Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
Gastrointest Endosc. 2021 May;93(5):997-1005. doi: 10.1016/j.gie.2020.12.033. Epub 2021 Mar 10.
Multidrug-resistant infectious outbreaks associated with duodenoscopes have been documented internationally. Single-use duodenoscopes, disposable distal ends, or distal end cap sealants could eliminate or reduce exogenous patient-to-patient infection associated with ERCP.
This document reviews technologies that have been developed to help reduce or eliminate exogenous infections because of duodenoscopes.
Four duodenoscopes with disposable end caps, 1 end sheath, and 2 disposable duodenoscopes are reviewed in this document. The evidence regarding their efficacy in procedural success rates, reduction of duodenoscope bacterial contamination, clinical outcomes associated with these devices, safety, and the financial considerations are discussed.
Several technologies discussed in this document are anticipated to eliminate or reduce exogenous infections during endoscopy requiring a duodenoscope. Although disposable duodenoscopes can eliminate exogenous ERCP-related risk of infection, data regarding effectiveness are needed outside of expert centers. Additionally, with more widespread adoption of these new technologies, more data regarding functionality, medical economics, and environmental impact will accrue. Disposable distal end caps facilitate duodenoscope reprocessing; postmarketing surveillance culture studies and real-life patient infection analyses are important areas of future research.
国际上已有文献报道与十二指肠镜相关的多药耐药感染爆发。一次性使用十二指肠镜、一次性使用远端末端或远端末端帽密封件可以消除或减少与 ERCP 相关的外源性患者间感染。
本文回顾了旨在帮助减少或消除因十二指肠镜引起的外源性感染的技术。
本文综述了 4 种带有一次性末端帽、1 种内镜外套管和 2 种一次性十二指肠镜的技术。讨论了它们在程序成功率、减少十二指肠镜细菌污染、与这些器械相关的临床结果、安全性以及经济考虑因素方面的疗效证据。
本文讨论的几种技术预计将消除或减少需要十二指肠镜的内镜检查中的外源性感染。虽然一次性十二指肠镜可以消除 ERCP 相关的外源性感染风险，但需要在专家中心之外获得关于其有效性的数据。此外，随着这些新技术的更广泛应用，将获得更多关于功能、医疗经济学和环境影响的数据。一次性末端帽有助于十二指肠镜的再处理；上市后监测培养研究和真实患者感染分析是未来研究的重要领域。
