Post written by Harishankar Gopakumar, MD, FACP, from the Division of Gastroenterology, Hepatology and Nutrition, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA.
This study is a systematic review and meta-analysis of the performance characteristics, safety profile, and overall endoscopist satisfaction with single-use fully disposable duodenoscopes.
Transmission of exogenous pathogens during ERCP using reusable duodenoscopes is a significant health concern. Single-use duodenoscopes (SUDs) have emerged as a viable alternative to mitigate this risk.
Given the enthusiasm and drive for adopting this technology, we wanted to evaluate the available data on the performance characteristics, safety profile, and overall endoscopist satisfaction with SUDs.
This study was a pooled analysis of 420 patients who underwent ERCP procedures using SUDs. Of those, 38% of the ERCPs were American Society for Gastrointestinal Endoscopy grade 3 or 4.
Our evaluation showed that SUDs deliver consistent performance comparable with standard reusable duodenoscopes across a wide range of complexities, with a pooled ERCP completion rate of 92%.
In cases where a switch to a standard reusable duodenoscope was made, 38% of the ERCPs still could not be completed, suggesting that some of the SUD failures were because of the inherent anatomical complexity in those patients. Adverse event rate and distribution were comparable with those reported for ERCPs, and none of the adverse events were attributable specifically to the use of SUDs in the entire pool.
Hence, our results support that SUDs are technically feasible in most cases for the performance of ERCP.
In conclusion, SUDs are an exciting alternative to reduce the risk of exogenous duodenoscope-related infections. However, adopting this technology, especially on a larger scale, must address questions in addition to its technical feasibility, such as whether it is financially and environmentally reasonable and if it genuinely has a real-world positive outcome for patients and health care systems. Further robust research is needed to clarify the most appropriate indications for its use.
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Forest plot showing pooled ERCP completion rates with the single-use duodenoscope.
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