Contributors: John Vargo, MD, MPH, Bret Lashner, MD, Mansour Parsi, MD, MPH, and Maged Rizk, MD
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There have been a lot of news stories lately about people undergoing endoscopy procedures who have contracted the superbug called carbapenem-resistant Enterobacteriaceae — or what’s more commonly referred to as CRE. As a result, many of our patients have reached out to us wanting to know if it is still safe for them to have their regularly scheduled colonoscopies or other endoscopic procedures.
Here’s what we know about the CRE outbreaks:
1. None of the infections were related to colonoscopy.
None of the CRE infections were contracted during colonoscopy, sigmoidoscopy or upper endoscopy (EGD). All of the infections occurred during a procedure called ERCP. The endoscopes used during the procedures were incompletely decontaminated and the infection was passed from patient to patient via the scope.
It’s important to note that the endoscopes that are used for ERCP (called duodenoscopes) are not the same endoscopes that are used for colonoscopy, sigmoidoscopy or EGD. The reason this is an important distinction is that duodenoscopes are more complicated instruments, and as such, they require a more careful cleaning process.
2. It’s important to your health to continue to have endoscopy procedures as ordered.
Timely diagnosis and treatment of GI conditions can improve your health and save your life. It has been proven that colonoscopy can be used to detect and remove polyps and prevent colorectal cancer from occurring. In fact, the colorectal cancer rate in the U.S. has shown dramatic declines in recent years due to preventive colonoscopy.
Despite the recent outbreaks, your risk of contracting CRE during endoscopy, including ERCP, is low. And the benefits of ERCP outweigh the risk of infection. ERCP is often used to treat life-threatening conditions that can lead to serious health consequences if left untreated.
3. There are things you can do to protect yourself.
Before undergoing any endoscopic procedure, ask your doctor what to expect following the procedure and when to seek medical attention. After endoscopy, many patients may experience mild symptoms, such as a sore throat (after ERCP or EGD) or mild abdominal discomfort.
Following your procedure, call your doctor if you have a fever or chills, or other symptoms that may be a sign of a more serious problem (for example, chest pain, severe abdominal pain, trouble swallowing or breathing, nausea and vomiting or black or tarry stools).
The U.S. Food and Drug Administration and manufacturers have set criteria for the cleaning and decontamination of endoscopes, and all endoscopy centers should closely adhere to these standards. Before your procedure, talk to your doctor about what measures the center is taking to ensure your procedure is safe. Make sure you are comfortable with the answers you receive.
4. As of now, there have been no endoscope-related CRE outbreaks at Cleveland Clinic.
To date, there have been no documented CRE infections transmitted by the endoscopes at Cleveland Clinic. Our GI doctors are dedicated to our patients’ outcomes and safety, and are constantly re-evaluating our performance and quality standards.
We have a competency-based standard for how our endoscopes are cleaned that we adhere to strictly. We have ensured that we are compliant, and appropriately trained in the most up-to-date cleaning techniques.
Also, we are engaging in a number of practices in addition to those required by the FDA.
These include using magnification techniques to assess for cleanliness, and chemical testing to assess for biomaterial. Patient safety and quality care are expectations we hold as our highest priority.