characteristics of duodenoscope, related infection outbreak cases, outbreak control measures, and the use of disposable duodenoscopy, so as to provide guidance and reference for the duodenoscopy reprocessing and related nosocomial infections prevention and control work in China.
Citation： GE Maojun. International advances in duodenoscopy reprocessing. West China Medical Journal, 2024, 39(3): 344-352. doi: 10.7507/1002-0179.202402059 Copy
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- 1. Weber DJ. Managing and preventing exposure events from inappropriately reprocessed endoscopes. Infect Control Hosp Epidemiol, 2012, 33(7): 657-660.
- 2. ASGE Standards of Practice Committee, Khashab MA, Chithadi KV, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc, 2015, 81(1): 81-89.
- 3. Haugen SP, Ferriter A, Connell J, et al. Recent actions by the US Food and Drug Administration: reducing the risk of infection from reprocessed duodenoscopes. Gastrointest Endosc Clin N Am, 2020, 30(4): 711-721.
- 4. Rutala WA, Weber DJ. Disinfection and sterilization in health care facilities: an overview and current issues. Infect Dis Clin North Am, 2016, 30(3): 609-637.
- 5. Alfa MJ, Degagne P, Olson N. Worst-case soiling levels for patient-used flexible endoscopes before and after cleaning. Am J Infect Control, 1999, 27(5): 392-401.
- 6. Kovaleva J, Peters FT, van der Mei HC, et al. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev, 2013, 26(2): 231-254.
- 7. Chu NS, Favero M. The microbial flora of the gastrointestinal tract and the cleaning of flexible endoscopes. Gastrointest Endosc Clin N Am, 2000, 10(2): 233-244.
- 8. Rutala WA, Weber DJ. FDA labeling requirements for disinfection of endoscopes: a counterpoint. Infect Control Hosp Epidemiol, 1995, 16(4): 231-235.
- 9. Rutala WA, Weber DJ. ERCP scopes: what can we do to prevent infections?. Infect Control Hosp Epidemiol, 2015, 36(6): 643-648.
- 10. Ross AS, Baliga C, Verma P, et al. A quarantine process for the resolution of duodenoscope-associated transmission of multidrug-resistant Escherichia coli. Gastrointest Endosc, 2015, 82(3): 477-483.
- 11. ASGE Quality Assurance In Endoscopy Committee, Petersen BT, Chennat J, et al. Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011. Gastrointest Endosc, 2011, 73(6): 1075-1084.
- 12. Association for the Advancement of Medical Instrumentation. ANSI/AAMI ST58: chemical sterilization and high-level disinfection in health care facilities. Virginia: Association for the Advancement of Medical Instrumentation, 2013.
- 13. ASGE Ensuring Safety in the Gastrointestinal Endoscopy Unit Task Force, Calderwood AH, Chapman FJ, et al. Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointest Endosc, 2014, 79(3): 363-372.
- 14. Association for the Advancement of Medical Instrumentation. ANSI/AAMI ST91: flexible and semi-rigid endoscope processing in healthcare facilities. Virginia: Association for the Advancement of Medical Instrumentation, 2015.
- 15. SGNA Practice Committee 2013-14. Guideline for use of high-level disinfectants and sterilants for reprocessing flexible gastrointestinal endoscopes. Gastroenterol Nurs, 2015, 38(1): 70-80.
- 16. Beilenhoff U, Biering H, Blum R, et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) - update 2018. Endoscopy, 2018, 50(12): 1205-1234.
- 17. Nelson DB, Barkun AN, Block KP, et al. Technology status evaluation report. Transmission of infection by gastrointestinal endoscopy. May 2001. Gastrointest Endosc, 2001, 54(6): 824-828.
- 18. Ofstead CL, Dirlam Langlay AM, Mueller NJ, et al. Re-evaluating endoscopy-associated infection risk estimates and their implications. Am J Infect Control, 2013, 41(8): 734-736.
- 19. Snauwaert C, Dekoninck X, Moreels T. Current ERCP practice in Belgium: the BSGIE survey. Acta Gastroenterol Belg, 2021, 84(1): 73-77.
- 20. Alrabaa SF, Nguyen P, Sanderson R, et al. Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment. Am J Infect Control, 2013, 41(6): 562-564.
- 21. Carbonne A, Thiolet JM, Fournier S, et al. Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009. Euro Surveill, 2010, 15(48): 19734.
- 22. Fraser TG, Reiner S, Malczynski M, et al. Multidrug-resistant Pseudomonas aeruginosa cholangitis after endoscopic retrograde cholangiopancreatography: failure of routine endoscope cultures to prevent an outbreak. Infect Control Hosp Epidemiol, 2004, 25(10): 856-859.
- 23. Verfaillie CJ, Bruno MJ, Voor in’t Holt AF, et al. Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa. Endoscopy, 2015, 47(6): 493-502.
- 24. Epstein L, Hunter JC, Arwady MA, et al. New Delhi metallo-β-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA, 2014, 312(14): 1447-1455.
- 25. Kola A, Piening B, Pape UF, et al. An outbreak of carbapenem-resistant OXA-48 - producing Klebsiella pneumonia associated to duodenoscopy. Antimicrob Resist Infect Control, 2015, 4: 8.
- 26. Wendorf KA, Kay M, Baliga C, et al. Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak. Infect Control Hosp Epidemiol, 2015, 36(6): 634-642.
- 27. Kim S, Russell D, Mohamadnejad M, et al. Risk factors associated with the transmission of carbapenem-resistant Enterobacteriaceae via contaminated duodenoscopes. Gastrointest Endosc, 2016, 83(6): 1121-1129.
- 28. Smith ZL, Oh YS, Saeian K, et al. Transmission of carbapenem-resistant Enterobacteriaceae during ERCP: time to revisit the current reprocessing guidelines. Gastrointest Endosc, 2015, 81(4): 1041-1045.
- 29. Shenoy ES, Pierce VM, Walters MS, et al. Transmission of mobile colistin resistance (mcr-1) by duodenoscope. Clin Infect Dis, 2019, 68(8): 1327-1334.
- 30. Marsh JW, Krauland MG, Nelson JS, et al. Genomic epidemiology of an endoscope-associated outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae. PLoS One, 2015, 10(12): e0144310.
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