Conventional cleaning and disinfection techniques eliminate the risk of endoscopic transmission of Helicobacter pylori.
OBJECTIVE
To determine whether endoscopes serve as a reservoir for Helicobacter pylori and whether two commonly used cleaning and disinfection methods eliminate the risk of H. pylori transmission.


METHODS
A prospective study was carried out in 107 patients who were undergoing upper gastrointestinal endoscopy for routine clinical indications. H. pylori DNA was assayed by polymerase chain reaction (PCR) of endoscope washes before and after procedure, in gastric aspirates and in endoscope washes after cleaning and disinfection of endoscopes. Gastric biopsies were assayed by rapid urease test (CLOtest, Tri-Med Specialties Inc., Lenexa, KS) of two antral biopsies.


RESULTS
Forty-one of 107 (38%) patients were H. pylori-positive by PCR. Endoscopes were contaminated after 25 of 41 (61%) H. pylori-positive procedures. However, 107 of 107 pre-endoscopy and postcleaning aspirates were negative, indicating that decontamination was 100% effective. The urease test was positive in 25 of 41 H. pylori-positive patients, a sensitivity of 61%. PCR was positive in 41 of 41 H. pylori-positive patients, a sensitivity of 100%. In 5 of 16 PCR-positive/urease-negative patients, the identification of H. pylori was clinically relevant.


CONCLUSIONS
Endoscopes are frequently contaminated with H. pylori after endoscopy in H. pylori-infected patients, but conventional cleaning and disinfection techniques are highly effective in eliminating H. pylori. When appropriate negative control samples are obtained from the endoscope, PCR of endoscopic gastric aspirates appears to be a sensitive test that can detect clinically relevant H. pylori infection that is missed when only a rapid urease test is used.
Department of Medicine, University of Maryland, Baltimore.
G T
GT
Fantry
Q X
QX
Zheng
S P
SP
James
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001483:Base Sequence; D004203:Disinfection / Q000379:methods; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005976:Glutaral; D016481:Helicobacter Infections / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D010463:Peracetic Acid; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D013270:Stomach / Q000382:microbiology
D010463:Peracetic Acid; D005976:Glutaral