Digestive Endoscopy Is Not a Major Risk Factor for Transmitting Hepatitis C Virus

7 June 2005 | Volume 142 Issue 11 | Pages 903-909

Background: The potential role of digestive endoscopy as a mode for transmission of hepatitis C virus (HCV) is controversial.

Objective: To evaluate the role of digestive endoscopy in transmitting HCV by comparing the incidence of HCV infection in a cohort of patients undergoing endoscopy and in a cohort of blood donors.

Design: Prospective cohort study.

Setting: 3 endoscopic units and 2 blood banks in northwestern Italy.

Patients: The potentially exposed cohort consisted of 9188 outpatients consecutively recruited from 3 endoscopic units. Of 9008 patients negative for antibody to HCV (anti-HCV), 8260 (92%) were retested for anti-HCV 6 months after endoscopy. The unexposed cohort consisted of 51 230 healthy, anti-HCV–negative persons who donated blood at 2 blood banks in the same area and during the same time period; 38 280 of them (75%) were tested again for anti-HCV 6 to 48 months after the first blood donation (95 317 person-years of observation).

Measurements: Differences in the anti-HCV seroconversion rate between the exposed cohort (patients undergoing endoscopy) and the unexposed cohort (blood donors). Seroconversion was evaluated by a third-generation enzyme immunoassay for anti-HCV; persons positive for anti-HCV were tested for HCV RNA by polymerase chain reaction.

Results: All 8260 persons undergoing endoscopy remained negative for anti-HCV 6 months after the procedure (risk per 1000 persons, 0 [95% CI, 0 to 0.465]); in particular, none of the 912 patients who underwent endoscopy with the same instrument previously used on HCV carriers showed anti-HCV seroconversion (risk per 1000 persons, 0 [CI, 0 to 4.195]). Four blood donors became positive for anti-HCV and HCV RNA (mean follow-up, 2.49 years; 0.042 case per 1000 person-years [CI, 0.011 to 0.107 case per 1000 person-years]); each had undergone minor surgery before the second test.

Limitations: In the endoscopy cohort, 8.3% of patients were lost to follow-up.

Conclusions: These findings support the hypothesis that properly performed digestive endoscopy is not a major risk factor for the transmission of HCV.

Editors' Notes Context Controversy persists regarding the risk for transmission of hepatitis C virus (HCV) as a result of digestive-tract endoscopy. Contribution This prospective study of HCV-negative patients who underwent gastroscopy with the same endoscopes as HCV-positive patients showed no transmission of infection on follow-up 6 months later. Biopsy with reusable or disposable forceps did not increase the risk for HCV infection. Blood donors who were HCV negative without endoscopic exposure showed a few conversions to infected status an average of 2.5 years later. Implications The risk for HCV transmission by endoscopy is extremely low when standard instrument-cleaning techniques are used. –The Editors

 

Author and Article Information

From Ospedale Molinette, Banca del Sangue e del Plasma della città di Torino, Torino, Italy; Servizio di Immunotrasfusione, Pinerolo, Italy; Ospedale Maggiore della Carità, Novara, Italy; and ASL 9, Ivrea, Italy.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Giorgio Saracco, MD, Dipartimento di Gastroenterologia, Ospedale Molinette, Corso Bramante 88, 10126 Torino, Italy; e-mail, g.saracco{at}tin.it.

Current Author Addresses: Dr. Ciancio: Dipartimento di Gastroenterologia, Ospedale Molinette, c.so Bramante 88, 10126 Torino, Italy.

Drs. Manzini, Castagno, and D'Antico: Banca del Sangue e del Plasma della città di Torino, c.so Bramante 88, 10126, Torino, Italy.

Drs. Reynaudo and Coucourde: Servizio di Immunotrasfusione ASL 10, via Brigata Cagliari 39, 10064 Pinerolo, Torino, Italy

Dr. Ciccone: Unità di Epidemiologia dei Tumori, CPO Piemonte, Ospedale Molinette, c.so Bramante 88, 10126 Torino, Italy.

Drs. Del Piano and Ballarè: Divisione di Gastroenterologia, Ospedale Maggiore della Carità, via Mazzini 18, 28100 Novara, Italy.

Drs. Peyre and Rizzi: U.O.A. Gastroenterologia e Endoscopia Digestiva, ASL 9, P.za Credenza 2, 10015 Ivrea, Italy.

Drs. Barletti, Bruno, and Caronna: Dipartimento di Gastroenterologia, Ospedale Molinette, c.so Bramante 88, 10126 Torino, Italy.

Drs. Carucci, De Bernardi Venon, De Angelis, Morgando, Musso, Repici, Rizzetto, and Saracco: Dipartimento di Gastroenterologia, Ospedale Molinette, c.so Bramante 88, 10126 Torino, Italy.

Author Contributions: Conception and design: G. Saracco.

Analysis and interpretation of the data: A. Ciancio, G. Saracco.

Drafting of the article: A. Ciancio, G. Saracco.

Critical revision of the article for important intellectual content: M. Rizzetto.

Provision of study materials or patients: P. Manzini, F. Castagno, S. D'Antico, P. Reynaudo, L. Coucourde, M. Del Piano, M. Ballarè, S. Peyre, R. Rizzi, C. Barletti, M. Bruno, S. Caronna, P. Carucci, W. De Bernardi Venon, C. De Angelis, A. Morgando, A. Musso, A. Repici, G. Saracco.

Statistical expertise: G. Ciccone.

Collection and assembly of data: A. Ciancio.

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