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A Surprising and Dangerous Risk from Colonoscopy

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When you’re scheduled for a colonoscopy, your thoughts are on getting a clean bill of health at the end of it…not on whether the procedure could give you a dangerous infection. But according to a new study, that is a surprising risk you need to be aware of. It’s not that you should forgo this very effective cancer screening…but you should take the simple steps described below to protect yourself.

What we know: Every year, more than 20 million Americans people have internal medical tests and treatments done with reusable scopes mounted on the end of tubes that are inserted through either the anus or the mouth and pushed along to various parts of the digestive tract. These tools are marvelous instruments, but they are complex, delicate and very hard to completely disinfect and fully dry between uses.

This can lead to dangerous situations. In a study recently published in the American Journal of Infection Control, researchers went to three (unnamed) US hospitals and tested 45 endoscopes that were disinfected after previous uses and ready to be used in additional procedures—and  found water-borne germs—germs that bred in water left behind after the scopes were cleaned—on 71% of them. In other words, these medical devices, soon to be inserted into new patients’ bodies, were literally breeding grounds for infection.

The danger is not only hypothetical. For example, since 2013, there have been 35 deaths in the US linked to infections stemming from duodenoscopes, scopes often used to diagnose and treat problems with the pancreas.

More new findings. To assess the infection risk from reusable scopes, researchers at The Johns Hopkins University reviewed records of hospitalizations and emergency department visits in six states over a one-year period to see how many infections developed within seven to 30 days after about two million scope procedures. They focused on ambulatory surgery centers, where about half of such procedures are done, and picked a timeframe that would make it more likely for the infections to be related to the procedures.

The researchers were surprised to find that infections were much more common than previously thought. There were 1.1 infections per 1,000 screening colonoscopies, 1.6 per 1,000 diagnostic colonoscopies and three per 1,000 through-the-mouth procedures. Here’s what else they found…

  • Having been in the hospital and/or having had another type of endoscopic procedure within the previous 30 days increased a patient’s risk for infection.
  • The most common infections were gastrointestinal tract infections and pneumonia. (The reason for pneumonia, a previously known risk, may be sedation, which can cause patients to aspirate fluids from the respiratory tract and isn’t related to contaminated scopes.)

How to Reduce Your Risk

There was some good news from this study—the more of these procedures a center had performed, the lower its infection rate tended to be, which suggests a way that you as a patient can reduce your odds of infection if you need a scope procedure. Call or e-mail various centers where you might have a procedure and ask how often each center does the procedure and how often patients have gotten infections. Even better, find out whether the center can use (or already is using) one of the disposable scopes recently approved by the FDA. Doctors and facilities have been slow to adapt to this change, but some recognize how this can be an important step to reduce infections, particularly dangerous antibiotic-resistant ones, and have started using them.

According to Susan Hutfless, MD, one of the Johns Hopkins researchers, just before your procedure starts, you might also ask your surgeon how confident he or she is that the scope is “clean”—your question might prompt him or her to check this information before using it on you. Even though you might be met with a puzzled expression, the more patients who ask the question, the more likely physicians will be to find out the answers, Dr. Hutfless said.

If you need a scope procedure for treatment or to diagnose a problem, you may not be able to put it off. But if you’ve recently been sick or hospitalized or had another endoscopic procedure, consider delaying a screening colonoscopy for a little while to avoid a possible double exposure to infection-causing germs, suggested Dr. Hutfless.

After a scope procedure, be on the lookout for the following infection symptoms…

  • Fever
  • Chills
  • Cramps
  • Nausea
  • Vomiting
  • Diarrhea
  • Cough
  • Shortness of breath

Report any and all to your doctor’s office right away.

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Source: Susan Hutfless, PhD, assistant professor of medicine at the Johns Hopkins University School of Medicine and of epidemiology at its Bloomberg School of Public Health, both in Baltimore, and coauthor of the study “Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA” published in Gut.

Study titled “Residual moisture and waterborne pathogens inside flexible endoscopes: Evidence from a multisite study of endoscope drying effectiveness” by researchers in St. Paul, Minnesota, published in American Journal of Infection Control. Date: October 1, 2018 Publication: Bottom Line Health
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