Query: single use endoscopy

title: Endoscopy during the COVID 19 pandemic: simple construction of a single use, disposable face shield using inexpensive and readily available materials
abstract: To date, the COVID 19 pandemic has infected over 1.5 million people globally, despite all efforts to control its transmission, and has had wide reaching negative consequences. Personal protective equipment, so vital to the protection of medical staff on the frontline, is universally in short supply, regardless of a production step up in an attempt to meet the ever increasing international demand. A critical component of personal protective equipment, especially required for endoscopy, is the face shield (visor) which is designed to reduce the risk of exposure to potentially infective droplets through splashing. Unfortunately, during the COVID 19 pandemic, face shields are particularly in very short supply. Although most commercially available face shields are designed for single use, the global shortage has driven frontline healthcare professionals to resort to reuse after attempted "cleansing" with disinfecting wipes.

title: Shielding for patients using a single use vinyl box under continuous aerosol suction to minimize SARS CoV 2 transmission during emergency endoscopy
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title: ERCP in patients with COVID 19 infection is a single use duodenoscope the safer option?
abstract: We read with interest the article by Zhang et al. regarding suggestions for infection prevention and control in digestive endoscopy during the COVID 19 pandemic in Wuhan, China  All upper gastrointestinal endoscopy procedures are aerosol generating, hence there is risk of spreading infection  Endoscopic retrograde cholangiopancreatography (ERCP) carries the additional risk of duodenoscope related infection [3, 4] Recently, the US Food and Drug Administration approved the use of disposable duodenoscopes. We report performing an ERCP in a patient with cholangitis who was under investigation for COVID19 using a single use duodenoscope. The patient was a 90 year old woman with a past history of congestive heart failure and dementia who presented with fever and abdominal pain. She was tested for COVID 19. Physical examination, laboratory data, and imaging were suggestive of acute cholangitis and septic shock. Therefore, we proceeded to ERCP and, given that the patient was under investigation for COVID 19, she was presumed to be positive as per our institutional guidelines. A single use duodenoscope (EXALT Model D; Boston Scientific Corporation, Marlborough, Massachusetts, USA) was used for the procedure. The common bile duct was cannulated and a cholangiogram revealed choledocholithiasis. A biliary sphincterotomy was deferred because of clopidogrel use and a plastic biliary stent was placed. The procedure duration was 15 minutes. Upon completion, the endoscope was disconnected from the processor and sealed in a bag, and the room was disinfected. Single use duodenoscopes could be beneficial in COVID 19 patients requiring ERCP. The use of a disposable duodenoscope eliminates the low risk of patientto patient transmission related to inadequate disinfection. There is also a risk of aerosolization during disinfection and therefore of exposure risk to personnel performing endoscope cleaning, both in the procedure room and in the endoscope cleaning room. Furthermore, the theoretical risk of aerosolization during endoscope disinfection could contaminate the cleaning room necessitating its closure for 30 minutes after the disinfection process is completed. Using a single use duodenoscope for ERCP in patients with confirmed or suspected COVID 19 may be a reasonable strategy to reduce the risk of infection among patients and healthcare personnel. However, more data are needed to see if SARS Cov 2 specifically is difficult to remove from duodenoscopes, and considerations of cost effectiveness and environmental impact of single use devices will need to be taken into account.

title: Single Use Bronchoscopes: Applications in COVID 19 Pandemic.
abstract: We read with interest the American Association for Bronchology and Interventional Pulmonology (AABIP) statement on COVID 19 and endorse the statement that "disposable bronchoscopes should be used first line when available" in patients with suspected or confirmed COVID19 infection.1 Single use bronchoscopes have been used primarily by intensivists and anesthesiologists for intubation; however, there are a number of commercially available products now worldwide with on going improvements in handling, performance, reliability, image quality, and increasing channel size. Before the COVID 19 pandemic, single use bronchoscopes had a number of potential advantages including cost, risk of nosocomial infection spread, and portability. Regarding cost, a systematic review and micro costing analysis including studies in endoscopy and intensive care units identified a reduced cost in comparison to standard bronchoscopes.2 Cost reduction is due to a number of factors including the cost of bronchoscopes, processors, monitors, bronchoscopy repairs, cleaning room, cleaning consumables, and cleaning staff wages. Although a reduction in risk of infection has not been formally studied comparing single use with standard bronchoscopes, there have been many publications regarding the risk of infection and the identification of disease causing bacteria, human protein and DNA on bronchoscopes after standard cleaning processes.3,4 Single use bronchoscopes are completely sterile without this associated risk. In the current era of COVID19 pandemic, there are a number of reasons why single use bronchoscopes have advantages. The AABIP state correctly that bronchoscopy should be avoided where possible in patients with COVID 19 and that only urgent and emergent bronchoscopy performed.1 Local COVID 19 infection rates are dictating in many locations that all patients having bronchoscopy are treated as possible COVID 19 cases with full personal protective equipment (PPE) precautions. Although there have been no reports of nosocomial infection with COVID 19 related to bronchoscopy, in a scenario where a scope is not properly cleaned it is a possibility. Singleuse bronchoscopes are associated which less staff handling of bronchoscopes before bronchoscopy which should reduce the risk of contamination also. In Italy, ~20% of responding health care workers were infected and in the United States at least 11% of COVID 19 cases are in health care workers.5,6 A scenario may therefore arise that no staff are available to clean bronchoscopes impacting bronchoscopy lists. Shortages of PPE are frequent and appropriate PPE may not be available to staff who are cleaning bronchoscopes. Single use bronchoscopes have also advantages in "out of hours" bronchoscopy and bronchoscopy outside of the endoscopy or bronchoscopy unit. Monitors used with single use bronchoscopes are smaller and easier to clean and companies are developing software to allow providers use their own phones or tablets for image analysis. Another potential use is the availability of a single use bronchoscope at the time of endobronchial ultrasound if a complete airway inspection is required. In time, direct comparisons of standard and single use bronchoscopy will be performed. However, we agree with the AABIP endorsement of single use bronchoscopes in patients with or suspected of COVID 19 infection.

title: Novel single use duodenoscope compared with 3 models of reusable duodenoscopes for ERCP: a randomized bench model comparison.
abstract: Multidrug resistant infectious outbreaks associated with duodenoscope reuse have been documented internationally. A single use endoscope could eliminate exogenous patient to patient infection associated with ERCP.  We conducted a comparative bench simulation study of a new single use and 3 models of reusable duodenoscopes on a synthetic anatomic bench model. Four ERCP tasks were performed: guidewire locking (single use and 1 reusable duodenoscope only) plastic stent placement and removal, metal stent placement and removal, and basket sweeping. The study schedule included block randomization by 4 duodenoscopes, 4 tasks, and 2 anatomic model ERCP stations. Ability to complete tasks, task completion times, and subjective ratings of overall performance, navigation/pushability, tip control, and image quality on a scale of 1 (worst) to 10 (best) were compared among duodenoscopes.  All 4 ERCP tasks (total 14 subtasks) were completed by 6 expert endoscopists using all 4 duodenoscopes, with similar task completion times (median, 1.5 8.0 minutes per task) and overall performance ratings by task (median, 8.0 10.0) Navigation/pushability ratings were lower for the single use duodenoscope than for the 3 reusable duodenoscopes (median, 8.0, 10.0, 9.0, and 9.0, respectively; P .01) Tip control ratings were similar among all the duodenoscopes (median, 9.0 10.0; P .77) Image quality ratings were lower for 1 reusable duodenoscope compared with the single use and other 2 reusable duodenoscopes (median, 8.0, 9.0, 9.0, and 9.0, respectively; P .01)  A new single use duodenoscope was used to simulate 4 ERCP tasks in an anatomic model, with performance ratings and completion times comparable with 3 models of reusable duodenoscopes.

title: Risk Stratification and Personal Protective Equipment Use in Pediatric Endoscopy During the Coronavirus Disease 2019 Outbreak: A Single center Protocol
abstract: SARS CoV 2, the novel coronavirus causing coronavirus disease 2019 (COVID 19) is now a global pandemic. Human to human transmission has been documented to occur through respiratory secretions, feces, aerosols, and contaminated environmental surfaces. Pediatric patients present a unique challenge as they may have minimal symptoms and yet transmit disease. Endoscopists face risk for infection with viruses like SARS CoV 2, as the aerosol generating nature of endoscopy diffuses respiratory disease that can be spread via an airborne and droplet route. We describe our center's methodology for pediatric patient risk stratification to facilitate responsible use of endoscopic resources during this crisis. We also describe our recommendations for use of personal protective equipment by endoscopists, with the goal of ensuring the safety of ourselves, our anesthesiology and endoscopy staff, and our patients.

title: Single use versus reuse of endoscopy biopsy forceps: A survey of patient preference.
abstract: Although there are no confirmatory data on this, we suspect that most endoscopy centres in India reuse single use 'disposable' endoscopic biopsy forceps due to the cost of these forceps and the perceived low risk of infection transmission on reuse. Low cost single use biopsy forceps are now available in India, bringing into question the justification for such a practice. We aimed to determine the type of forceps (single use or reused) patients would prefer during endoscopy for themselves, whether this is dependent on cost, and what cost would be acceptable to them.  Among patients (conveniently selected from indoor or outdoor) reporting for endoscopy at the division of gastroenterology at a private tertiary level hospital, we distributed an information sheet about the survey 30 45 minutes before the procedure. After they completed reading the sheet, an endoscopy nurse and/or doctor explained the study. The patient then completed a questionnaire of multiple choices with tick boxes.  Of 151 patients approached, 4 declined to participate. Of 147 patients surveyed (age range 16 83 years; 82 men) 127 (86.4% preferred single use forceps, 16 (10.9% preferred reused forceps, and 4 (2.7% could not decide and left the decision to the physician. When informed that single use forceps may be available for about Rs1000 (approximately US$ 15) 131 patients (89.1% preferred these forceps, 11 (7.4% preferred reused forceps, and 5 (3.4% could not decide. Forty four patients (33.1% stated that an acceptable cost for a forceps for them would be Rs500 (approximately US$ 8) for 65 patients (48.9% patients it was Rs1000, and for 24 (18.1% it was Rs1500.  About 90% of patients in this survey preferred single use forceps; a cost of Rs1000 for single use forceps was acceptable to over two thirds of them.

title: Combined versus single use 20 G fine needle biopsy and 25 G fine needle aspiration for endoscopic ultrasound guided tissue sampling of solid gastrointestinal lesions.
abstract: Instead of choosing one endoscopic ultrasound (EUS) needle over the other, some advocate the use of fine needle aspiration (FNA) and fine needle biopsy (FNB) consecutively. We explored the yield of combined use of 20 G FNB and 25 G FNA needles in patients with a suspicious solid gastrointestinal lesion.  Patients from the ASPRO study who were sampled with both needles during the same procedure were included. The incremental yield of dual sampling compared with the yield of single needle use on the diagnostic accuracy for malignancy was assessed for both dual sampling approaches FNA followed by FNB, and vice versa.  73 patients were included. There were 39 (53 pancreatic lesions, 18 (25 submucosal masses, and 16 (22 lymph nodes. FNA was used first in 24 patients (33 and FNB was used first in 49 (67 Generally, FNB was performed after FNA to collect tissue for ancillary testing (75 whereas FNA was used after FNB to allow for on site pathological assessment (76 Diagnostic accuracy for malignancy of single needle use increased from 78 to 92 with dual sampling (P 0.002) FNA followed by FNB improved the diagnostic accuracy for malignancy (P 0.03) whereas FNB followed by FNA did not (P 0.13) CONCLUSION Dual sampling only improved diagnostic accuracy when 25 G FNA was followed by 20 G FNB and not vice versa. As the diagnostic benefit of the 20 G FNB over the 25 G FNA needle has recently been proven, sampling with the FNB needle seems a logical first choice.

title: Reprocessed single use devices in laparoscopy: assessment of cost, environmental impact, and patient safety
abstract: United States health care spending rose 4.3% in 2016 to reach $3.2 trillion dollars, or 17.9% of the GDP  It is predicted that, without intervention, this will reach 20% by 2025. In addition, it has been recently calculated that the healthcare industry in the United States accounts for nearly 10% of the country's carbon dioxide emissions  One of the most important factors contributing to these escalating trends is the fact that many devices used in healthcare are intended for single patient use and are subsequently disposed resulting in significant waste as well as cost. Such devices are as ubiquitous as they are necessary for patient care and range from blood pressure cuffs to laparoscopic trocars to cardiac catheterization balloons. In order to curtail rising trends in cost and waste, the concept of using reprocess single use devices (RSUD) was introduced in the year 2000. However, given the ethical implications of reusing medical devices on multiple patients, it is important that certain safeguards are in place to ensure that RSUDs do not result in transmission of disease or malfunction in the clinical setting. The following is a review of RSUDs along with an assessment of their impact on cost, the environment and patient safety in laparoscopy. Regulation and life cycle of RSUDs

title: Disposable single use choledochoscopy may facilitate recanalization of occlusive biliary anastomotic strictures
abstract: Biliary interventions are commonplace in interventional radiology. Occasionally, an anastomotic occlusion is encountered that cannot be traversed with fluoroscopy alone. Endoscopy is a tool that should be added to the interventional radiology armamentarium. Unfortunately, most departments do not have endoscopes regularly available for use by nonendoscopists. The disposable single use flexible LithoVue scope has the potential to provide many applications for interventional radiologists. It is relatively low cost and is easy to use with a simple setup for novice endoscopists.