Duodenoscopes Spreading Super Bugs In The News

[sunny2012]

Check out the type of endoscope your doctor wants to use. They can't be cleaned well enough to prevent antibiotic resistant bacteria surviving and several people ahve been made sick or died.

 

Check out this article before you go so you can check to be safe:

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[kareng]

Check out the type of endoscope your doctor wants to use. They can't be cleaned well enough to prevent antibiotic resistant bacteria surviving and several people ahve been made sick or died.

Check out this article before you go so you can check to be safe:

Open Original Shared Link

Those are not what is used for regular endoscopies to look for Celiac disease.

 

 

The scopes in the news story are for - "The scopes are used for a procedure called ERCP, or Endoscopic Retrograde Cholangiopancreatography, in which the devices are used with contrast dyes and X-rays to help doctors locate and treat blockages in the bile and pancreatic ducts."  

 

This is NOT for regular endoscopies to diagnose Celiac disease. 

[Firsttimemama2014]

Everyone.. I just saw this article posted on Celiac.com. It's referring to endoscopy patients.. why is this referring to celiacs???

 

https://www.celiac.com/articles/23910/1/Endoscopy-Patients-Warned-of-Super-bug-Exposure-at-UCLA-Medical-Center/Page1.html

 

Quote "Given the fact that celiac disease diagnosis and follow up care require the use of endoscopy, this news is particularly disturbing to those in the celiac community."

[kareng]

Everyone.. I just saw this article posted on Celiac.com. It's referring to endoscopy patients.. why is this referring to celiacs???

 

https://www.celiac.com/articles/23910/1/Endoscopy-Patients-Warned-of-Super-bug-Exposure-at-UCLA-Medical-Center/Page1.html

 

Quote "Given the fact that celiac disease diagnosis and follow up care require the use of endoscopy, this news is particularly disturbing to those in the celiac community."

 

 

Not sure.  That is the author's own opinion.  Not sure he really understands the difference in the procedures.

[LauraTX]

That author tends to report on all kinds of things, some of them with very little impact to actual Celiacs.  

[Firsttimemama2014]

Well, looks like Celiac.com needs some new authors

[murphy203]

FTM, I saw my GI today and asked about this specific issue. Their practice does indeed reuse scopes for endoscopies -- they are $40,000 each otherwise. She assured me that they have stringent measures in place to keep things clean, make of that what you will.

[sunny2012]

Those are not what is used for regular endoscopies to look for Celiac disease.

 

 

The scopes in the news story are for - "The scopes are used for a procedure called ERCP, or Endoscopic Retrograde Cholangiopancreatography, in which the devices are used with contrast dyes and X-rays to help doctors locate and treat blockages in the bile and pancreatic ducts."  

 

This is NOT for regular endoscopies to diagnose Celiac disease. 

ALL scopes are very difficult to properly clean. The rate for contaminated scopes is only slightly better for gastroscopes at 24 percent found contaminated. Compare that with 30 percent for duodenoscopes and the risks of serious infections is essentially equal for all upper GI procedures.

 

information about dirty scopes of all sorts were known in 2013. 

The flexible material from which these tools are made makes it nearly impossible to properly sterilize them. 

 

All endoscopes are difficult to properly sterilize due to the flexible materials from which they are made which cannot tolerate the high temperatures that normally sterilize other surgical equipment. This applies to ALL endoscopes.

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Table. Manual Cleaning Failure Rate

Instrument

Failure Rate, %

Mean Relative Light Units

Duodenoscope (n = 30)

30

145

Gastroscope (n = 116)

24

86

Colonoscope (n = 129)

3

30

 

Several hospitals called back patients from many years of treatment at endoscopy centers to be tested and diagnosed for HIV and HEP C and other dangerous infections.

Patients already ill from celiac being either diagnosed or having it ruled out are at greater risk due to the increased stress on the immune system. Patients receiving such procedures for Celiac are forced to damage their health with a lengthy period of gluten ingestion KNOWN to cause serious health issues in order to purposely damage the lining of the bowel. Thusly, they are in a higher risk group when compared to the average patient receiving care.

Celiac is a sufficiently difficult disease with which to live a lifetime. Every patient deserves the right to know about the actual risks and dangers in order to choose a diagnostic method that best serves their own personal choice. Preventing patients from having such information available exposes them to unnecessary risks.

All aspects of the dangers of diagnosis and living with Celiac should be topics of discussion. Otherwise, we prevent people from making informed choices.

 

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'Biological dirt' from other patient's colons lingers on three in twenty endoscopes, increasing the chance of infection from colonoscopies and other endoscopic procedures, according to a study presented at the Association for Professionals in Infection Control and Epidemiology's annual meeting.

 

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A recent study examined the cleanliness of endoscopes in the United States. An endoscope is a tool that is used during a colonoscopy procedure and examines the GI tract of the patient's colon. The study found that 15 percent of the five hospitals examined had endoscopes that contained "biodirt," which is material left behind from previous patients. These endoscopes were dirty even after they had been cleaned by the hospital.

 

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A new study disturbingly discovered that an average of 15 percent of flexible endoscopes used to examine GI tracts and colons at five hospitals were harboring "bio-dirt"—cells and other material from previously examined patients. This was even after the instruments had been cleaned.

 

The discovery of dirty endoscopes has previously led hospitals to issue alarming warnings to thousands of endoscopy patients that they should be tested for diseases such as HIV and hepatitis B and C.

About 10,000 patients who underwent endoscopies at three U.S. Veterans Affairs hospitals between 2003 and 2009 were warned four years ago that they might have been exposed to blood-borne pathogens from contaminated instruments. In 2010, the Palomar Medical Center in San Diego notified 3,400 patients that they could receive free tests for diseases after having had endoscopies with potentially dirty equipment.

 

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When U.S. Army veteran Juan Rivera turned 55 and decided it was time for a colonoscopy, he turned to the Veterans Administration hospital in Miami. He had the test, got a clean bill of health and didn't give it another thought.

A year later, he received a chilling letter from the VA. It said the equipment used in the procedure might have been contaminated. And it asked him to come in for viral testing.

He came up HIV positive.

So far, five Miami-area vets who had colonoscopies at the VA during the five years have tested positive for HIV, eight for hepatitis C and one for hepatitis B.

 

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UNSTERILE DEVICES PROMPT WARNINGS; Use of dirty endoscopes in colon and throat exams can pass along infections, activists say

- By John M. Glionna. The Los Angeles Times. Feb 13, 2003. pg. B.1

The nation’s leading manufacturer of endoscopes has known for a decade that some scopes contain cavities inaccessible to cleaning by hand but has failed to fix the oversight, said David Lewis, a University of Georgia research microbiologist who has conducted research for the federal Environmental Protection Agency on the issue of dirty endoscopes.

There is wide consensus that it is difficult to sterilize the devices, which can cost $28,000 each, without using temperatures so high that the scopes themselves become damaged. The scopes have numerous cavities that are difficult to clean, even by hand, critics say.

Acknowledged Timothy Ulatowski, an FDA official who oversees endoscope compliance: “When these things were designed, cleaning and sterilization was obviously an afterthought.”

 

 

Even the government can’t agree on how long is needed to clean the devices. The FDA says endoscopes should be disinfected for 45 minutes to kill tuberculosis bacteria, but the Centers for Disease Control believes the job can be done in 20 minutes, Lewis says.

[murphy203]

Not sure how to react, buyer beware?? Unfortunatey, people with posible celiacs or undxd "bleeding" from aemia, etc, cant avoid the latest technologies. What would you suggest???

[cyclinglady]

Every medical procedure has risks -- every single one! Everyone should do their own research (preferably from reliable sources) and talk to their physicians. In the past, I have gone for 2nd or 3rd medical opinions and paid cash for their unbiased advice.

There is so much information or reporting about endoscopy equipment and it is confusing. If someone is contemplating an endoscopy, one should, with the help of their physicians, decide its the procedure can be delayed or not. It is a personal decision.

Endoscopies have saved lives! My friend was diagnosed with stomach cancer in his 40s (firefighter) and without using an endoscopy he would be dead!

From my personal experience, my blood test was barely positive. My husband is an undiagnosed celiac or NCGI (14 years) and I thought what are the odds that both of us have it? I knew the gluten-free lifestyle, and let's face it, it is not pretty. I needed definitive proof in order for me to be diet compliant since I had no intestinal symptoms. I already was nut, egg and dairy free and if I avoided them, I did not have gastrointestinal, skin or respiratory symptoms. Gluten too? What about my kid and others in my family? Will my firm diagnosis help save others? Why was I still anemic after going through menopause? Did I have cancer? How bad was the damage?

In the end, I went with the endoscopy. It was a risk I was willing to take. Helps to have a Risk management expert in the household too!

If I were facing a endoscopy now and I had stomach issues and a positive blood test, I might prudently wait until the dust settles. I would see if I could be a diagnosed based on my blood test alone, go on the gluten-free diet and reevaluate in six months or so. But in my case, I had no stomach issues. I had to know for sure. It was a good thing, because two months later, my bones were breaking. I had no idea that I had osteoporosis which, although devastating to anyone, it was especially devastating to me since I am so active!

Again, it is a personal decision.

[LauraTX]

This topic was split off into its own thread since it is it's own discussion that is spanning multiple threads.  Original thread here: https://www.celiac.com/forums/topic/110978-apparently-more-celiacs-cancel-endoscopies-than-non-celiacs/

 

Feel free to continue this discussion here instead of multiple duplicate posts on other threads.

[sunny2012]

What frightens me most is the those who contracted HIV and Hepatitis from a colonoscopy. The contamination percentage for those is only 3%! Yet, people have contracted Hepatitis and HIV from colonoscopies! How often do those actually involved biopsy while diagnosing Celiac ALWAYS involves multiple biopsies? With a contamination rate of nearly 25% AND multiple biopsies, it seems to me that those of us who have had upper GI’s have just been lucky so far.

 

The average time to diagnosis is still around 7 years. That is much too long to suffer. And we still hear about people who choose a gluten free diet out of sheer desperation after too much time wasted on doctors not finding the issue.

 

I would not be in chronic pain, unemployable with severe nerve, liver, and brain damage if such a test were available. It might be worthwhile if these deaths and infections pushed us into better diagnostic procedures.

 

I was on the team that developed the blood testing that we have now. That was developed due to the difficulty with diagnosis many decades ago (sorry not revealing my age with that one). It is sadly a fact of life that tragedy is usually required before changes for the better occur. 

 

Anyway, There should be a push for development and advancement of testing that makes it simpler and faster to diagnose this disease. Improvements are in the works. Maybe it is time to push for these advancements. See this article:

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The testing uses whole blood which is easier to analyze, cheaper for patients and insurance companies and so far appears more accurate. This is what the report says, “the whole blood IP-10 ELISA was 94% sensitive and 100% specific”. And patients do NOT have to resume consuming gluten causing intestinal damage and months of illness just to receive a diagnosis. As an added benefit it appears that this testing might rule out Celiac with a very high accuracy rate. This would mean people could easily be tested for Celiac in the primary care doctor’s office or as part of a routine physical. And best of all, they could know before any symptoms of damage occurred. (This is my summary based on the things that I found most interesting. You should read it for yourself to see what is of interest to you.)

 

I am with cyclinglady about getting it done when necessary. I had a GI bleed and thought long and hard and decided to get the upper GI done. Like everything else that I did, I asked many questions FIRST. I am used to being a "pain in the tush" about everything having to do with this disease.

[sunny2012]

Not sure how to react, buyer beware?? Unfortunatey, people with posible celiacs or undxd "bleeding" from aemia, etc, cant avoid the latest technologies. What would you suggest???

Personally, when it comes to medical procedures, I don't think "buyer beware" should be our acceptable level of risk. I have enough troubles with Celiac and the consequences of 40 years struggling to get a doctor to actually look at me instead of simply writing me off as a "mental case".

 

I guess I made my suggestion in the post above. Changes do happen and we can be advocating for improvements in Celiac diagnosis. 

 

That would reduce the time pressure on these facilities and perhaps allow more time to clean these scopes.

[Scott Adams]

You might find this interesting:

ALL scopes are very difficult to properly clean. The rate for contaminated scopes is only slightly better for gastroscopes at 24 percent found contaminated. Compare that with 30 percent for duodenoscopes and the risks of serious infections is essentially equal for all upper GI procedures.:

Open Original Shared Link