SINGLE-USE DUODENOSCOPES IN COMPLEX PROCEDURES

Aims The duodenoscope is a complex instrument with unique mechanical features incorporated at the distal tip that creates hard-to-reach areas that make optimal mechanical cleaning and disinfection difficult.

Persistent bacterial growth in duodenoscopes allows the development of biofilm considered to be an important impediment to the effective cleaning and disinfection of scopes. A single-use duodenoscope should reduce or eliminate transmission of infection from the endoscopic instrument, but if the functionality is suboptimal, it may simply create a trade-off to reduce one complication while increasing others. We investigate the feasibility, safety and performance of disposable duodenoscope during complex procedures such as cholangioscopy with biliary tract biopsies to evaluate indeterminate strictures and to manage of difficult biliary stones.

Methods We performed, from June 2020 through October 2021, cholangiopancreatography with single-use duodenoscope (EXALT Model D Boston Scientific Corporation, Marlborough, Massachusetts, USA) in patients with symptomatic pancreatic–biliary disorders and multidrug-resistant infections by carbapenem-resistant Klebsiella and Pseudomonas aeruginosa

Results Ten cholangiopancreatography were completed with single-use duodenoscope in multidrug-resistant infections by carbapenem-resistant pathogens. The indications of procedure are: 7 indeterminate biliary obstructions, 3 common bile duct difficult stones. We performed 3 complete common bile duct stone clereance, 7 optimal self-expandable metal stents. In 7 patients we achieved a definitive histological diagnosis of malignancy throught single operator cholangioscopy. Serious adverse events did not occurred.

Conclusions All procedures were successfully performed by single single-use duodenoscopes without serious adverse events. We achieved the goal with definitive diagnosis, cleareance of indeterminate biliary obstructions and bile duct stone. Further data are required

Publication History

Article published online:
14 April 2022