Fig. 1

Microbial analysis of the duodenoscope and the biliary tract. Microbial bile analysis showed significant changes in the microbial composition over 10 years (A). Microbial analysis showed a positive result in 12 duodenoscopes before ERC (B) and these microbes were found in bile aspirates of these patients (C). A longitudinal analysis showed a high persistence rate of transmitted microbes in bile aspirates (D). Patients undergoing ERC with a microbial positive tested duodenoscope had no longer hospital stay (E) or higher cholangitis rates (F). After ERC in 78.8% the microbial analysis of the biliary tract and the used duodenoscopes matched (G). Abbreviations in order of their appearance: ERC – endoscopic retrograde cholangiography, * - p ˂ 0.05, ** - p ˂ 0.01, ns – non significant, = - positive microbiology of duodenoscope and bile acid match, ≠ - positive microbiology of duodenoscope and bile acid did not match