Quality Assurance in Endoscopic Infection Control, Disposable Duodenoscopes, and the Environmental Impact of Endoscopy

Increased attention has been directed in recent years to the reprocessing of gastrointestinal endoscopes, largely driven by concerns over infectious complications linked to duodenoscopes. Duodenoscopes clearly present numerous challenges to effective reprocessing. Accordingly, multiple enhanced reprocessing methods, including sterilization, repeat high level disinfection, and microbiological culturing, have been advocated to decrease the infectious risk linked to duodenoscopes. Quality indicators to assess reprocessing adequacy in real time are also available, including adenosine triphosphate, hemoglobin, protein, and carbohydrate testing. Data supporting the effectiveness of these indicators are overall limited. Fully disposable duodenoscopes and disposable duodenoscope components have recently become available, and these have significant appeal as they may make duodenoscope reprocessing easier or unnecessary, and thereby decrease infectious risk. Important questions have been raised about the usability and performance of these disposable duodenoscopes. Additionally, the significant economic and environmental impacts tied to disposable duodenoscopes present major challenges to a potential transition to these devices. On a broader scale, the massive environmental impact of endoscopy as a whole has become increasingly recognized as an issue of vital importance, one which demands action as gastrointestinal endoscopy moves into the future.

Duke Scholars

Author Joshua Paul Spaete Medicine, Gastroenterology