Single-use duodenoscopes are an efficient tool for emergency ERCP in real life

Abstract

Background: Biliary emergencies are managed by endoscopic retrograde cholangiopancreatography (ERCP) using duodenoscopes which are reusable devices requiring high-level disinfection to minimize the risk of cross-contamination. Recent reports on newly developed single-use duodenoscopes (SUDs) suggest equivalent performance with reusable duodenoscopes, but the effectiveness of SUDs in emergency ERCP has not been studied yet. Method: We conducted a prospective case series of emergency ERCP procedures using SUDs (EXALT model D-Boston Scientific, USA) in a real life, tertiary care setting without any possibility of a reusable duodenoscope back-up. Results: During 3 weeks, 22 emergent ERCPs (acute cholangitis 48%, severe jaundice 38%, others 14%) were performed in 19 patients (mean age 49.5 ± 15 years). Almost all procedures (21/22; 95%) were technically and clinically successful, whereas selective cannulation failed in one. Of the successful ERCPs, 2 (5%) were achieved by a novice operator. The image was often considered skewed towards yellow tones (50%) whereas stiffness and pushability for stent insertion were found suboptimal in 5% of the procedures, with no prejudice to procedural success. Conclusion: SUDs are effective devices, appropriate for emergent situations in real life even in non-expert hands and even if a regular duodenoscope backup is unavailable.

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

“…[20] While most of these studies included elective procedures, a recent French study confirmed those outcomes also in the setting of emergent ERCPs performed for several indications. [14] Finally, the present study contributes with data in a homogeneous albeit small population.…”

“…While most studies on SUD use for ERCP have been conducted in elective settings, by experienced operators from tertiaryreferral centers [10,11,12,13], only a recent French study conducted on patients with different indications (acute cholangitis, jaundice, etc.) showed that SUDs also could be considered for emergent situations in real life [14].…”

“…[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.…”

“…To date, a similar French experience has been published, but in a relatively inhomogeneous group of patients (the authors included not only acute cholangitis but also progressive jaundice due to malignant biliary obstruction). [14] Another limitation is related to the performance of all procedure by a single operator. In this case, the good ERCP outcomes with SUD use could be related to the previous experience in the French registration study that allowed the operator to test the SUD and take This article is protected by copyright.…”

“…showed that SUDs could be considered also for emergent situations in real life. [14] Therefore, we aimed to assess the clinical outcomes of urgent ERCP performed with SUD in a prospective study conducted in patients with moderate or severe cholangitis; technical performance and safety profile were also evaluated as secondary outcomes.…”