Post written by Yervant Ichkhanian, MD, and Mark A. Gromski, MD, from the Indiana University School of Medicine, Indianapolis, Indiana, USA.

Duodenoscope-related infections—especially those involving multidrug-resistant organisms—have driven innovation in endoscopic technology. This study, conducted at a high-volume tertiary care center, explores the evolving integration of single-use duodenoscopes into routine endoscopic retrograde cholangiopancreatography (ERCP) practice. The goal was to examine, over more than 3 years of real-world experience, trends in their use, procedural outcomes, and physician satisfaction, as well as identify practical barriers to wider adoption.

Why did we think it was important to conduct the study?

Reusable duodenoscopes carry an ongoing risk of cross-contamination despite advanced reprocessing methods and disposable enhancements. These risks are particularly significant for vulnerable patient populations, including those at high risk for multidrug-resistant organisms or with compromised immune systems. Although single-use duodenoscopes promise to eliminate infection transmission, long-term data are limited on how they perform in clinical settings, how they are received by users, and where they fit best in ERCP workflows. Understanding these dynamics is crucial to making informed, evidence-based decisions on technology adoption in endoscopy.

Key findings, knowledge gained, and next steps

In 8375 ERCPs performed between July 2020 and September 2023, single-use duodenoscopes were used in 3.2% of cases, with annual use nearly doubling over time. Most procedures targeted high-risk patient tiers (79% were patients at risk for drug-resistance [tier 1] and/or immunosuppressed [tier 2]), and use among lower-risk patients (tier 3) declined significantly. Technical success was achieved in 94% of cases, and adverse events remained low at 3%, with no reported post-ERCP pancreatitis. User satisfaction improved notably over the study period, especially with newer device iterations (which addressed initial concerns around stiffness and image quality).

In particular, junior faculty drove the majority of adoption. Interestingly, user-based satisfaction scores improved significantly from the first to the third version of the single-use duodenoscope (the most recent data collected for this study). Importantly, this study used the previously described 3-tiered patient selection framework—stratifying cases by infection risk—to help clinicians identify appropriate scenarios for using single-use duodenoscopes in a high-volume setting. This structured approach may be a useful clinical guide as institutions weigh cost, safety, and procedural complexity.

Concluding thoughts

This study offers the most comprehensive single-center report to date on real-world deployment of single-use duodenoscopes in ERCP, to our knowledge. With low adverse event rates, improving performance, and increasing user acceptance, these devices are proving to be a valuable complement in high-risk endoscopic care.

Future work should focus on cost-effectiveness, multicenter comparisons, and refinement of scope designs to further improve performance, but also potentially to harness applications or features that are not available in reusable duodenoscopes. As the field continues to evolve, real-world data such as these will be vital in shaping safe and scalable endoscopy practices.

Summary of the trends regarding use of single-use duodenoscopes over time. A, Indications for single-use duodenoscope use based on the 3-tier categorization over the course of the study. B, Trends in the proportion of use, procedural characteristics, and outcomes of single-use duodenoscopes over time. C, Trends in single-use duodenoscope utilization over time, stratified according to endoscopic retrograde cholangiopancreatography (ERCP) procedural complexity as per the American Society for Gastrointestinal Endoscopy (ASGE) complexity grade.

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