A recent article in USA Today reported that localized outbreaks of the carbapenem-resistant enterobacteriaceae (CRE) bacteria a deadly bacteria that is resistant to most, if not all, antibiotics has been linked to the use of a certain endoscope in GI endoscopy procedures. While this may be true, the spreading of diseases via endoscopes is not a new concern in health care and is more common than most of us would think.

To provide some context about the reported situation, CRE has been linked to a number of deaths in the US among patients who previously underwent an endoscopic retrograde cholangiopancreatography (ERCP), which requires the use of a duodenoscope, a specialized endoscope that reaches the duodenum and allows the physician to gain access into the biliary and pancreatic structures. Like any type of durable medical equipment, duodenoscopes and endoscopes in general are used over and over again; typically, the life span of a duodenoscope is no less than five years before it gets replaced by a newer model on the market. Endoscope sterilization in between each use is the only safeguard against diseases being passed along to the next person in line try not to think about a high volume colonoscopy clinic right now!

From a health care provider's point of view, the risk of disease transmission from endoscopy procedures is a concern that can be mitigated with sterilization protocols. From a patient's point of view, this risk is probably an afterthought given the more salient fears and concerns of undergoing such a procedure (i.e., anesthesia, embarrassment, pain). While the recent CRE outbreak is a good wake up call for facilities to ensure durable medical equipment are cleaned according to the highest of standards, we also have to put into perspective the fact that gut bacteria both good and bad are very resilient and numerous, and that their transmission via endoscopy will continue to be a reality despite even the most rigorous of sterilizations. For the average patient, rather than fear the extremely unlikely event of dying from nightmare bacteria on the endoscope that is examining you, let's calm ourselves by keeping in mind the other side of the coin that is, we would not exist without the incredible diversity of our gut flora. Anyone still in doubt should just remember that the gut microbiome remains a fast-growing area of research because to understand and harness its wonders (e.g., fecal transplants) will provide us with new options to treat common afflictions, such as C. difficile infections and other bowel diseases.

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