Digestive endoscopy is not a major risk factor for transmitting hepatitis C virus

Ann Intern Med. 2005 Jun 7;142(11):903-9. doi: 10.7326/0003-4819-142-11-200506070-00008.


Background: The potential role of digestive endoscopy as a mode for transmission of hepatitis C virus (HCV) is controversial.

Objective: To evaluate the role of digestive endoscopy in transmitting HCV by comparing the incidence of HCV infection in a cohort of patients undergoing endoscopy and in a cohort of blood donors.

Design: Prospective cohort study.

Setting: 3 endoscopic units and 2 blood banks in northwestern Italy.

Patients: The potentially exposed cohort consisted of 9188 outpatients consecutively recruited from 3 endoscopic units. Of 9008 patients negative for antibody to HCV (anti-HCV), 8260 (92%) were retested for anti-HCV 6 months after endoscopy. The unexposed cohort consisted of 51,230 healthy, anti-HCV-negative persons who donated blood at 2 blood banks in the same area and during the same time period; 38,280 of them (75%) were tested again for anti-HCV 6 to 48 months after the first blood donation (95,317 person-years of observation).

Measurements: Differences in the anti-HCV seroconversion rate between the exposed cohort (patients undergoing endoscopy) and the unexposed cohort (blood donors). Seroconversion was evaluated by a third-generation enzyme immunoassay for anti-HCV; persons positive for anti-HCV were tested for HCV RNA by polymerase chain reaction.

Results: All 8260 persons undergoing endoscopy remained negative for anti-HCV 6 months after the procedure (risk per 1000 persons, 0 [95% CI, 0 to 0.465]); in particular, none of the 912 patients who underwent endoscopy with the same instrument previously used on HCV carriers showed anti-HCV seroconversion (risk per 1000 persons, 0 [CI, 0 to 4.195]). Four blood donors became positive for anti-HCV and HCV RNA (mean follow-up, 2.49 years; 0.042 case per 1000 person-years [CI, 0.011 to 0.107 case per 1000 person-years]); each had undergone minor surgery before the second test.

Limitations: In the endoscopy cohort, 8.3% of patients were lost to follow-up.

Conclusions: These findings support the hypothesis that properly performed digestive endoscopy is not a major risk factor for the transmission of HCV.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Ambulatory Care / standards
  • Blood Donors
  • Endoscopy, Gastrointestinal / standards*
  • Female
  • Follow-Up Studies
  • Hepatitis C / epidemiology
  • Hepatitis C / transmission*
  • Hepatitis C Antibodies / blood
  • Humans
  • Incidence
  • Infection Control / standards
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Prospective Studies
  • RNA, Viral / blood
  • Risk Factors


  • Hepatitis C Antibodies
  • RNA, Viral