Clin Endosc > Epub ahead of print
Contamination Rates in Duodenoscopes Reprocessed Using Enhanced Surveillance and Reprocessing Techniques: A Systematic Review and Meta-Analysis
Shivanand Bomman1 , Munish Ashat2 , Navroop Nagra1 , Mahendran Jayaraj3 , Shruti Chandra4 , Richard A Kozarek1 , Andrew Ross1 , Rajesh Krishnamoorthi1
1Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
2Indiana University Health, Indianapolis, IN, USA
3University of Nevada, Las Vegas, NV, USA
4Mayo Clinic, Rochester, MN, USA
Correspondence :  Rajesh Krishnamoorthi ,Tel: +1-206-223-2319, Fax: +1-206-341-0061, Email:
Received: August 3, 2021  Revised: August 26, 2021   Accepted: August 26, 2021

Multiple outbreaks of multidrug-resistant organisms have been reported worldwide due to contaminated duodenoscopes. In 2015, the United States Food and Drug Administration recommended the following supplemental enhanced surveillance and reprocessing techniques (ESRT) to improve duodenoscope disinfection: 1. microbiological culture, 2. ethylene oxide sterilization, 3. liquid chemical sterilant processing system, and 4. double high-level disinfection. A systematic review and metaanalysis was performed to assess the impact of ESRT on the contamination rates.
A thorough and systematic search was performed across several databases and conference proceedings from inception until January 2021, and all studies reporting the effectiveness of various ESRTs were identified. The pooled contamination rates of post-ESRT duodenoscopes were estimated using the random effects model.
A total of seven studies using various ESRTs were incorporated in the analysis, which included a total of 9,084 post-ESRT duodenoscope cultures. The pooled contamination rate of the post-ESRT duodenoscope was 5% (95% confidence interval [CI]: 2.3%–10.8%, inconsistency index [I2]=97.97%). Pooled contamination rates for high-risk organisms were 0.8% (95% CI: 0.2%–2.7%, I2=94.96).
While ESRT may improve the disinfection process, a post-ESRT contamination rate of 5% is not negligible. Ongoing efforts to mitigate the rate of contamination by improving disinfection techniques and innovations in duodenoscope design to improve safety are warranted.
Key Words: Contamination; Culture; Duodenoscope sterilization; Ethylene oxide sterilization; High-level disinfection; Surveillance
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