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DOI: 10.1055/s-2001-18937
Variant Creutzfeldt-Jakob Disease (vCJD) and Gastrointestinal Endoscopy
Publikationsverlauf
Publikationsdatum:
07. Dezember 2001 (online)
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Variant Creutzfeldt-Jakob disease (vCJD) is a transmissible form of spongiform encephalopathy believed to be contracted from the consumption of bovine spongiform encephalopathy (BSE) infected beef products. To date over 100 individuals have developed this incurable disease. There have been no documented cases of iatrogenic infection, but there is a theoretical risk that surgical procedures could transmit the disease. This review describes the background of the disease and assesses the possible risks of transmission through endoscopic procedures. The risk of transmission by endoscopy is small and probably negligible if suitable procedures are followed. The greatest potential danger arises from healthy individuals who are incubating the disease. Pathological prions (PrPsc) may be found in lymphatic tissue of these individuals (particularly tonsils), but smaller amounts have been identified in the appendix and Peyer’s patches. These prions are resistant to all forms of conventional sterilization. There is a theoretical risk that biopsy forceps and the operating channel of endoscopes could become contaminated. This review gives recommendations as to how these small risks can be minimized. They include the employment of single-use forceps for biopsies taken from the terminal ileum, greater attention to the maintenance of endoscopic equipment and accessories, more rigorous manual cleaning of endoscopic equipment and the use of well designed, disposable cleaning brushes for the operating channel of the endoscope.
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Addendum - The European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA)
Recommendation for the Reduction of the Risk of Transmission of Prions in Endoscopy
This document is supplemental to the previously published ESGE/ESGENA Reprocessing Guidelines
Introduction
As there are no known effective means of disinfection or sterilisation following exposure to prions the emphasis in preventing transmission of prions in endoscopy must be on the removal of organic matter from equipment and the prevention of cross contamination of the environment.
I. Staff Safety
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II. Choice of Accessories
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III. Utilisation of Accessories During Endoscopie Procedures
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IV. Reprocessing of Equipment
Key points for reprocessing endoscopie equipment are as follows:
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Accessories
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Endoscopes
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V. Automated Reprocessing Systems
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The previously published ESGE-ESGENA Guidelines on Cleaning and Disinfection in GI Endoscopy have to be adhered to (Endoscopy 2000; 32: 77-83).
A. T. Axon
Div. of Gastroenterology
The General Infirmary
Great George Street
LS1 3EX Leeds
United Kingdom
Fax: + 44-113-392-2125
eMail: anthony.axon@leedsth.nhs.uk