Introduction
Increasing infectious rate estimates and low microbiological surveillance affect safety of gastrointestinal endoscopy globally. Single use endoscopes and accessories have been claimed to improve safety, but there is lack of data on their indication and sustainability. We aimed to identify a series of best practice recommendations for the use of single use endoscopes and accessories using a modified Delphi.
Aims & Methods
Consensus statements for the use of single use endoscopy and accessories were developed using a modified Delphi process, utilizing an international endoscopist expert panel of 62 experts from 33 nations. The main steps in the process were selecting the consensus group, conducting systematic literature reviews, developing statements, and anonymous voting on the statements until consensus was reached. High-risk patients were defined as those with multi-drug-resistant infections, immunosuppressive medication or chemotherapy, post-transplantation, or with severe neutropenia.
Results
Twenty-six statements were voted upon through two rounds, the statements were categorised as single use accessories, clinical indication for single use endoscopes, technical factors, environmental issues, and financial implications addressing relevant areas of patient safety, infection, climate change and cost. Of the 26 statements, 17 statements reached consensus. Category 1: single use accessories (8 statements), related to defining recommendations for the use of single use accessories in all patient populations or high-risk patients. Category 2: clinical indication for single use endoscopes (9 statements), including indications to high-risk patients, protecting the endoscope apparatus and contamination measures in endoscopy units. Category 3: technical factors (4 statements), related to superior performance and technical specifications with the new innovation. Category 4: environmental issues (2 statements), concerning mechanisms that reduce the detrimental burden to the environment. Category 5: financial implications (3 statements), related to healthcare policies, cost neutrality and other financial associations of single use endoscopy.
Conclusion
This is the first international initiative in determining clinical indications for single use endoscopy and accessories. The study's findings should serve as a framework for future physicians to guide future research and aid the proper evidence-based indications for the implementation of single use endoscopes in clinical practice.
References
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Disclosure
Cesare Hassan: Consulting fees for Fuji, and Medtronic. Alessandro Repici: Consulting fees for Fuji, Olympus, and Medtronic and receiving research grant and speaker fees from Boston Scientific, ERBE, Alfasigma, Norgine. Pradeep Bhandari: Research support from Fujifilm Europe, Boston Scientific, Pentax and Olympus Medical. Other authors declare no competing interests.
