Clin Endosc.  2022 Mar;55(2):191-196. 10.5946/ce.2021.075.

Single Use (disposable) Duodenoscope: Recent Development and Future

• Ryu K
• Jang S

• KMID: 2527560
• DOI: http://doi.org/10.5946/ce.2021.075

Abstract

Unlike simple forward-viewing endoscopes such as gastroscope or colonoscope, duodenoscope houses much more complex design to fulfil its function. This design differences leave duodenoscopes more prone to contamination from inadequate disinfection process and potential dissemination of pathogens. Recent reports on dissemination of infection through the duodenoscope mandated an overhaul of duodenoscope utilization including development of a disposable duodenoscope. This article reviews the current state of disposable duodenoscope development, including reported early efficacy as well as its future direction and utilization.

Keyword

Disposable equipment; Duodenoscopes; Infectious disease transmission

Reference

1. Ha J, Son BK. Current issues in duodenoscope-associated infections: now is the time to take action. Clin Endosc. 2015; 48:361–363.

2. Rutala WA, Weber DJ. Disinfection and sterilization in health care facilities: an overview and current issues. Infect Dis Clin North Am. 2016; 30:609–637.

3. Aumeran C, Poincloux L, Souweine B, et al. Multidrug-resistant klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy. 2010; 42:895–899.

4. Epstein L, Hunter JC, Arwady MA, et al. New Delhi metallo-β-lactamase-producing carbapenem-resistant escherichia coli associated with exposure to duodenoscopes. JAMA. 2014; 312:1447–1455.

5. Wendorf KA, Kay M, Baliga C, et al. Endoscopic retrograde cholangiopancreatography-associated AmpC escherichia coli outbreak. Infect Control Hosp Epidemiol. 2015; 36:634–642.

6. Kola A, Piening B, Pape U-F, et al. An outbreak of carbapenem-resistant OXA-48 - producing klebsiella pneumonia associated to duodenoscopy. Antimicrob Resist Infect Control. 2015; 4:8.

7. Muscarella LF. Risk of transmission of carbapenem-resistant enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy. World J Gastrointest Endosc. 2014; 6:457–474.

8. Verfaillie CJ, Bruno MJ, Voor in ’t Holt AF, et al. Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing pseudomonas aeruginosa. Endoscopy. 2015; 47:493–502.

9. Loeve AJ. Investigational report on a TJF-Q180V duodenoscope following contamination after cleaning and disinfection. Available on request from the Dutch Healthcare Inspectorate/National Institute for Public Health and the Environment. Bilthoven: The Netherlands;2012.

10. Ross AS, Baliga C, Verma P, Duchin J, Gluck M. A quarantine process for the resolution of duodenoscope-associated transmission of multidrug-resistant Escherichia coli. Gastrointest Endosc. 2015; 82:477–483.

11. Rauwers AW, Voor In ’t Holt AF, Buijs JG, et al. High prevalence rate of digestive tract bacteria in duodenoscopes: a nationwide study. Gut. 2018; 67:1637–1645.

12. Rex DK, Sieber M, Lehman GA, et al. A double-reprocessing high-level disinfection protocol does not eliminate positive cultures from the elevators of duodenoscopes. Endoscopy. 2018; 50:588–596.

13. Vickery K, Ngo Q-D, Zou J, Cossart YE. The effect of multiple cycles of contamination, detergent washing, and disinfection on the development of biofilm in endoscope tubing. Am J Infect Control. 2009; 37:470–475.

14. Pajkos A, Vickery K, Cossart Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination? J Hosp Infect. 2004; 58:224–229.

15. Naryzhny I, Silas D, Chi K. Impact of ethylene oxide gas sterilization of duodenoscopes after a carbapenem-resistant Enterobacteriaceae outbreak. Gastrointest Endosc. 2016; 84:259–262.

16. Kim S, Russell D, Mohamadnejad M, et al. Risk factors associated with the transmission of carbapenem-resistant enterobacteriaceae via contaminated duodenoscopes. Gastrointest Endosc. 2016; 83:1121–1129.

17. Chan JK, Ng I, Ang JP, et al. Randomised controlled trial comparing the Ambu® aScopeTM2 with a conventional fibreoptic bronchoscope in orotracheal intubation of anaesthetised adult patients. Anaesth Intensive Care. 2015; 43:479–484.

18. Mager R, Kurosch M, Höfner T, Frees S, Haferkamp A, Neisius A. Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study. Urolithiasis. 2018; 46:587–593.

19. Terjesen CL, Kovaleva J, Ehlers L. Early assessment of the likely cost effectiveness of single-use flexible video bronchoscopes. Pharmacoecon Open. 2017; 1:133–141.

20. Hennessey DB, Fojecki GL, Papa NP, Lawrentschuk N, Bolton D. Single-use disposable digital flexible ureteroscopes: an ex vivo assessment and cost analysis. BJU Int. 2018; 121(Suppl 3):55–61.

21. Muthusamy VR, Bruno MJ, Kozarek RA, et al. Clinical evaluation of a single-use duodenoscope for endoscopic retrograde cholangiopancreatography. Clin Gastroenterol Hepatol. 2020; 18:2108–2117.e3.

22. Cotton PB, Eisen G, Romagnuolo J, et al. Grading the complexity of endoscopic procedures: results of an ASGE working party. Gastrointest Endosc. 2011; 73:868–874.

23. Ross AS, Bruno MJ, Kozarek RA, et al. Novel single-use duodenoscope compared with 3 models of reusable duodenoscopes for ERCP: a randomized bench-model comparison. Gastrointest Endosc. 2020; 91:396–403.

24. Bang JY, Sutton B, Hawes R, Varadarajulu S. Concept of disposable duodenoscope: at what cost? Gut. 2019; 68:1915–1917.

25. Alrabaa SF, Nguyen P, Sanderson R, et al. Early identification and control of carbapenemase-producing klebsiella pneumoniae, originating from contaminated endoscopic equipment. Am J Infect Control. 2013; 41:562–564.