Disclosures: Varadarajulu reports consulting for Boston Scientific, Covidien, Creo Medical and Olympus America.
September 16, 2020
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Single-use duodenoscopes offer viable alternative for ERCP

Disclosures: Varadarajulu reports consulting for Boston Scientific, Covidien, Creo Medical and Olympus America.
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Single-use duodenoscopes offered similar technical and safety outcomes in endoscopic retrograde cholangiopancreatography procedures when compared with reusable scopes, according to research published in Gut.

Shyam Varadarajulu, MD, from the center for interventional endoscopy at AdventHealth in Orlando, and colleagues wrote that, while single-use scopes have been developed as a way to reduce risk for the transmission of infection during ERCP, little research has directly compared them with traditional, reusable scopes.

“While this new design should reduce or eliminate transmission of infection from the duodenoscope, if the functionality is suboptimal, it may simply create a trade-off to reduce one complication while increasing others,” they wrote. “It is therefore critically important to ascertain whether the newly developed duodenoscopes function equally well, or perhaps better, than the older, reusable duodenoscopes.”

Researchers randomly assigned patients who were scheduled to undergo ERCP to complete the procedure using either single-use (n = 48) or reusable (n = 50) duodenoscopes. The primary outcome of the study was the number of attempts to achieve successful cannulation of the desired duct. Investigators also compared technical traits, such as maneuverability, mechanical-imaging characteristics and ability to perform therapeutic interventions.

The single-use group had a lower median number of attempts to achieve successful cannulation (2 vs. 5; P = .013). However, other factors, like ease of passage into the stomach, image quality, image stability and air-water button functionality were all worse, compared with the traditional design.

Researchers found no difference in rate of cannulation, adverse events, need to cross-over or need for advanced cannulation techniques between the two groups. In their analysis, Varadarajulu and colleagues found that only the single-use scope was associated with less than six attempts to achieve selective cannulation (P = .012).

“Given the overall safety profile and similar technical performance, single-use duodenoscopes may represent an alternative to reusable duodenoscopes for performing low-complexity ERCP procedures in experienced hands,” they wrote. “Therefore, this innovation is a significant advancement in the field of ERCP.”