P. Rozen et al., ENDOSCOPE-INDUCED COLITIS - DESCRIPTION, PROBABLE CAUSE BY GLUTARALDEHYDE, AND PREVENTION, Gastrointestinal endoscopy, 40(5), 1994, pp. 547-553
Six cases of acute, self-limited colitis that occurred after screening
flexible sigmoidoscopy were deduced to be iatrogenic, probably caused
by glutaraldehyde residues in the endoscopes after disinfection in an
automatic disinfecting machine. The concentration of these residues w
as indirectly estimated by conductivity measurements of electrolyte co
ncentration in the rinse-water tank of the disinfecting machine during
and after five cycles and also in fluid remaining on the surface of t
he endoscopes and in the endoscope channels. After five cycles, residu
es in both the rinse water and fluid in the endoscope channels contain
ed the, equivalent of 0.2% glutaraldehyde. This was the result of a co
mbination of technical and human errors. It can be prevented by changi
ng the rinse water after each cycle, using forced air to dry the instr
uments, and washing the endoscopes before use. Users of the automatic
disinfecting machine should be aware of the potential accumulation of
toxic levels of residues that remain in endoscopes after disinfection.