Duodenoscopes

This is a resource page developed by “Discussion in Infection Control” for the public to use to learn more about the risk of “superbug” infection associated with duodenoscopes (and “EUS” endoscopes).

Dr. Muscarella’s postings discussing duodenoscopes:

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  • U.S. Department of Justice:

    — Olympus Medical Systems (2018):

    Pentax of America (2020):


    Some FDA notices and guidance documents discussing duodenoscopes:


    Some FDA Correspondence to Duodenoscope Manufacturers:



    A congressional report that focused on the risk of duodenoscopes infecting patients with superbug:

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    Confidential Safety Services, Research, Reviews Performed for Hospitals, Device Manufacturers and the Consumer: 

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    • Click here to read more about Dr. Muscarella’s confidential quality and safety services designed to help hospitals (and manufacturers and patients) better understand — and prevent — healthcare-associated infections, including those linked to contaminated GI endoscopes and heater-cooler devices, among other types of contaminated medical devices.


    Some FDA Communications on duodenoscopes:


    Some Updated Duodenoscope Reprocessing Instructions:


    Some publications in the peer-reviewed medical literature discussing duodenoscopes (and “EUS” echo-endoscopes):

    1. Muscarella LF. Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy. World J Gastrointest Endosc 2014 Oct 16;6(10):457-74. [This article has been viewed almost 3,000 times.]
    2. Verfaillie CJ, et al. Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa. Endoscopy 2015 Jun;47(6):493-502.
    3. Muscarella LF. Investigation and prevention of infectious outbreaks during endoscopic retrograde cholangiopancreatography. Endoscopy 2010 Nov;42(11):957-9.
    4. Chapman CG, et al. Risk of infection transmission in curvilinear array echoendoscopes: results of a prospective reprocessing and culture registry.Gastrointest Endosc 2017 Feb;85(2):390-397.
    5. Wendorf KA, et al. Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak. Infect Control Hosp Epidemiol 2015 Jun;36(6):634-42.
    6. Naryzhny I, et al. Impact of ethylene oxide gas sterilization of duodenoscopes after a carbapenem-resistant Enterobacteriaceae outbreak.Gastrointest Endosc 2016 Aug;84(2):259-62.
    7. Ross AS, et al. A quarantine process for the resolution of duodenoscope-associated transmission of multidrug-resistant Escherichia coli. Gastrointest Endosc 2015 Sep;82(3):477-83.
    8. Epstein L, et al. New Delhi metallo-β-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA 2014 Oct 8;312(14):1447-55.
    9. Tokar JL, et al. Getting to Zero: Reducing the Risk for Duodenoscope-Related Infections. Ann Intern Med. 2015 Dec 1;163(11):873-4.
    10. Nelson DB, Muscarella LF. Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy.World J Gastroenterol 2006 Jul 7;12(25):3953-64.

    Dr. Muscarella’s 5 most recently posted articles on a number of topics: