« 100,000 patients become ill after a digestive endoscopy each year in the US and in Europe ». That’s a lot, but is this figure credible 🤔 ?

Medical endoscopes are highly contaminated : Lionel Pineau (Endosc Int Open 2023; 11: E247–E257) found a mean ratio of 19.5% contamination rate at action and alert level in France. That means 1 out 5 endoscopes is so soiled that it shouldn’t be used on a patient.

A contaminated endoscope is hazardous, but it doesn’t necessarily lead to an actual infection on a patient. So what is the infection rate in endoscopy?

Since 2016 the French 🇫🇷 Ministry of Health has been giving an estimate of 1 to 3 infections per million endoscopies, ie: an infection rate between 0,0001% and 0,0003%.

If true, this figure is good news : it is close to the levels of safety brought by sterilisation, the probability of 1 out one million of finding a contaminated device.

The truth is this figure is largely underestimated. Linking an infection to a contaminated device is notoriously difficult.

First, the time between performing the endoscopy and detecting the infection can conceal the causal link.

Then it is necessary to identify that it is indeed the same pathogen which had contaminated the endoscope and which made the patient ill. As microbiological samples on endoscopes don’t take place after each procedure, the culprits are often only identified when there’s an outbreak in a hospital.

Finally, research and surveillance on that matter is not popular, as there is no available way of sterile reprocessing for GI endoscopes. What use would it be to identify a problem, if you don’t have many options to solve it?

We must therefore salute all the more the work of Anasua Deb, MD PhD et al. (Gastrointestinal Endoscopy‐Associated Infections: Update on an Emerging Issue, Digestive Diseases and Sciences · May 2022).

They did a comprehensive review of the litterature on gastro-intestinal endoscope acquired infections (EAI) from 1987 to 2020. The studies strictly concerned clinically and microbiologically confirmed infections as the complication event following an endoscopic procedure.

The rate of EAI they calculated is a stunning 0.2% – well above the figure of the French Ministry of Health, and 2000 times above the sanitary safety level offered by sterilisation of endoscopes.

But the authors of this study warn against this figure of 0.2%: data is underreported and underrecognised. The rate of infection could thus be higher than that.

So back to our initial question: are there really 100,000 patients who become ill after a digestive endoscopy each year in the US and in Europe?

With more than 40 millions GI endoscopies performed each year in these countries, the figure of 100,00 endoscopy acquired infections could well be true ✅.