|Year : 2015 | Volume
| Issue : 1 | Page : 1-3
How relevant is pre-gastrointestinal endoscopy screening for HBV and HIV infections?
Adegboyega Akere, Jesse A Otegbayo, Samuel O Ola
Department of Medicine, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
|Date of Web Publication||7-Jan-2015|
Department of Medicine, College of Medicine, University of Ibadan, University College Hospital, P.O. Box 28829, Agodi, Ibadan
Source of Support: None, Conflict of Interest: None
Aim: To determine the prevalence of HBV and HIV infections among patients referred for gastrointestinal (GI) endoscopy and evaluate the need for prescreening of patients prior to this procedure.
Settings and Design: Retrospective study carried out in a teaching hospital.
Methodology: The data of 772 patients referred for GI endoscopy were retrospectively reviewed, but the screening results of only 711 patients were available for review.
Statistical Analysis Used: SPSS version 7.
Results: The 772 patients, consisted of 420 (54.4%) males and 352 (45.6%) females with a mean age of 50.4 ± 16.5 years (range 10-100). Of the 711 patients with screening results, 574 (80.7%) had UGI endoscopy, while 137 (19.3%) had Colonoscopy. It showed that 82 (11.5%) had HBV and 26 (3.7%) had HIV, while 8 (1.1%) patients had co-infection.
Conclusion: The high prevalence of HBV and HIV infections observed calls for high level precaution to prevent transmission of these infections to other patients and health care personnel.
Keywords: Gastrointestinal endoscopy, hepatitis B virus, human immunodeficiency virus, prescreening
|How to cite this article:|
Akere A, Otegbayo JA, Ola SO. How relevant is pre-gastrointestinal endoscopy screening for HBV and HIV infections?. J Med Trop 2015;17:1-3
| Introduction|| |
During gastrointestinal endoscopy, occurrence of serious complications is minimal in trained hands. The major complications are cardiovascular and respiratory events, mechanical injuries, hemorrhages, and infections. The latter constitute about 1% of all the complications and the risk of clinically significant infection is low.
Contaminated endoscopes have been found to transmit some microorganisms such as salmonellae, mycobacteria, Helicobacter pylori, and hepatitis B virus (HBV) directly from patient to patient. The transmission of HIV infection through this means is yet to be confirmed. A review article reported 281 cases of transmission of infectious agents during gastrointestinal endoscopy. 
In the United States of America, the incidence of transmission of infectious agents during endoscopy was estimated to be 1 in 1.8 million.  This indicates that such transmission is rare. However, concerns about effective cleaning and disinfection of gastrointestinal endoscopes have focused on the risks of transmission of HBV and HIV infections. These infections are common worldwide and often constitute serious public health concerns, especially in developing countries where these infections are most prevalent.
The aim of this study was to determine the prevalence of HBV and HIV infections among patients referred for gastrointestinal endoscopy and to evaluate the need for prescreening of patients prior to this procedure, using this information.
| Methodology|| |
This was a retrospective study carried out in the Endoscopy unit of a Teaching Hospital in south-west Nigeria. Data of 772 patients, who were not previously known to have HBV/HIV infections referred for gastrointestinal endoscopy were reviewed. However, out of 772, only 711 patients had the results of their screening tests for HBV and HIV infections available for review. Data were analyzed using SPSS version 7. Mean and standard deviations were used to describe continuous variables and proportions for categorical data. A significance level of P < 0.05 was used for all statistical analyses.
| Results|| |
Out of 772 patients, 420 (54.4%) were males and 352 (45.6%) were females. The mean age was 50.4 ± 16.5 years and the age range was 10-100 years. In total, 550 (68.9%) patients were less than 60 years of age, of which 172 (21.7%) were in the age range 50-59 years. Of the 711 patients with available results, 574 (80.7%) had upper gastrointestinal (UGI) endoscopy, while 137 (19.3%) had colonoscopy. The results showed that 82 (11.5%) and 26 (3.7%) patients were positive for HBV and HIV infections, respectively. Among patients with HBV infection, 71 (86.6%) had UGI endoscopy, while among those with HIV infection, 21 (80.8%) had UGI endoscopy (P = 0.95) [Table 1]. Among patients with HBV infection, 41 (52.6%) were between the ages of 30-49 years, compared to other age groups, and this was statistically significant. Among patients with HIV infection, 10 (38.4%) were between the ages of 30-49 years. Six (23.1%) patients were less than 30 years of age [Figure 1].
|Table 1: Distribution of patients with HBV and HIV infections by procedure |
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Among patients with HBV infection, 62 (75.6%) patients were male while 20 (24.4%) were female, and this was significant (P = 0.00). Among patients with HIV infection, 16 (61.5%) were male while 10 (38.5%) were female (P = 0.39). Co-infection was observed in 8 (1.1%) patients, out of which 3 (37.5%) patients were in the age group 40-49 years. Six (75.0%) of these patients were male, while 2 (25.0%) were female [P = 0.29; [Figure 2].
| Discussion|| |
In this study, the prevalence of HBV infection was found to be 11.5%. This figure is in the high (>8%) endemicity range of the global prevalence of HBV infection. This value is also far higher than the 2.7% recorded by Cakabay  and the 2.8% recorded by Gulsen  in Turkey. The potential risk for transmission of hepatitis viruses via gastrointestinal endoscopy devices exists, though minimal.  In a study by Zill-e-Humayun et al.  two out of 100 patients who were negative pre-procedure were found to be positive for HBsAg 4 months after undergoing gastrointestinal endoscopy. However, some prospective studies had observed that, none of the patients who were HBsAg negative out of the 120 patients who had gastrointestinal endoscopy with scopes previously used on patients who had HBV infection developed clinical or serological manifestation of hepatitis B. These patients were followed up for six months. ,,,,
Inadequate washing of endoscopes may promote the transmission of hepatitis viruses, especially following therapeutic endoscopic procedures.  All our patients in this study had only diagnostic procedures. It is a common practice in many dialysis centers across the world that patients are prescreened for these viruses, and those that are positive have dedicated dialysis machines so as to prevent transmission. However, no such dedication of endoscopes or even prescreening for HBV and HIV infections before gastrointestinal endoscopy is practiced in many centers.
It has been observed that gastrointestinal endoscopes are in more direct contact with patients' blood and secretions and therefore at a higher risk of transmission of these infections than dialysis machines. In view of this, prescreening for HBV and HIV, and dedication of endoscopes for those that are positive might be necessary in routine gastrointestinal practice.
Although it is believed that if the guidelines for cleaning and disinfection of endoscopes are strictly followed, transmission of HBV should not take place. However, the high prevalence of HBV infection observed in this study and the occasional difficulties encountered in endoscope disinfection may warrant the need for routine prescreening of patients before endoscopy, and the dedication of separate endoscopes for those who are positive. However, considering the cost of these equipments, dedication of scopes for this group of patients might not be feasible, especially in low-income countries. Therefore, universal precaution should always be practiced as a way of ameliorating the potential hazard of transmission of these infections.
The prevalence of HIV infection of 3.2% observed in this category of patients is also extremely significant. Although there are no documented reports of HIV transmission via gastrointestinal endoscopy, proper precaution should still be ensured to prevent transmission of this virus to other patients or healthcare personnel. It has been observed that using standard manual cleaning and high-level disinfection protocols would eliminate the virus in all cases. 
The higher prevalence of these infections in males observed in this study might just be a reflection of what is observed in the community concerning the sex distribution of these infections. Another explanation for this might be because more males presented for these procedures than females.
| Conclusion|| |
The high prevalence of HBV and HIV infections observed in patients undergoing gastrointestinal endoscopy calls for high level precaution to prevent transmission of these infections to other patients and healthcare personnel. Nevertheless, transmission of these viruses via gastrointestinal endoscopes is rare if cleaning and disinfection protocols are strictly followed. However, prescreening of patients for HBV, HCV, and HIV infections is being suggested, and the option of dedicating scopes to positive patients may be warranted in the near future, as is the practice in most hemodialysis centers. However, in all cases, universal precaution should always be observed.
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[Figure 1], [Figure 2]