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. 1983 Nov;24(11):1067–1077. doi: 10.1136/gut.24.11.1067

Gastrointestinal endoscopy: infection and disinfection.

H J O'Connor, A T Axon
PMCID: PMC1420103  PMID: 6414894

Abstract

The past decade has seen the development of an array of complex flexible fibreoptic instruments for gastrointestinal (GI) endoscopy, and an increasing use of these for diagnostic and therapeutic purposes. It has been recognised more recently that the use of contaminated endoscopic equipment can lead to serious and occasionally fatal infections. Infection with a wide variety of micro-organisms has been reported following oesophago-gastroduodenoscopy (OGD) and endoscopic retrograde cholangio-pancreatography (ERCP).

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Selected References

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  1. Ammann R. W., Deyhle P., Butikofer E. Fatal nectotizing pancreatitis after peroral cholangiopancreatography. Gastroenterology. 1973 Feb;64(2):320–323. [PubMed] [Google Scholar]
  2. Anacker H., Weiss H. D., Kramann B., Rupp N. Experience with endoscopic retrograde pancreaticography. Am J Roentgenol Radium Ther Nucl Med. 1974 Oct;122(2):375–384. doi: 10.2214/ajr.122.2.375. [DOI] [PubMed] [Google Scholar]
  3. Andersen S. R. Ethylene oxide toxicity. A study of tissue reactions to retained ethylene oxide. J Lab Clin Med. 1971 Feb;77(2):346–356. [PubMed] [Google Scholar]
  4. Ansink-Schipper M. C., van der Horst Bruijn J. G., Zanen H. C. De verborgen bron; ziekenhuisinfectie door met Pseudomonas aeruginosa besmette endoscopen voor gastro-enterologisch gebruik. Ned Tijdschr Geneeskd. 1981 Jun 13;125(24):956–959. [PubMed] [Google Scholar]
  5. Axon A. T., Banks J., Cockel R., Deverill C. E., Newmann C. Disinfection in upper-digestive-tract endoscopy in Britain. Lancet. 1981 May 16;1(8229):1093–1094. doi: 10.1016/s0140-6736(81)92252-2. [DOI] [PubMed] [Google Scholar]
  6. Axon A. T., Phillips I., Cotton P. B., Avery S. A. Disinfection of gastrointestinal fibre endoscopes. Lancet. 1974 Apr;1(7859):656–658. doi: 10.1016/s0140-6736(74)93202-4. [DOI] [PubMed] [Google Scholar]
  7. Ayliffe A. J., Deverill C. Decontamination of gastroscopes. Health Soc Serv J. 1979 May 4;89(4640):538–541. [PubMed] [Google Scholar]
  8. Ayoola E. A. The risk of type B hepatitis infection in flexible fiberoptic endoscopy. Gastrointest Endosc. 1981 May;27(2):60–62. doi: 10.1016/s0016-5107(81)73150-x. [DOI] [PubMed] [Google Scholar]
  9. BORICK P. M., DONDERSHINE F. H., CHANDLER V. L. ALKALINIZED GLUTARALDEHYDE, A NEW ANTIMICROBIAL AGENT. J Pharm Sci. 1964 Oct;53:1273–1275. doi: 10.1002/jps.2600531041. [DOI] [PubMed] [Google Scholar]
  10. Babb J. R., Bradley C. R., Ayliffe G. A. Sporicidal activity of glutaraldehydes and hypochlorites and other factors influencing their selection for the treatment of medical equipment. J Hosp Infect. 1980 Mar;1(1):63–75. doi: 10.1016/0195-6701(80)90033-x. [DOI] [PubMed] [Google Scholar]
  11. Babb J. R., Bradley C. R., Deverill C. E., Ayliffe G. A., Melikian V. Recent advances in the cleaning and disinfection of fibrescopes. J Hosp Infect. 1981 Dec;2(4):329–340. doi: 10.1016/0195-6701(81)90065-7. [DOI] [PubMed] [Google Scholar]
  12. Beecham H. J., 3rd, Cohen M. L., Parkin W. E. Salmonella typhimurium. Transmission by fiberoptic upper gastrointestinal endoscopy. JAMA. 1979 Mar 9;241(10):1013–1015. doi: 10.1001/jama.241.10.1013. [DOI] [PubMed] [Google Scholar]
  13. Belsito A. A., Cramer G. G., Dickinson P. B. Delayed ductal drainage: an endoscopic pancreatographic sign of carcinoma of the head of the pancreas. Am J Roentgenol Radium Ther Nucl Med. 1973 Sep;119(1):109–114. doi: 10.2214/ajr.119.1.109. [DOI] [PubMed] [Google Scholar]
  14. Bergan T., Lystad A. Antitubercular action of disinfectants. J Appl Bacteriol. 1971 Dec;34(4):751–756. doi: 10.1111/j.1365-2672.1971.tb01011.x. [DOI] [PubMed] [Google Scholar]
  15. Bilbao M. K., Dotter C. T., Lee T. G., Katon R. M. Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases. Gastroenterology. 1976 Mar;70(3):314–320. [PubMed] [Google Scholar]
  16. Birnie G. G., Quigley E. M., Clements G. B., Follet E. A., Watkinson G. Endoscopic transmission of hepatitis B virus. Gut. 1983 Feb;24(2):171–174. doi: 10.1136/gut.24.2.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Blumgart L. H., Salmon P. R., Cotton P. B. Endoscopy and retrograde choledochopancreatography in the diagnosis of the patient with jaundice. Surg Gynecol Obstet. 1974 Apr;138(4):565–570. [PubMed] [Google Scholar]
  18. Bond W. W., Favero M. S., Mackel D. C., Mallison G. F. Sterilization or disinfection of flexible fiberoptic endoscopes. AORN J. 1979 Aug;30(2):350–352. doi: 10.1016/s0001-2092(07)61858-4. [DOI] [PubMed] [Google Scholar]
  19. Bond W. W., Moncada R. E. Viral hepatitis B infection risk in flexible fiberoptic endoscopy. Gastrointest Endosc. 1978 Aug;24(5):225–232. doi: 10.1016/s0016-5107(78)73517-0. [DOI] [PubMed] [Google Scholar]
  20. Bond W. W., Pattison C. P. Letter: Control of hepatitis B virus in environmental contamination. JAMA. 1975 Feb 17;231(7):700–701. [PubMed] [Google Scholar]
  21. Bond W. W., Petersen N. J., Favero M. S. Viral hepatitis B: aspects of environmental control. Health Lab Sci. 1977 Oct;14(4):235–252. [PubMed] [Google Scholar]
  22. Brandes J. W., Scheffer B., Lorenz-Meyer H., Körst H. A., Littmann K. P. ERCP: Complications and prophylaxis a controlled study. Endoscopy. 1981 Jan;13(1):27–30. doi: 10.1055/s-2007-1021637. [DOI] [PubMed] [Google Scholar]
  23. Burdon D. W., Whitby J. L. Contamination of hospital disinfectants with Pseudomonas species. Br Med J. 1967 Apr 15;2(5545):153–155. doi: 10.1136/bmj.2.5545.153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Carr-Locke D. L., Clayton P. Disinfection of upper gastrointestinal fibreoptic endoscopy equipment: an evaluation of a cetrimide chlorhexidine solution and glutaraldehyde. Gut. 1978 Oct;19(10):916–922. doi: 10.1136/gut.19.10.916. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Chang F. M., Sakai Y., Ashizawa S. Bacterial pollution and disinfection of the colonofiberscope. I. An investigation of traditional sterilization methods. Am J Dig Dis. 1973 Nov;18(11):946–950. doi: 10.1007/BF01072438. [DOI] [PubMed] [Google Scholar]
  26. Chmel H., Armstrong D. Salmonella oslo. A focal outbreak in a hospital. Am J Med. 1976 Feb;60(2):203–208. doi: 10.1016/0002-9343(76)90429-0. [DOI] [PubMed] [Google Scholar]
  27. Chow A. W., Taylor P. R., Yoshikawa T. T., Guze L. B. A nosocomial outbreak of infections due to multiply resistant Proteus mirabilis: role of intestinal colonization as a major reservoir. J Infect Dis. 1979 Jun;139(6):621–627. doi: 10.1093/infdis/139.6.621. [DOI] [PubMed] [Google Scholar]
  28. Classen M., Koch H., Ruskin H., Pesch H. J., Demling L. Pancreatitis after endoscopic-retrograde pancreatography (ERP). Gut. 1973 May;14(5):431–431. [PubMed] [Google Scholar]
  29. Colin-Jones D. G., Cockel R., Schiller K. F. Current endoscopic practice in the United Kingdom. Clin Gastroenterol. 1978 Sep;7(3):775–786. [PubMed] [Google Scholar]
  30. Cotton P. B., Burney P. G., Mason R. R. Transnasal bile duct catheterisation after endoscopic sphincterotomy: method for biliary drainage, perfusion, and sequential cholangiography. Gut. 1979 Apr;20(4):285–287. doi: 10.1136/gut.20.4.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Cotton P. B. Cannulation of the papilla of Vater by endoscopy and retrograde cholangiopancreatography (ERCP). Gut. 1972 Dec;13(12):1014–1025. doi: 10.1136/gut.13.12.1014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Cotton P. B. ERCP. Gut. 1977 Apr;18(4):316–341. doi: 10.1136/gut.18.4.316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Cotton P. B., Lees W. R., Vallon A. G., Cottone M., Croker J. R., Chapman M. Gray-scale ultrasonography and endoscopic pancreatography in pancreatic diagnosis. Radiology. 1980 Feb;134(2):453–459. doi: 10.1148/radiology.134.2.7352230. [DOI] [PubMed] [Google Scholar]
  34. Cotton P. B. Non-operative removal of bile duct stones by duodenoscopic sphincterotomy. Br J Surg. 1980 Jan;67(1):1–5. doi: 10.1002/bjs.1800670102. [DOI] [PubMed] [Google Scholar]
  35. Craven D. E., Moody B., Connolly M. G., Kollisch N. R., Stottmeier K. D., McCabe W. R. Pseudobacteremia caused by povidone-iodine solution contaminated with Pseudomonas cepacia. N Engl J Med. 1981 Sep 10;305(11):621–623. doi: 10.1056/NEJM198109103051106. [DOI] [PubMed] [Google Scholar]
  36. Davis J. L., Milligan F. D., Cameron J. L. Septic complications following endoscopic retrograde cholangiopancreatography. Surg Gynecol Obstet. 1975 Mar;140(3):365–367. [PubMed] [Google Scholar]
  37. Dean A. G. Transmission of Salmonella typhi by fiberoptic endoscopy. Lancet. 1977 Jul 16;2(8029):134–134. doi: 10.1016/s0140-6736(77)90138-6. [DOI] [PubMed] [Google Scholar]
  38. Demling L. Significance and current status of disinfection in gastroenterological endoscopy. Endoscopy. 1978 May;10(2):69–70. doi: 10.1055/s-0028-1098266. [DOI] [PubMed] [Google Scholar]
  39. Dunkerley R. C., Cromer M. D., Edmiston C. E., Jr, Dunn G. D. Practical technique for adequate cleansing of endoscopes: a bacteriological study of pHisoHex and Betadine. Gastrointest Endosc. 1977 Feb;23(3):148–149. doi: 10.1016/s0016-5107(77)73621-1. [DOI] [PubMed] [Google Scholar]
  40. Elson C. O., Hattori K., Blackstone M. O. Polymicrobial sepsis following endoscopic retrograde cholangiopancreatography. Gastroenterology. 1975 Aug;69(2):507–510. [PubMed] [Google Scholar]
  41. Greene W. H., Moody M., Hartley R., Effman E., Aisner J., Young V. M., Wiernik R. H. Esophagoscopy as a source of Pseudomonas aeruginosa sepsis in patients with acute leukemia: the need for sterilization of endoscopes. Gastroenterology. 1974 Nov;67(5):912–919. [PubMed] [Google Scholar]
  42. Hartley C. L., Richmond M. H. Antibiotic resistance and survival of E coli in the alimentary tract. Br Med J. 1975 Oct 11;4(5988):71–74. doi: 10.1136/bmj.4.5988.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Hatfield A. R., Leung T., Ahmet Z., Williams J. D. The microbiology of direct bile sampling at the time of endoscopic retrograde cholangiopancreatography. J Infect. 1982 Mar;4(2):119–125. doi: 10.1016/s0163-4453(82)93663-5. [DOI] [PubMed] [Google Scholar]
  44. Hawkey P. M., Davies A. J., Viant A. C., Lush C. J., Mortensen N. J. Contamination of endoscopes by Salmonella species. J Hosp Infect. 1981 Dec;2(4):373–376. doi: 10.1016/0195-6701(81)90071-2. [DOI] [PubMed] [Google Scholar]
  45. Hemminki K., Mutanen P., Saloniemi I., Niemi M. L., Vainio H. Spontaneous abortions in hospital staff engaged in sterilising instruments with chemical agents. Br Med J (Clin Res Ed) 1982 Nov 20;285(6353):1461–1463. doi: 10.1136/bmj.285.6353.1461. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Hershey S. D., Sugawa C., Cushing R., Ledgerwood A. M., Lucas C. E. The value of prophylactic antibiotic therapy during endoscopic retrograde cholangiopancreatography. Surg Gynecol Obstet. 1982 Dec;155(6):801–803. [PubMed] [Google Scholar]
  47. Hoofnagle J. H., Blake J., Buskell-Bales Z., Seeff L. B. Lack of transmission of type B hepatitis by fiberoptic upper endoscopy. J Clin Gastroenterol. 1980 Mar;2(1):65–69. doi: 10.1097/00004836-198003000-00010. [DOI] [PubMed] [Google Scholar]
  48. James E. C., Collin D. B. Sepsis complications in endoscopic retrograde cholangiopancreatography. Am Surg. 1976 Apr;42(4):229–232. [PubMed] [Google Scholar]
  49. Kaslow R. A., Mackel D. C., Mallison G. F. Nosocomial pseudobacteremia. Positive blood cultures due to contaminated benzalkonium antiseptic. JAMA. 1976 Nov 22;236(21):2407–2409. doi: 10.1001/jama.236.21.2407. [DOI] [PubMed] [Google Scholar]
  50. Keighley M. R., Baddeley R. M., Burdon D. W., Edwards J. A., Quoraishi A. H. A controlled trial of parenteral prophylactic gentamicin therapy in biliary surgery. Br J Surg. 1975 Apr;62(4):275–279. doi: 10.1002/bjs.1800620406. [DOI] [PubMed] [Google Scholar]
  51. Kessler R. E., Falkenstein D. B., Clemett A. R., Zimmon D. S. Indications, clinical value and complications of endoscopic retrograde cholangiopancreatography. Surg Gynecol Obstet. 1976 Jun;142(6):865–870. [PubMed] [Google Scholar]
  52. Koretz R. L., Camacho R. Failure of endoscopic transmission of hepatitis B. Dig Dis Sci. 1979 Jan;24(1):21–24. doi: 10.1007/BF01297233. [DOI] [PubMed] [Google Scholar]
  53. Leers W. D. Disinfecting endoscopes: how not to transmit Mycobacterium tuberculosis by bronchoscopy. Can Med Assoc J. 1980 Aug 23;123(4):275-80, 283. [PMC free article] [PubMed] [Google Scholar]
  54. Lindstaedt H., Krizek L., Miederer S. E., Botzenhart K. Experiences and problems in the disinfection of fibre endoscopes. Endoscopy. 1978 May;10(2):80–85. doi: 10.1055/s-0028-1098269. [DOI] [PubMed] [Google Scholar]
  55. Low D. E., Micflikier A. B., Kennedy J. K., Stiver H. G. Infectious complications of endoscopic retrograde cholangiopancreatography. A prospective assessment. Arch Intern Med. 1980 Aug;140(8):1076–1077. [PubMed] [Google Scholar]
  56. MALIZIA W. F., GANGAROSA E. J., GOLEY A. F. Benzalkonium chloride as a source of infection. N Engl J Med. 1960 Oct 20;263:800–802. doi: 10.1056/NEJM196010202631608. [DOI] [PubMed] [Google Scholar]
  57. Maddocks A. C., Hilson G. R., Taylor R. The bacteriology of the obstructed biliary tree. Ann R Coll Surg Engl. 1973 May;52(5):316–319. [PMC free article] [PubMed] [Google Scholar]
  58. Mandelstam P., Sugawa C., Silvis S. E., Nebel O. T., Rogers B. H. Complications associated with esophagogastroduodenoscopy and with esophageal dilation. Gastrointest Endosc. 1976 Aug;23(1):16–19. doi: 10.1016/s0016-5107(76)73568-5. [DOI] [PubMed] [Google Scholar]
  59. McClelland D. B., Burrell C. J., Tonkin R. W., Heading R. C. Hepatitis B: absence of transmission by gastrointestinal endoscopy. Br Med J. 1978 Jan 7;1(6104):23–24. doi: 10.1136/bmj.1.6104.23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. McDonald G. B., Silverstein F. E. Can gastrointestinal endoscopy transmit hepatitis B to patients? Gastrointest Endosc. 1976 Feb;22(3):168–170. doi: 10.1016/s0016-5107(76)73735-0. [DOI] [PubMed] [Google Scholar]
  61. Miner N. A., McDowell J. W., Willcockson G. W., Bruckner N. I., Stark R. L., Whitmore E. J. Antimicrobial and other properties of a new stabilized alkaline glutaraldehyde disinfectant/sterilizer. Am J Hosp Pharm. 1977 Apr;34(4):376–382. [PubMed] [Google Scholar]
  62. Moncada R. E., Denes A. E., Berquist K. R., Fields H. A., Murphy B. L., Maynard J. E. Inadvertent exposure of endoscopy patients to viral hepatitis B. Gastrointest Endosc. 1978 Aug;24(5):231–232. doi: 10.1016/s0016-5107(78)73518-2. [DOI] [PubMed] [Google Scholar]
  63. Morgan A. G., McAdam W. A., Walker B. E. Hepatitis B and endoscopy. Br Med J. 1978 Feb 11;1(6109):369–369. doi: 10.1136/bmj.1.6109.369. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Morris I. M., Cattle D. S., Smits B. J. Letter: Endoscopy and transmission of hepatitis B. Lancet. 1975 Dec 6;2(7945):1152–1152. doi: 10.1016/s0140-6736(75)91048-x. [DOI] [PubMed] [Google Scholar]
  65. Nebel O. T., Silvis S. E., Rogers G., Sugawa C., Mandelstam P. Complications associated with endoscopic retrograde cholangiopancreatography. Results of the 1974 A/S/G/E survey. Gastrointest Endosc. 1975 Aug;22(1):34–36. doi: 10.1016/s0016-5107(75)73681-7. [DOI] [PubMed] [Google Scholar]
  66. Noy M. F., Harrison L., Holmes G. K., Cockel R. The significance of bacterial contamination of fibreoptic endoscopes. J Hosp Infect. 1980 Mar;1(1):53–61. doi: 10.1016/0195-6701(80)90032-8. [DOI] [PubMed] [Google Scholar]
  67. O'Connor B. H., Bennett J. R., Alexander J. G., Sutton D. R., Leighton I., Mawer S. L., Dunlop J. M. Salmonellosis infection transmitted by fibreoptic endoscopes. Lancet. 1982 Oct 16;2(8303):864–866. doi: 10.1016/s0140-6736(82)90821-2. [DOI] [PubMed] [Google Scholar]
  68. O'Connor H. J., Rothwell J., Maxwell S., Lincoln C., Axon A. T. New disinfecting apparatus for gastrointestinal fibre-endoscopes. Gut. 1982 Aug;23(8):706–709. doi: 10.1136/gut.23.8.706. [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Parker H. W., Geenen J. E., Bjork J. T., Stewart E. T. A prospective analysis of fever and bacteremia following ERCP. Gastrointest Endosc. 1979 Aug;25(3):102–103. doi: 10.1016/s0016-5107(79)73385-2. [DOI] [PubMed] [Google Scholar]
  70. Ross P. W. A new disinfectant. J Clin Pathol. 1966 Jul;19(4):318–320. doi: 10.1136/jcp.19.4.318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Rutgeerts P., Geboes K., Ponette E., Coremans G., Vantrappen G. Acute infective colitis caused by endemic pathogens in western Europe: endoscopic features. Endoscopy. 1982 Nov;14(6):212–219. doi: 10.1055/s-2007-1021624. [DOI] [PubMed] [Google Scholar]
  72. Saitanu K., Lund E. Inactivation of enterovirus by glutaraldehyde. Appl Microbiol. 1975 May;29(5):571–574. doi: 10.1128/am.29.5.571-574.1975. [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. Sanford J. P. Disinfectants that don't. Ann Intern Med. 1970 Feb;72(2):282–283. doi: 10.7326/0003-4819-72-2-282. [DOI] [PubMed] [Google Scholar]
  74. Schenk J., Riemann J. F., Gräf W. Bacteriological efficiency of a standardized cleansing and disinfection technique for duodenoscopes. Endoscopy. 1978 May;10(2):75–79. doi: 10.1055/s-0028-1098268. [DOI] [PubMed] [Google Scholar]
  75. Schliessler K. H., Rozendaal B., Taal C., Meawissen S. G. Outbreak of Salmonella agona infection after upper intestinal fibreoptic endoscopy. Lancet. 1980 Dec 6;2(8206):1246–1246. doi: 10.1016/s0140-6736(80)92501-5. [DOI] [PubMed] [Google Scholar]
  76. Schoutens-Serruys E., Rost F., Depre G., Cremer M., Loriers M. The significance of bacterial contamination of fiberoptic endoscopes. J Hosp Infect. 1981 Dec;2(4):392–394. doi: 10.1016/0195-6701(81)90077-3. [DOI] [PubMed] [Google Scholar]
  77. Seefeld U., Bansky G., Jaeger M., Schmid M. Prevention of hepatitis B virus transmission by the gastrointestinal fibrescope. Successful disinfection with an aldehyde liquid. Endoscopy. 1981 Nov;13(6):238–239. doi: 10.1055/s-2007-1021694. [DOI] [PubMed] [Google Scholar]
  78. Selected papers from the Cleveland Clinic Course. "ERCP: diagnostic and therapeutic aspects--an international symposium," March 19 to 21, 1981. Gastrointest Endosc. 1982 Aug;28(3):197–209. [PubMed] [Google Scholar]
  79. Serpeau D., Mannoni P., Dhumeaux D., Berthelot P. Hepatitis-associated antigen in human bile. Lancet. 1971 Dec 4;2(7736):1266–1266. doi: 10.1016/s0140-6736(71)90589-7. [DOI] [PubMed] [Google Scholar]
  80. Siegel J. H., Harding G. T., Chateau F. Endoscopic decompression and drainage of benign and malignant biliary obstruction. Gastrointest Endosc. 1982 May;28(2):79–82. doi: 10.1016/s0016-5107(82)73004-4. [DOI] [PubMed] [Google Scholar]
  81. Sierra G., Boucher R. M. Ultrasonic synergistic effects in liquid-phase chemical sterilization. Appl Microbiol. 1971 Aug;22(2):160–164. doi: 10.1128/am.22.2.160-164.1971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  82. Silvis S. E., Nebel O., Rogers G., Sugawa C., Mandelstam P. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA. 1976 Mar 1;235(9):928–930. doi: 10.1001/jama.235.9.928. [DOI] [PubMed] [Google Scholar]
  83. Silvis S. E., Rohrmann C. A., Vennes J. A. Diagnostic criteria for the evaluation of the endoscopic pancreatogram. Gastrointest Endosc. 1973 Nov;20(2):51–55. doi: 10.1016/s0016-5107(73)73872-4. [DOI] [PubMed] [Google Scholar]
  84. Snydman D. R., Bryan J. A., Dixon R. E. Prevention of nosocomial viral hepatitis, type B (hepatitis B). Ann Intern Med. 1975 Dec;83(6):838–845. doi: 10.7326/0003-4819-83-6-838. [DOI] [PubMed] [Google Scholar]
  85. Stark D. C. Sterilization by chemical agents. Int Anesthesiol Clin. 1972 Summer;10(2):49–65. doi: 10.1097/00004311-197201020-00007. [DOI] [PubMed] [Google Scholar]
  86. Sumithran E., MacSween R. N. An appraisal of the relationship between primary hepatocellular carcinoma and hepatitis B virus. Histopathology. 1979 Nov;3(6):447–458. doi: 10.1111/j.1365-2559.1979.tb03027.x. [DOI] [PubMed] [Google Scholar]
  87. Thomas M. H., Dash C. H., Burnand K. G., Woodyer A. B. The excretion of cefuroxime in human bile. Br J Surg. 1981 Apr;68(4):290–291. doi: 10.1002/bjs.1800680421. [DOI] [PubMed] [Google Scholar]
  88. Thraenhart O., Kuwert E. K., Dermietzel R., Scheiermann N., Wendt F. Influence of different disinfection conditions on the structure of the hepatitis B virus (Dane particle) as evaluated in the morphological alteration and disintegration test (MADT). Zentralbl Bakteriol Orig A. 1978;242(3):299–314. [PubMed] [Google Scholar]
  89. Thurnherr N., Brühlmann W. F., Krejs G. I., Bianchi L., Faust H., Blum A. L. Fulminant cholangitis and septicemia after endoscopic retrograde cholangiography (ERC) in two patients with obstructive jaundice. Am J Dig Dis. 1976 Jun;21(6):477–481. doi: 10.1007/BF01072133. [DOI] [PubMed] [Google Scholar]
  90. Tolon M., Thofern E., Miederer S. E. Disinfection procedures of fiberscopes in endoscopy departments. Endoscopy. 1976 Feb;8(1):24–29. doi: 10.1055/s-0028-1098370. [DOI] [PubMed] [Google Scholar]
  91. Tseng A., Sales D. J., Simonowitz D. A., Enker W. E. Pancreas abscess: a fatal complication of endoscopic cholangiopancreatography (ERCP). Endoscopy. 1977 Nov;9(4):250–253. doi: 10.1055/s-0028-1098529. [DOI] [PubMed] [Google Scholar]
  92. Ujeyl A. K., Wurbs D., Adam W., Classen M. Gas sterilization of fiber endoscopes. Endoscopy. 1978 May;10(2):71–74. doi: 10.1055/s-0028-1098267. [DOI] [PubMed] [Google Scholar]
  93. Vennes J. A., Geenen J. E., Papp J. P., Schapiro M. Endoscopically related infections and their prevention. Gastrointest Endosc. 1981 Nov;27(4):239–240. doi: 10.1016/s0016-5107(81)73234-6. [DOI] [PubMed] [Google Scholar]
  94. Vennes J. A., Jacobson J. R., Silvis S. E. Endoscopic cholangiography for biliary system diagnosis. Ann Intern Med. 1974 Jan;80(1):61–64. doi: 10.7326/0003-4819-80-1-61. [DOI] [PubMed] [Google Scholar]
  95. Villarejos V. M., Visoná K. A., Gutiérrez A., Rodríguez A. Role of saliva, urine and feces in the transmission of type B hepatitis. N Engl J Med. 1974 Dec 26;291(26):1375–1378. doi: 10.1056/NEJM197412262912602. [DOI] [PubMed] [Google Scholar]
  96. Zimmon D. S., Falkenstein D. B., Riccobono C., Aaron B. Complications of endoscopic retrograde cholangiopancreatography. Analysis of 300 consecutive cases. Gastroenterology. 1975 Aug;69(2):303–309. [PubMed] [Google Scholar]

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