The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Transmission of Infection by Gastrointestinal Endoscopy and Bronchoscopy

David H. Spach, MD; Fred E. Silverstein, MD; and Walter E. Stamm, MD
[+] Article, Author, and Disclosure Information

From the University of Washington, Seattle, Washington. Requests for Reprints: Walter E. Stamm, MD, Division of Infectious Diseases, ZA-89, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104. Disclosure: Dr. Silverstein consults for and has equity in Vision Sciences Inc., the company that developed the sheathed endoscope (described in reference 132). Acknowledgments: The authors thank Jan Hirschmann, MD, Benjamin Lipsky, MD, David Saunders, MD, and Sarah McVicker for reviewing the manuscript; and Andrew Blair, PhD, for the computer-generated drawing of the endoscope.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(2):117-128. doi:10.7326/0003-4819-118-2-199301150-00008
Text Size: A A A

Objective: To review reports on the transmission of infections by flexible gastrointestinal endoscopy and bronchoscopy in order to determine common infecting microorganisms, circumstances of transmission, and methods of risk reduction.

Data Sources: Relevant English-language articles were identified through prominent review articles and a MEDLINE search (1966 to July 1992); additional references were selected from the bibliographies of identified articles.

Study Selection: All selected articles related to transmission of infection by gastrointestinal endoscopy or bronchoscopy; 265 articles were reviewed in detail.

Data Synthesis: Two hundred and eighty-one infections were transmitted by gastrointestinal endoscopy, and 96 were transmitted by bronchoscopy. The clinical spectrum of these infections ranged from asymptomatic colonization to death. Salmonella species and Pseudomonas aeruginosa were repeatedly identified as the causative agents of infections transmitted by gastrointestinal endoscopy, and Mycobacterium tuberculosis, atypical mycobacteria, and P. aeruginosa were the most common causes of infections transmitted by bronchoscopy. One case of hepatitis B virus transmission via gastrointestinal endoscopy was documented. Major reasons for transmission were improper cleaning and disinfection procedures; the contamination of endoscopes by automatic washers; and an inability to decontaminate endoscopes, despite the use of standard disinfection techniques, because of their complex channel and valve systems.

Conclusions: The most common agents of infection transmitted by endoscopy are Salmonella, Pseudomonas, and Mycobacterium species. To prevent endoscopic transmission of infections, recommended disinfection guidelines must be followed, the effectiveness of automatic washers must be carefully monitored, and improvements in endoscope design are needed to facilitate effective cleaning and disinfection.


Grahic Jump Location
Figure 3.
Cross-section of typical gastrointestinal endoscope.

A schematic drawing of a fiberoptic gastrointestinal endoscope shows the complex internal design.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Resistance of microorganisms to disinfectants.

Descending order of in vitro resistance to germicidal chemicals. Modified from reference 2; reproduced with the permission of the author and publisher.

Grahic Jump Location
Grahic Jump Location
Figure 1.
Nosocomial transmission of microorganisms via endoscopes.

Flow diagram shows major routes and sources of nosocomial transmission of microorganisms via endoscopes.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.