Performance and applicability of a first generation single use duodenoscope: a single-center cohort study

Persyn, Diederik; Malenstein, Hannah van; Vanderschueren, Emma; Schuermans, Annette; Dreesen, Mira; Meert, Wouter; Buysschaert, Kristof; Merwe, Schalk van der; Laleman, Wim

doi:10.20524/aog.2022.0723

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…This circumstance can pose a substantial risk, particularly for liver transplant recipients, wherein the susceptible biliary pathways can become colonized with pathogens during ERCP. As a potential solution, the implementation of single-use duodenoscopes has been deliberated upon, obviating the potential for pathogen transmission [ 21 ]. While our study does not contribute further insights to this matter, it should serve as an impetus for the exploration of this subject through prospective investigations.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies suggest a protective effect against transient bacteremia, but its impact on the development of cholangitis and sepsis is unclear [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. There are concerns about the potential for enhancing multidrug-resistant organisms (MDROs) that may lead to duodenoscope-related infections and outbreaks [ 21 ]. Currently, the American and European Societies for Gastrointestinal Endoscopy (ASGE and ESGE) recommend prophylactic antibiotic therapy for non-transplant patients with unlikely complete bile duct drainage and all liver transplant patients undergoing ERCP.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Infectious Complications following Endoscopic Retrograde Cholangiopancreatography in Liver Transplant Patients: A Single-Center Study

Kühl,

Vollenberg,

Meier

et al. 2024

JCM

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Background: Liver transplant recipients often require endoscopic retrograde cholangiopancreatography (ERCP) for biliary complications, which can lead to infections. This retrospective single-center study aimed to identify risk factors for infectious complications following ERCP in liver transplant patients. Methods: A retrospective analysis was conducted on 285 elective ERCP interventions performed in 88 liver transplant patients at a tertiary care center. The primary endpoint was the occurrence of an infection following ERCP. Univariable and multivariable regression analyses, Cox regression, and log-rank tests were employed to assess the influence of various factors on the incidence of infectious complications. Results: Among the 285 ERCP interventions, isolated anastomotic stenosis was found in 175 cases, ischemic type biliary lesion (ITBL) in 103 cases, and choledocholithiasis in seven cases. Bile duct interventions were performed in 96.9% of all ERCPs. Infections after ERCP occurred in 46 cases (16.1%). Independent risk factors for infection included male sex (OR 24.19), prednisolone therapy (OR 4.5), ITBL (OR 4.51), sphincterotomy (OR 2.44), cholangioscopy (OR 3.22), dilatation therapy of the bile ducts (OR 9.48), and delayed prophylactic antibiotic therapy (>1 h after ERCP) (OR 2.93). Additionally, infections following previous ERCP interventions were associated with an increased incidence of infections following future ERCP interventions (p < 0.0001). Conclusion: In liver transplant patients undergoing ERCP, male sex, prednisolone therapy, and complex bile duct interventions independently raised infection risks. Delayed antibiotic treatment further increased this risk. Patients with ITBL were notably susceptible due to incomplete drainage. Additionally, a history of post-ERCP infections signaled higher future risks, necessitating close monitoring and timely antibiotic prophylaxis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Infectious Complications following Endoscopic Retrograde Cholangiopancreatography in Liver Transplant Patients: A Single-Center Study

Kühl,

Vollenberg,

Meier

et al. 2024

JCM

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“…Several clinical studies [10,11,12,13,14,15,16,17,18] and two meta-analyses [19,20] confirmed that ERCP procedures performed with SUDs achieve high cannulation rates, technical performance rates, and have good safety profiles.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] Single use duodenoscopes (SUD) have been recently introduced in clinical practice, hypothesizing that the use of a sterile disposable duodenoscope abolish the risk of patient-to-patient crossinfections. [8][9] Several clinical studies [10][11][12][13][14][15][16][17][18] and two meta-analyses [19,20] confirmed that ERCP procedures performed with SUDs achieve with high cannulation rates, technical performance, and safety profile.…”

Section: Introductionmentioning

confidence: 88%

Urgent ERCP performed with single-use duodenoscope (SUD) in patients with moderate-to-severe cholangitis: Single-center prospective study

Masciangelo,

Cecinato,

Bacchilega

et al. 2023

Endosc Int Open

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Background. To assess the outcomes of urgent ERCP performed with single-use duodenoscope (SUD) in patients with moderate-to-severe cholangitis. Material and methods. Between 2021-2022 consecutive patients with moderate-to-severe cholangitis were prospectively enrolled to underwent urgent ERCP with SUD. Technical success was defined as the completion of planned procedure with SUD. Multivariate analysis was used to identify factors related to incidence of adverse events and mortality. Results. Thirty-five consecutive patients (15 female, age 81.4±6.7 years) were enrolled. Twelve (34.3%) had severe cholangitis; 26 (74.3%) were ASA≥3. Twenty-eight (80.0%) patients had a naïve papilla. Biliary sphincterotomy and complete steno stone clearance were performed in 29 (82.9%) and 30 (85.7%) patients, respectively; in 3 (8.6%) cases, concomitant EUS-gallbladder drainage was performed. Technical and clinical success rate were 100%. 30-day and 3-month mortality were 2.9% and 14.3%, respectively. One patient had mild post-ERCP pancreatitis and 2 delayed bleeding. No patients’ or procedural variables were related to adverse events. ASA score 4 and leucopenia were related to 3-month mortality; on multivariate analysis, leucopenia was the only variable independently related to 3-month mortality (odd ratio 12.8; 95% confidence interval 1.03 – 157.2; P 0.03). Conclusion. The results of this “proof of concept” study suggest that SUD use could be considered safe and effective for urgent ERCP for acute cholangitis. This approach abolishes duodenoscope contamination from infected patients without impairing clinical outcomes.

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“…JID: YDLD [m5G; 22:49 ] patients, are duodenoscope-related infections with emerging multi-drug resistant bacteria despite all effort s to optimize disinfection protocols [67] . A recent systematic review revealed a contamination rate of 15% despite reprocessed patient-ready duodenoscopes [68] .…”

Section: Article In Pressmentioning

confidence: 99%

Role of endoscopy in hepatology

Laleman,

Peiffer,

Tischendorf

et al. 2024

Digestive and Liver Disease

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Performance and applicability of a first generation single use duodenoscope: a single-center cohort study

Cited by 3 publications

References 14 publications

Risk Factors for Infectious Complications following Endoscopic Retrograde Cholangiopancreatography in Liver Transplant Patients: A Single-Center Study

Risk Factors for Infectious Complications following Endoscopic Retrograde Cholangiopancreatography in Liver Transplant Patients: A Single-Center Study

Urgent ERCP performed with single-use duodenoscope (SUD) in patients with moderate-to-severe cholangitis: Single-center prospective study

Role of endoscopy in hepatology

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