Risk of Exposure to CJD Via Endoscopy Requires Further Study

Researchers from Geneva, Switzerland describe the case of a 68-year-old male with autopsy-confirmed sporadic Creutzfeld-Jakob Disease (CJD) who had undergone two colonoscopies prior to this diagnosis.The involved endoscopy center had multiple colonoscopes and gastroscopes that are cleaned and disinfected in the same automatic washers/disinfectors (AWD). There was no system in place to track the use and disinfection of individual endoscopes.

Iten, et al. say that four questions arise:

- Is it necessary to dispose of colonoscopes potentially contaminated by CJDs?

- Is it necessary to dispose of the AWD where the endoscopes were washed?

- Is it necessary to dispose gastroscopes at risk of contamination during the disinfection process in the AWD?

- Is it necessary to inform the patients who were exposed to these endoscopes ?

The researchers estimated that this situation occurs approximately 17 times each year in Switzerland. They say that to answer these questions requires data on the presence of CJDs prions in the colon, the risk of contamination of the endoscopes, the risk of prion transmissions to other patients via the endoscopes, and the procedures of cleansing and disinfection. Finally, it is also necessary to take into account psychological, financial and ethical implications for the endoscopy centre and the patients exposed to the potentially contaminated endoscopes. Iten, et al. add that this complex situation highlights the need for guidance recommendations in this area. Their research was presented at the International Conference on Prevention & Infection Control (ICPIC) held in Geneva, Switzerland June 29-July 2, 2011.

Reference: A Iten, H Sax, V Camus, D Scalia, A Hadengue, P-Y Martin, S Hurst and D Pittet. The management of potential exposures to Creutzfeld-Jakob Disease (CJD) via endoscopy. Presentation at International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6):P312doi:10.1186/1753-6561-5-S6-P312