Single-use duodenoscopes and duodenoscopes with disposable end caps

Arvind J Trindade; Andrew Copland; Amit Bhatt; Juan Carlos Bucobo; Vinay Chandrasekhara; Kumar Krishnan; Mansour A Parsi; Nikhil Kumta; Ryan Law; Rahul Pannala; Erik F Rahimi; Monica Saumoy; Guru Trikudanathan; Julie Yang; David R Lichtenstein

doi:10.1016/j.gie.2020.12.033

Single-use duodenoscopes and duodenoscopes with disposable end caps

Gastrointest Endosc. 2021 May;93(5):997-1005. doi: 10.1016/j.gie.2020.12.033. Epub 2021 Mar 10.

Authors

Affiliations

¹ Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
² Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
³ Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, USA.
⁴ Department of Gastroenterology, Stony Brook Medicine, Stony Brook, New York, USA.
⁵ Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA.
⁷ Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
⁸ Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA.
⁹ Department of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
¹⁰ Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.
¹¹ Department of Gastroenterology, Baylor Scott & White Health, Lakeway, Texas, USA.
¹² Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹³ Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
¹⁴ Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
¹⁵ Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.

PMID: 33712228
DOI: 10.1016/j.gie.2020.12.033

Abstract

Background and aims: Multidrug-resistant infectious outbreaks associated with duodenoscopes have been documented internationally. Single-use duodenoscopes, disposable distal ends, or distal end cap sealants could eliminate or reduce exogenous patient-to-patient infection associated with ERCP.

Methods: This document reviews technologies that have been developed to help reduce or eliminate exogenous infections because of duodenoscopes.

Results: Four duodenoscopes with disposable end caps, 1 end sheath, and 2 disposable duodenoscopes are reviewed in this document. The evidence regarding their efficacy in procedural success rates, reduction of duodenoscope bacterial contamination, clinical outcomes associated with these devices, safety, and the financial considerations are discussed.

Conclusions: Several technologies discussed in this document are anticipated to eliminate or reduce exogenous infections during endoscopy requiring a duodenoscope. Although disposable duodenoscopes can eliminate exogenous ERCP-related risk of infection, data regarding effectiveness are needed outside of expert centers. Additionally, with more widespread adoption of these new technologies, more data regarding functionality, medical economics, and environmental impact will accrue. Disposable distal end caps facilitate duodenoscope reprocessing; postmarketing surveillance culture studies and real-life patient infection analyses are important areas of future research.

Publication types

Practice Guideline

MeSH terms

Cholangiopancreatography, Endoscopic Retrograde / adverse effects
Cross Infection* / prevention & control
Disease Outbreaks
Disinfection
Duodenoscopes*
Equipment Contamination / prevention & control
Humans