GLUTARALDEHYDE AS A POSSIBLE CAUSE OF DIARRHEA AFTER SIGMOIDOSCOPY

Background An outbreak of proctitis at the start of a colorectal cance r screening programme utilizing flexible sigmoidoscopy prompted scruti ny of the incidence of this complication and the role of glutaraldehyd e in its aetiology. Methods Questionnaires completed 1 day and 3 month s after sigmoidoscopy were reviewed for 388 patients, and glutaraldehy de levels in the recycled rinse water of the endoscope washing machine were measured. The incidence of symptoms in the subsequent 612 patien ts after installation of a washer that does not recycle rinse water wa s examined. Results Five patients (1 3 per cent) presented to hospital with bloody diarrhoea occurring immediately after a normal flexible s igmoidoscopy. Repeat examination confirmed the presence of proctitis. Symptoms subsided rapidly with either no treatment or steroid enemas. Eight additional patients (2.1 per cent) recorded similar problems but received no treatment and the symptoms settled spontaneously. Glutara ldehyde levels rose progressively in the rinse water after each wash c ycle with 2 per cent glutaraldehyde solution. Only one possible case o f proctitis (0.2 per cent) was identified from the questionnaires comp leted by 612 patients after changing to a washer that did not recycle the rinse water. Conclusion These observations should prompt the caref ul assessment of cleaning techniques. The use of washing machines that do not recycle rinse water may avoid this complication.