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Scoping Out Endoscopes

Scoping Out Endoscopes

When James Garner starred as Lt. Kenneth Braden in Up Periscope (1959), the submarine commander knew infiltrating Japanese waters to retrieve secret radio codes was risky business. But getting super-scoped in a hospital can be more perilous.

Headlines revealed “Fatal Superbugs at UCLA Medical Center” killed two people and another 170 may have been exposed to a multiple-antibiotic-resistant infection. The cause was a super-complex endoscope (duodenoscope) used for endoscopic retrograde cholangiopancreatography, or ERCP. This duodenoscope is fed through your mouth into your small intestine so X-rays can be taken to detect disease in and around ducts of the liver and pancreas; docs can also provide treatment or do surgery via duodenoscope.

Unfortunately, at UCLA the device was persistently contaminated, even though it was repeatedly cleaned properly. Reuse introduced bacteria into a series of patients receiving ERCP.

The FDA now recommends stepped-up disinfection for these devices. Unfortunately, that may not be enough. They also say, “Meticulously cleaning duodenoscopes prior to high-level disinfection should reduce the risk of transmitting infection, but may not entirely eliminate it.”

So what can you do if you need any type of endoscopy or an ERCP? Discuss risks and benefits (risks remain small overall) with your doc and ask about alternatives: For ERCPs, percutaneous cholangiography (X-ray of the bile ducts), ultrasound, CT or MRI cholangiography are noninvasive; all deliver very similar information. Open surgery is often an option for removal of gallstones and treatment of tumors. The good news? These events will increase the safety of endoscopies for everyone.   

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