Disposable elevator cap duodenoscopes less contaminated than standard designs when used during ERCP

It is already known that despite high-level disinfection to completely eliminate the micro-organisms from the instrument, infection transmission following ERCP occurs due to persistent contamination of duodenoscopes.

Forbes et al. and colleagues from the University of Calgary conducted a study to determine the rate of contamination following high-level disinfection and the performance of duodenoscopes with disposable elevator caps than standard designs.

The key question here is, in patients undergoing, do duodenoscopes with disposable elevator caps reduce the rate of contamination after high-level disinfection or maintain the technical performance of the procedure as compared with standard designs of duodenoscopes?

The study points include the following:

• The trials were conducted at two tertiary ERCP centres in Canada, including patients aged 18 years and older undergoing ERCP.
• The use of duodenoscopes with disposable elevator caps was compared with duodenoscopes of standard design.
• The persistent microbial contamination was the growth of at least ten colony-forming units of any organism or any growth of gram-negative bacteria after disinfection (high-level).
• Five hundred eighteen patients were included (Dec 2019 – Feb 2022).
• The study had 260 men and 258 women.
• The mean age of patients was 60.7 years, constituting 49.8 % female.
• In 259 patients, the ERCP procedure was performed using a novel DEC (Disposable elevator cap) duodenoscope.
• In 259 patients, ERCP was performed using a traditional duodenoscope.
• 11.2% standard group and 3.8% of the DEC group had Persistent microbial contamination (PMC), having a relative risk of 0.34, and a number needed to treat 13.6 to avoid the persistence of contamination.
• As measured, the technical success using the disposable cap scope was noninferior to the standard scope (94.6% vs 90.7%)
• No difference existed between study groups for adverse events.

PMC was lower in the DEC group than in the standard group. The technical success of the DEC group was non-inferior to the standard group.

The research said, Duodenoscopes with a disposable elevator cap substantially reduce persistent microbial contamination.

Preventing duodenoscope-related infections also requires personnel training and communication between those involved in the procedure, they mentioned.

Further reading:

Forbes N et al. Effect of Disposable Elevator Cap Duodenoscopes on Persistent Microbial Contamination and Technical Performance of Endoscopic Retrograde Cholangiopancreatography: The ICECAP Randomized Clinical Trial. JAMA Intern Med. Published online January 23, 2023. doi:10.1001/jamainternmed.2022.6394