SpyGlass application for duodenoscope working channel inspection: Impact on the microbiological surveillance

Abstract

BACKGROUND Patient-ready duodenoscopes were designed with an assumed contamination rate of less than 0.4%; however, it has been reported that 5.4% of clinically used duodenoscopes remain contaminated with viable high-concern organisms despite following the manufacturer’s instructions. Visual inspection of working channels has been proposed as a quality control measure for endoscope reprocessing. There are few studies related to this issue. AIM To investigate the types, severity rate, and locations of abnormal visual inspection findings inside patient-ready duodenoscopes and their microbiological significance. METHODS Visual inspections of channels were performed in 19 patient-ready duodenoscopes using the SpyGlass visualization system in two endoscopy units of tertiary care teaching hospitals (Tri-Service General Hospital and National Taiwan University Hospital) in Taiwan. Inspections were recorded and reviewed to evaluate the presence of channel scratches, buckling, stains, debris, and fluids. These findings were used to analyze the relevance of microbiological surveillance. RESULTS Seventy-two abnormal visual inspection findings in the 19 duodenoscopes were found, including scratches ( n = 10, 52.6%), buckling ( n = 15, 78.9%), stains ( n = 14, 73.7%), debris ( n = 14, 73.7%), and fluids ( n = 6, 31.6%). Duodenoscopes > 12 mo old had a significantly higher number of abnormal visual inspection findings than those ≤ 12 mo old (46 findings vs 26 findings, P < 0.001). Multivariable regression analyses demonstrated that the bending section had a significantly higher risk of being scratched, buckled, and stained, and accumulating debris than the insertion tube. Debris and fluids showed a significant positive correlation with microbiological contamination ( P < 0.05). There was no significant positive Spearman’s correlation coefficient between negative bacterial cultures and debris, between that and fluids, and the concomitance of debris and fluids. This result demonstrated that the presence of fluid and debris was associated with positive cultures, but not negative cultures. Further multivariate analysis demonstrated that fluids, but not debris, is an independent factor for bacterial culture positivity. CONCLUSION In patient-ready duodenoscopes, scratches, buckling, stains, debris, and fluids inside the working channel are common, which increase the microbiological contamination susceptibility. The SpyGlass visualization system may be recommended to identify suboptimal reprocessing.

Two novel protocols for cleaning residual simethicone and fluid in patient‐ready duodenoscopes

“…SpyScope (SpyGlass™ DS Direct Visualization System, Boston Scientific Corp, MA, USA) was used for 27 the visual inspection of the residual fluid inside working channel (Fig. 1a,b).…”

“…Corp, MA, USA) was used for 27 the visual inspection of the residual fluid inside working channel (Fig. 1a,b).…”

“…1a,b). 6,27,28 Visual inspection of working channel of duodenoscope (140 cm) was divided into three sections: proximal (0 to 45 cm), middle (46 to 90 cm), and distal (91 to 140 cm). Residual fluid (fluid droplets) was the sum of three maximum numbers of fluid droplets at each section of the working channel.…”

Gastrointestinal endoscope contamination rates – elevators are not only to blame: a systematic review and meta-analysis

“…Visual inspection using a borescope has been suggested as a quality assurance step in reprocessing to detect scratches and other irregularities within endoscope channels. Several studies identified internal defects of instrument channels to be more frequent than anticipated, increasing their microbiological contamination susceptibility [6,10,11]. Inconsistencies in recommended quality measures to detect microbiological debris in endoscope channels may also pose safety risks.…”

The utility of lighted magnification and borescopes for visual inspection of flexible endoscopes

“…13 Studies that used borescopes have identified visible defects in nearly 100% of previously uninspected endoscopes, including residual soil, debris, retained fluid, and damage. 12,[14][15][16][17][18][19][20] In some cases, new scratches and channel shredding appeared within a few uses 16,20 and critical defects requiring repair were observed. 16,18,19 Given that researchers have also detected soil and microbial bioburden on more than 50% of fully-processed endoscopes, [17][18][19]21 there is a clear need to improve visual inspection practices to ensure that endoscopes are free of visible damage and soil before each procedure.…”