Digestive endoscopies are not a risk factor for transmission of virus C

Dear Sir, The aim of the study reported by Karmochkine [1] was to identify the routes of transmission of hepatitis C virus in a group of infected patients who were not drug-addicts and had not received any blood products, by comparing their exposure to habits that are potentially at risk for the transmission of virus C with that of a test group. The authors find certain probable routes among which they list digestive endoscopy on par with dermatological procedures, parenteral injections, beauty treatments, acupuncture, tattooing, contact sports or cocaine-use, that may account for 73% of the contamination cases. This study the results of which were already presented in 2002 is open to criticism on several points. It concerns a historic comparison of two groups of patients, one with 450 HCV-infected people and the other one, the control group, with 750 people not tested for virus C. Even though the two groups were carefully matched, what is surprising is the size of the control group and the fact that they were not strictly comparable on the ethnic level. The gathering of information from the patients and particularly the verifying of risk factors through a simple telephonic interview do not guarantee the reliability of the collected data. Moreover, the date of performance of the digestive endoscopy with regard to the discovery of anti-HCV (mean time of seropositivity of 4 years) is not specified. As the methods of performing the endoscopy were not always known, other risk factors may be responsible for contamination during hospitalization or associated treatments [2]. Finally, a recent prospective study [3] concerning 9000 patients tested before and after endoscopy (and among whom 912 had their endoscopy after an endoscopy realized on a patient known to be infected by virus C) and a large review [4] of carefully selected studies have clearly demonstrated the lack of virus C transmission through endoscopy. The fact that these very important results were not taken into account to moderate the conclusion of the present study is most surprising. So the conclusions of this study remain wrongly alarmist and finally propose an improvement of the procedures of endoscope disinfection regardless of many statutory measures that have regularly reinforced these procedures in digestive endoscopy since 1995. Under these conditions, such results with two times more digestive endoscopies found in the anti-HCV+ group are highly questionable as regards methodology and above all do not correspond to up-to-date scientific data. We must reassert that nowadays the endoscopic practice does not present any risk of infections.