Endoscopy 2007; 39(8): 742-778
DOI: 10.1055/s-2007-966504

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopy-related infections and toxic reactions: an international comparison

E.  Seoane-Vazquez1 , 2 , 3 , R.  Rodriguez-Monguio2 , 3 , J.  Visaria1 , A.  Carlson4
  • 1College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
  • 2School of Public Health, The Ohio State University, Columbus, Ohio, USA
  • 3Center for Health Outcomes, Policy and Evaluation Studies, The Ohio State University, Columbus, Ohio, USA
  • 4Data Intelligence Consultants, LLC, and College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
Further Information

Publication History

submitted 30 August 2006

accepted after revision 24 January 2007

Publication Date:
22 June 2007 (online)

This article is an analysis of the characteristics of exogenous endoscopy-related infections, pseudoinfections, and toxic reactions that have occurred worldwide during the period 1974 - 2004. A systematic review of the scientific literature published between 1966 and 2004 was conducted in Medline and the Food and Drug Administration Reports database, using a prospective protocol developed by the authors. The literature review identified 140 outbreaks, reported in 134 scientific articles. More than 94 % of the outbreaks identified could have been prevented by improved decontamination processes. Proper decontamination practices and the improvement of surveillance systems could reduce the clinical burden associated with exogenous endoscopy-related events.


  • 1 Muscarella L F. Dear Los Angeles Times: the risk of disease transmission during gastrointestinal endoscopy.  Gastroenterol Nurs. 2004;  27 271-278
  • 2 Nelson D B. Infection control during gastrointestinal endoscopy.  J Lab Clin Med. 2003;  141 159-167
  • 3 Cronmiller J R, Nelson D K, Salman G. et al . Antimicrobial efficacy of endoscopic disinfection procedures: a controlled, multifactorial investigation.  Gastrointest Endosc. 1999;  50 152-158
  • 4 Foliente R L, Kovacs B J, Aprecio R M. et al . Efficacy of high-level disinfectants for reprocessing gastrointestinal endoscopes in simulated-use testing.  Gastrointest Endosc. 2001;  53 456-462
  • 5 Spach D H, Silverstein F E, Stamm W E. Transmission of infection by gastrointestinal endoscopy and bronchoscopy.  Ann Intern Med. 1993;  118 117-128
  • 6 Prakash U B. Does the bronchoscope propagate infection?.  Chest. 1993;  104 552-559
  • 7 Nelson D B. Infectious disease complications of GI endoscopy: part I, endogenous infections.  Gastrointest Endosc. 2003;  57 546-556
  • 8 Vennes J A. Infectious complications of gastrointestinal endoscopy.  Dig Dis Sci. 1981;  26 (7 Suppl) 60S-64S
  • 9 Favero M S. Strategies for disinfection and sterilization of endoscopes: the gap between basic principles and actual practice.  Infect Control Hosp Epidemiol. 1991;  12 279-281
  • 10 Axon A T. Working Party Report to the World Congresses. Disinfection and endoscopy: summary and recommendations.  J Gastroenterol Hepatol. 1991;  6 23-24
  • 11 Pajkos A, Vickery K, Cossart Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination?.  J Hosp Infect. 2004;  58 224-229
  • 12 Tunuguntla A, Sullivan M J. Monitoring quality of flexible endoscope disinfection by microbiologic surveillance cultures.  Tenn Med. 2004;  97 453-456
  • 13 Aanstoos C M. Endoscopes: clean clear through?.  Am J Nurs. 1992;  92 14
  • 14 Urayama S, Kozarek R A, Sumida S. et al . Mycobacteria and glutaraldehyde: is high-level disinfection of endoscopes possible?.  Gastrointest Endosc. 1996;  43 451-456
  • 15 Vesley D, Melson J, Stanley P. Microbial bioburden in endoscope reprocessing and an in-use evaluation of the high-level disinfection capabilities of Cidex PA.  Gastroenterol Nurs. 1999;  22 63-68
  • 16 Nelson D B. Infectious disease complications of GI endoscopy: part II, exogenous infections.  Gastrointest Endosc. 2003;  57 695-711
  • 17 Gorse G J, Messner R L. Infection control practices in gastrointestinal endoscopy in the United States: a national survey.  Gastroenterol Nurs. 1991;  14 72-79
  • 18 Seoane-Vazquez E, Rodriguez-Monguio R, Visaria J. et al . Exogenous endoscopy-related infections, pseudo-infections, and toxic reactions: clinical and economic burden.  Curr Med Res Opin. 2006;  22 2007-2021
  • 19 Alvarado C J, Reichelderfer M. APIC guideline for infection prevention and control in flexible endoscopy. Association for Professionals in Infection Control.  Am J Infect Control. 2000;  28 138-155
  • 20 Food and Drug Administration .Manufacturer and User Facility Device Experience Database (MAUDE). Food and Drug Administration, 2005 [accessed 2005, July 20]. http://www.fda.gov/cdrh/maude.html
  • 21 Food and Drug Administration .Medical Device Reporting (MDR): General Information. Food and Drug Administration, 2002 [accessed 2005, July 20]. http://www.fda.gov/cdrh/mdr/mdr-general.html
  • 22 Food and Drug Administration .FDA Enforcement Report Index 2005 [accessed 2005, July 20]. http://www.fda.gov/opacom/Enforce.html
  • 23 Lautenbach E, Woeltje K (eds). Practical handbook for healthcare epidemiologists, 2nd edn. Thorofare, New Jersey; Slack Inc 2004
  • 24 Manzoor S E, Lambert P A, Griffiths P A. et al . Reduced glutaraldehyde susceptibility in Mycobacterium chelonae associated with altered cell wall polysaccharides.  J Antimicrob Chemother. 1999;  43 759-765
  • 25 Archibald L, Phillips L, Monnet D. et al . Antimicrobial resistance in isolates from inpatients and outpatients in the United States: increasing importance of the intensive care unit.  Clin Infect Dis. 1997;  24 211-215
  • 26 Ward M M, Diekema D J, Yankey J W. et al . Implementation of strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in U.S. hospitals.  Infect Control Hosp Epidemiol. 2005;  26 21-30
  • 27 Goldmann D A, Weinstein R A, Wenzel R P. et al . Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals: a challenge to hospital leadership.  JAMA. 1996;  275 234-240

E. Seoane-Vazquez, PhD

College of Pharmacy
The Ohio State University

500 West 12th Avenue
Ohio 43210

Fax: +1-614-292-1335

Email: pharmacoeconomics@osu.edu