Endoscopic procedures in the AIDS patient: risks, precautions, indications, and obligations

Gastroenterologists are frequently asked to perform endoscopy on patients with AIDS. A survey of university-based endoscopy units in the United States indicates that at the majority of these centers, endoscopic personnel are concerned about the risk of contracting AIDS and that these concerns have altered endoscopic practices. The actual risks are difficult to determine, but appear to be very low. Nevertheless, a variety of precautions are warranted to decrease the risk of transmitting AIDS virus or other pathogens to endoscopic personnel and patients. These precautions include the wearing of protective attire (gloves, gowns, masks, eye protection), careful handling of biological specimens, and adequate decontamination of equipment and surfaces. Indications for endoscopy in patients with AIDS are generally the same as those for other patients, but special diagnostic considerations include esophageal candidiasis, enteric Kaposi's sarcoma, cytomegalovirus infection, and a variant of sclerosing cholangitis. Patients with AIDS are entitled to the same consideration and medical care as other patients. This includes the performance of indicated endoscopic procedures.