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three MDRO outbreaks in Dutch hospitals were reported in the literature with 21 patients suffering from a clinical infection based on a microorganism proven to be transmitted by a duodenoscope. In that time period, approximately 203.500 ERCP procedures were performed. Hence, for every 1 out of 9690 procedures one patient developed a clinically relevant infection amounting to a DAI risk of 0.010%. Conclusion: The risk of developing a DAI is at least 30 to 180 times higher than the risks that were previously reported for all types of endoscopyassociated infections. Importantly, the current calculated risk of 0.010% constitutes a bare minimum risk of DAI because endoscope related infections are under-reported. Apart from DAI risk there is also the risk of patients becoming colonized with MO through contaminated endoscopes but without developing symptoms of a clinical infection. These data call for consorted action of medical practitioners, industry and government agencies to minimize and ultimately ban the risk of exogenous endoscope associated infections and contamination. As a first step, the FDA recently recommended health care facilities and manufacturers begin transitioning to duodenoscopes with disposable components.

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