Gastroenterology Unit, RLUH, December 2009

Risk of contamination of gastrointestinal endoscopy channels with vCJD

Screening questions : patients at risk of vCJD (Annexe J, revised July 2009)

All patients must be asked a single question prior to GI endoscopy:

“Have you ever been notified that you are at risk of vCJD for public health purposes?”

Note: This will include patients with haemophilia, related coagulation defects or immunodeficiencies, who received British plasma or blood products from 1980-2001, particularly directly implicated plasma products, directly implicated blood transfusions, and concentrated or pooled plasma products, including factor VIII and antithrombin.

6500 individuals have been notified of their specific risk in writing.

“yes” / Use non- fixative scope
Do NOT perform any contaminating invasive procedures (see below)
Refer to interventional endoscopy specialist if procedure necessary
“no” / Endoscopy can be carried out as normal
can’t answer / Endoscopy can be carried out as normal … there is NO requirement to contact relatives, the GP or to provisionally quarantine the scope

(Note: The previously-used questions from Annexe J relating to family history, cadaveric dural grafting and GH/gonadotrophin exposure are NO LONGER REQUIRED, as they pertain to CVD but not vCJD)

Scope use in different situations (Annexe F):

Definite /probable vCJD / Possible / unclear vCJD / “at risk” of vCJD
No contaminating procedure performed / Any scope / Any scope / Any scope
Contaminating procedure performed / Quarantine, destroy or refurbish the scope / Quarantine, destroy or refurbish the scope / Quarantine, destroy or refurbish the scope

(Note that as of December 2009, since we now use a non-fixative cleaning agent, there is no need for a “non-fixative” scope to be sent to theatre for decontamination after use on at-risk patients. Any scope may now be used and cleaned in the gastro unit, as long as no contaminating procedure is performed, see below)

Contaminating procedures(Annexe F, revised July 2009)

Certain procedures will contaminate the channels of the endoscope. If this occurs, the endoscope must be quarantined indefinitely, destroyed or sent for refurbishment.

Non-contaminating procedures / Contaminating procedures / Permitted modifications**
Visual inspection
EUS
Sheathed* injection of varices
Sheathed*injection of ulcer
Sheathed* brush cytology
Stenting (detachable)
Clipping (detachable)
Banding of varices (detachable)
Bougie dilatation
*Accessory must be sheathed before withdrawal into channel / Biopsy
Diathermy of any kind
Heater probe
APC
EMR
Polypectomy
Balloon dilatation
ERCP: balloon sphincteroplasty, sphincterotomy, or stone removal
PEG insertion
Pseudocyst drainage / Sheathed biopsies
Balloon dilatation with withdrawal as one
Polypectomy & EMR with continuous channel irrigation (to flush fragments)
PEG with thread kept in view
**ONLY to be performed by interventional endoscopy consultant with special expertise