Five important facts about duodenoscopes and ‘superbug’ contamination

There have been reports of patient-to-patient infections of carbapenem-resistant Enterobacteriaceae (CRE) bacteria linked to endoscopic retrograde cholangiopancreatography (ERCP) procedures.

Following are important facts for the public to know, supplied by the American Gastroenterological Association, which is taking the lead in addressing this issue.

• ERCP is performed using a special device called a duodenoscope. It is not the same device that is used in routine upper endoscopy or colonoscopy.

• Most people will never have an ERCP. But for patients who need it, ERCP is a critical and life-saving procedure. ERCP allows doctors to diagnose and treat problems in the bile duct and pancreatic ducts such as stones, narrowing, tumors, and blockages.

• The therapeutic benefits of ERCP outweigh the potential low risk of infection. The infectious complication rate for ERCP overall is only about 1%. That includes all types of bacteria, and these CRE cases do not change the overall risk.

• The problem of infection transmission lies in the complex design of duodenoscopes, where the elevator channel can allow bacteria to remain after cleansing, even if reprocessing follows accepted procedures.

• Any cases of patient infection tied to duodenoscopes are not acceptable and need to be thoroughly investigated, with solutions to be developed.

Through the AGA Center for GI Innovation and Technology, we are uniquely positioned to work with the FDA device branch and endoscope manufacturers. We have offered our help to resolve and monitor this issue. Our goal is safe patient care with no preventable infections.

For updates on this issue, please visit www.gastro.org.