Original articleClinical endoscopyEnvironmental and health outcomes of single-use versus reusable duodenoscopes
Graphical abstract
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.
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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.