Variant Creutzfeldt-Jakob disease (vCJD) and gastrointestinal endoscopy

Variant Creutzfeldt-Jakob disease (vCJD) is a transmissible form of spongif orm encephalopathy believed to be contracted from the consumption of bovine spongiform encephalopathy (BSE) infected beef products. To date over 100 i ndividuals have developed this incurable disease. There have been no docume nted cases of iatrogenic infection, but there is a theoretical risk that su rgical procedures could transmit the disease. This review describes the bac kground of the disease and assesses the possible risks of transmission thro ugh endoscopic procedures. The risk of transmission by endoscopy is small a nd probably negligible if suitable procedures are followed. The greatest po tential danger arises from healthy individuals who are incubating the disea se. Pathological prions (PrPsc) may be found in lymphatic tissue of these i ndividuals (particularly tonsils), but smaller amounts have been identified in the appendix and Peyer's patches. These prions are resistant to all for ms of conventional sterilization. There is a theoretical risk that biopsy f orceps and the operating channel of endoscopes could become contaminated. T his review gives recommendations as to how these small risks can be minimiz ed. They include the employment of single-use forceps for biopsies taken fr om the terminal ileum, greater attention to the maintenance of endoscopic e quipment and accessories, more rigorous manual cleaning of endoscopic equip ment and the use of well designed, disposable cleaning brushes for the oper ating channel of the endoscope.