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Multisociety guideline on reprocessing flexible GI endoscopes and accessories

      Gastrointestinal (GI) endoscopy is highly effective for the prevention, diagnosis, and treatment of many digestive diseases.
      • Zauber A.G.
      • Winawer S.J.
      • O'Brien M.J.
      • et al.
      Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.
      Endoscopes used in endoscopy are complex, diverse, and essential devices that require meticulous cleaning and reprocessing in strict accordance with manufacturer guidelines before being reused on patients. Multiple risks are associated with endoscopic procedures; one such risk includes patients developing an exogenous infection (ie, pathogen introduced through a contaminated device).
      • Calderwood A.H.
      • Day L.W.
      • et al.
      ASGE Quality Assurance in Endoscopy Committee
      ASGE guideline for infection control during GI endoscopy.
      Exogenous infections in endoscopy are attributed to a myriad of causes. In general, pathogen transmission related to standard end-viewing endoscopes are associated with a failure to follow established cleaning and disinfection/sterilization guidelines for endoscopes, accessories, or associated equipment or with the use of defective equipment.
      • Kovaleva J.
      • Peters F.T.
      • van der Mei H.C.
      • et al.
      Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy.
      • Spach D.H.
      • Silverstein F.E.
      • Stamm W.E.
      Transmission of infection by gastrointestinal endoscopy and bronchoscopy.
      • Nelson D.B.
      • Muscarella L.F.
      Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy.
      On the other hand, exogenous infections have occurred in patients undergoing specialized procedures using duodenoscopes, despite following established reprocessing protocols
      • Epstein L.
      • Hunter J.C.
      • Arwady M.A.
      • et al.
      New Delhi metallo-beta-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes.
      • Smith Z.L.
      • Oh Y.S.
      • Saeian K.
      • et al.
      Transmission of carbapenem-resistant Enterobacteriaceae during ERCP: time to revisit the current reprocessing guidelines.
      • Wendorf K.A.
      • Kay M.
      • Baliga C.
      • et al.
      Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak.
      • Alrabaa S.F.
      • Nguyen P.
      • Sanderson R.
      • et al.
      Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment.
      • Marsh J.W.
      • Krauland M.G.
      • Nelson J.S.
      • et al.
      Genomic epidemiology of an endoscope-associated outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae.
      ; such observations and findings have raised questions about the optimal methods for the cleaning and disinfection of these unique devices. At the same time, in recent years, concerns have been raised that many of these infectious risks to patients may be underestimated as a result of under-reporting or non-recognition. Consequently, this information highlights the need for clear, evidence-based reprocessing guidelines.

      Abbreviations:

      AER (automated endoscope reprocessor), ATP (adenosine triphosphate), CDC (Centers for Disease Control and Prevention), COVID-19 (coronavirus disease 2019), EtO (ethylene oxide), FDA (U.S. Food and Drug Administration), GRADE (Grading of Recommendations Assessment, Development and Evaluation), HLD (high-level disinfection), IFU (instructions for use), SARS-CoV-2 (severe acute respiratory syndrome–coronavirus 2)
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      • Erratum
        Gastrointestinal EndoscopyVol. 94Issue 5
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          Regarding the article “Multisociety guideline on reprocessing flexible GI endoscopes and accessories” (Gastrointest Endosc 2021;93:11-33), please see the following correction:
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