Digestive endoscopy is not a major risk factor for transmitting hepatitis C virus.
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.


METHODS
Prospective cohort study.


METHODS
3 endoscopic units and 2 blood banks in northwestern Italy.


METHODS
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).


METHODS
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.


CONCLUSIONS
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.
Ciancio
Alessia
A
Ospedale Molinette, Banca del Sangue e del Plasma della città di Torino, Torino, Italy. g.saracco@tin.it
Manzini
Paola
P
Castagno
Franco
F
D'Antico
Sergio
S
Reynaudo
Paolo
P
Coucourde
Laura
L
Ciccone
Giovannino
G
Del Piano
Mario
M
Ballarè
Marco
M
Peyre
Sergio
S
Rizzi
Roberto
R
Barletti
Claudio
C
Bruno
Mauro
M
Caronna
Stefania
S
Carucci
Patrizia
P
Venon
Wilma De Bernardi
Wde B
De Angelis
Claudio
C
Morgando
Anna
A
Musso
Alessandro
A
Repici
Alessandro
A
Rizzetto
Mario
M
Saracco
Giorgio
G
D000328:Adult; D000553:Ambulatory Care / Q000592:standards; D001782:Blood Donors; D016099:Endoscopy, Gastrointestinal / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000453:epidemiology / Q000635:transmission*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000592:standards; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors
D018937:Hepatitis C Antibodies; D012367:RNA, Viral