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We prospectively investigated the possibility that type B hepatitis might be transmitted during fiberoptic endoscopy from hepatitis B surface antigen (HBsAg)-positive patients to others subsequently endoscoped. All 186 patients having upper gastrointestinal endoscopy during a 6-month period at the Washington, D.C., Veterans Administration Medical Center had a blood sample obtained at the time of the procedure. Three patients were found to be HBsAg-positive and 45 others to have either antibody to HBsAg (anti-HBs) or antibody to hepatitis B core antigen (anti-HBc). Follow-up evaluation for evidence of type B hepatitis and hepatitis B virus infection was possible in only 76% of patients. One patient developed type B hepatitis. This patient's endoscopy did not follow endoscopy of any known HBsAg-positive individual, but he had received five units of blood 5 months before hepatitis developed. No other patient showed clinical, biochemical, or serologic evidence of hepatitis during the follow-up period. These data suggest that transmission of type B hepatitis during fiberoptic endoscopy is rare, if it occurs at all, and support the current policy of not sterilizing the fiberoptic endoscope between procedures and of not routinely screening patients for HBsAg.