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Multiple studies have documented a high rate of contaminated colonoscopes after reprocessing. Contaminated reusable colonoscopes may increase the risk of device-related patient infections. As disposable colonoscopes enter the market, they may play a role in infection prevention and may be cost-effective at some facilities or in high-risk patients. Using a micro-costing approach, this study found that the cost per colonoscopy including purchase, maintenance and reprocessing ranges from US$188.64 at high volume centres (3000 annual procedures) to US$501.16 at low volume centres (1000 annual procedures). Accordingly, per-procedure capital costs range from US$87.48 to US$262.45; repair costs range from US$68.77 to US$206.32; cleaning supplies and labour costs US$32.39 and infections requiring hospitalisation cost US$20.12 to US$46.52. As disposable colonoscopes enter the market, low volume centres are most likely to achieve cost savings. Determining if post-procedural infection rates differ with reusable vs disposable colonoscopes is needed. ### In more detail Each year more than 15 million colonoscopy procedures are performed in the USA and the number is increasing.1 Colonoscopy is generally thought to be safe; however, patients are sometimes hospitalised afterwards, due to infections that may have been transmitted via contaminated colonoscopes (MAUDE Adverse Event Report).2 3 Colonoscopy-related infections and complications have been reported in multiple studies, although at lower rates compared with endoscopic retrograde cholangiopancreatography (ERCP).1 4 5 Guideline revisions in response to endoscope-associated infections require healthcare institutions to invest more resources in the high-level disinfection process or conversion to sterilisation (Ofstead et al ).5,6 Despite colonoscopy being the highest volume GI procedure, the true cost and time associated with reusable colonoscopes are unknown. The purpose of this study was to explore real-world costs associated with …

ObjectiveContaminated reprocessed duodenoscopes pose a serious threat to patients in the endoscopy unit. Despite manufacturer changes to reprocessing guidelines, 20% of reprocessed duodenoscopes meet criteria for quarantine-level contamination based on microbiological or ATP testing. We aimed to examine risk factors for postendoscopic retrograde cholangiopancreatography (ERCP) infection.DesignRetrospective cohort analysis.SettingUS Medicare Fee-For-Service claims (2015–2021) and all-payer data (2017).ParticipantsIn the Medicare data, 823 575 ERCP procedures were included. The all-payer five-state data, 16 609 procedures were included.InterventionsERCP was identified by Current Procedural Terminology and International Classification of Disease (ICD) procedure codes. We identified inpatient infections using ICD diagnosis codes.Outcome measuresA logistic regression model predicted risk factors for infections occurring within 7-day and 30-day periods following ERCP. 7-day and 30-day all-cause hospitalisations and post-ERCP pancreatitis were also examined.ResultsPost-ERCP infection occurred within 3.5% of 7-day and 7.7% of 30-day periods in Medicare. Disposable duodenoscopes were billed in 711 procedures, with 1.4% (n=10, 7-day) and 3.5% (n=25, 30-day) post-ERCP infections. Urgent ERCPs were the strongest risk factor for infections in the 7-day period (OR 3.3, 95% CI 3.2 to 3.4). Chronic conditions, sex (male), age (older) and race (non-white) were also risk factors. In the all-payer five-state data, fewer infections (2.4%, 7 days) were observed. No difference arose between Medicare and other payers for 7-day period infections (OR 1.0, 95% CI 0.7 to 1.3).ConclusionsUrgent ERCPs, patient chronic conditions and patient demographics are post-ERCP infection risk factors. Patients with infection risk factors should be targeted for specialised infection control prevention measures, including disposable duodenoscopes.

ObjectiveOver 15 million colonoscopies and 7 million osophagogastroduodenoscopies (OGDs) are performed annually in the USA. We aimed to estimate the rates of infections after colonoscopy and OGD performed in ambulatory surgery centres (ASCs).DesignWe identified colonoscopy and OGD procedures performed at ASCs in 2014 all-payer claims data from six states in the USA. Screening mammography, prostate cancer screening, bronchoscopy and cystoscopy procedures were comparators. We tracked infection-related emergency department visits and unplanned in-patient admissions within 7 and 30 days after the procedures, examined infection sites and organisms and analysed predictors of infections. We investigated case-mix adjusted variation in infection rates by ASC.ResultsThe rates of postendoscopic infection per 1000 procedures within 7 days were 1.1 for screening colonoscopy, 1.6 for non-screening colonoscopy and 3.0 for OGD; all higher than screening mammography (0.6) but lower than bronchoscopy (15.6) and cystoscopy (4.4) (p<0.0001). Predictors of postendoscopic infection included recent history of hospitalisation or endoscopic procedure; concurrence with another endoscopic procedure; low procedure volume or non-freestanding ASC; younger or older age; black or Native American race and male sex. Rates of 7-day postendoscopic infections varied widely by ASC, ranging from 0 to 115 per 1000 procedures for screening colonoscopy, 0 to 132 for non-screening colonoscopy and 0 to 62 for OGD.ConclusionWe found that postendoscopic infections are more common than previously thought and vary widely by facility. Although screening colonoscopy is not without risk, the risk is lower than diagnostic endoscopic procedures.

In Gut , Villumsen et al 1 report a statistically significant association between UC and the risk of parkinsonism in a Danish nested case–control study. Patients with Crohn’s disease and UC with at least one inpatient or outpatient encounter for IBD between 1977 and 2014 were compared with age-matched and sex-matched controls (76 477 IBD; 7 548 259 controls). Follow-up started at the time of the first IBD encounter (or the corresponding date for the controls) until the first diagnosis of Parkinson’s disease or multiple system atrophy. Parkinsonism was increased among patients with UC (HR 1.35 (95% CI 1.20 to 1.52)), but not Crohn’s disease (HR 1.12 (95% CI 0.89 to 1.40)). Parkinson’s disease and multiple system atrophy were rare both in patients …