Digestive endoscopy and HCV transmission

Abstract

Digestive endoscopy is not a major risk factor for transmitting hepatitis C virus. Ciancio A, Manzini P, Castagno F, D'Antico S, Reynaudo P, Coucourde L, Ciccone G, Del Piano M, Ballare M, Peyre S, Rizzi R, Barletti C, Bruno M, Caronna S, Carucci P, Venon Wde B, De Angelis C, Morgando A, Musso A, Repici A, Rizzetto M, Saracco G. 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 Design Prospective cohort study. Setting Three endoscopic units and two blood banks in northwestern Italy. Patients The potentially exposed cohort consisted of 9188 outpatients consecutively recruited from three 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 two blood banks in the same area and during the same time period; 38,280 of them (75%) were tested again for anti-HCV 6–48 months after the first blood donation (95,317 person-years of observation). Measurements 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, 0–0.465]); 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, 0–4.195]). 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, 0.011–0.107 case per 1000 person-years]); each had undergone minor surgery before the second test Limitations 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. [Abstract reproduced by permission of Ann Intern Med 2005;142: 903–909]