Elsevier

Gastrointestinal Endoscopy

Volume 96, Issue 6, December 2022, Pages 1002-1008
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Environmental and health outcomes of single-use versus reusable duodenoscopes

https://doi.org/10.1016/j.gie.2022.06.014Get rights and content

Background and Aims

The large-scale effects of duodenoscopes on the environment and public health have not been quantified. Our aim was to perform an exploratory life cycle assessment comparing environmental and human health effects of single-use duodenoscopes (SDs) and reusable duodenoscopes (RDs).

Methods

We evaluated 3 duodenoscopes: conventional RDs, RDs with disposable endcaps, and SDs. The primary outcomes were impacts on climate change and human health, complemented by multiple environmental impacts.

Results

Performing ERCP with SDs releases between 36.3 and 71.5 kg of CO2 equivalent, which is 24 to 47 times greater than using an RD (1.53 kg CO2) or an RD with disposable endcaps (1.54 kg CO2). Most of the impact of SDs comes from its manufacturing, which accounts for 91% to 96% of its greenhouse gas emission. The human health impact of RDs becomes comparable with the SD lower bound if disposable endcaps or other design modifications can reduce serious infection rates below a target rate of 23 cases per year (.0046%).

Conclusions

Although SDs may provide incremental public health benefit compared with RDs, it comes at a substantially higher cost to the environment. As infection rates continue to decrease from more regimented cleaning protocols and enhanced designs such as disposable endcaps to facilitate cleaning, the negative impact to human health from contaminated RDs could be comparable with SDs.

Section snippets

Methods

We evaluated 3 duodenoscopes: a conventional RD (TJF-Q180V; Olympus, Center Valley, Penn, USA), an RD with disposable endcaps (TJF-Q190V; Olympus), and an SD (Exalt Model D; Boston Scientific, Natick, Mass, USA). LCA is a method of quantifying the environmental and human health burdens of specific stages of procurement and use of various products including medical devices. Our exploratory LCA model included literature-based quantitative environmental and human health impacts of production,

Results

Performing an ERCP with an SD releases between 36.3 and 71.5 kg CO2 equivalent, which is 24 to 47 times more than with an RD (1.53 kg CO2 equivalent) or an RD with a disposable endcap (1.54 kg CO2 equivalent). Figure 1 compares the CO2 emission of the 3 types of duodenoscopes. Most climate change impact of SDs comes from their manufacturing, which accounts for 91% to 96% of the GHG emission. The second-highest contributor is the disposal of the SD, which generates 1.8 kg of CO2 equivalent per

Discussion

We estimate that SDs emit 24 to 47 times more GHGs, have at least 4 times higher ecosystem impact, and consume at least 26 times more resources than RDs, even after accounting for postprocedure high-level disinfection of RDs. When serious infections from contaminated RDs are accounted for, the negative effects on human health of RDs and the lower bound of the SDs are comparable when we reach a threshold of 23 serious infections per 500,000 procedures for RDs. Using SDs for all ERCP procedures

Acknowledgment

We thank Ms Jacque Dresen for the preparation of this manuscript.

References (20)

There are more references available in the full text version of this article.

Cited by (26)

  • The carbon cost of inappropriate endoscopy

    2024, Gastrointestinal Endoscopy
View all citing articles on Scopus

DISCLOSURE: The following authors disclosed financial relationships: L. Hernandez: Contributor to Up-To-Date; associate editor for Gastrointestinal Endoscopy; consultant for Liquiglide and Iterative Scopes. N. Vakil: Consultant for Phathom Pharmaceuticals, Cinclus Pharmaceuticals, Isothrive, and Ironwood Pharmaceuticals; speaker for Astra Zeneca; writer for Merck. N. Guda: Consultant for Boston Scientific and Hemostatis LLC; speaker for Lupin Pharmaceuticals India. C. Patnode: Grant recipient and meeting fee compensation from Healthcare Without Harm. All other authors disclosed no financial relationships.

View full text