The latest, greatest advances in endoscope technology stand to improve both surgeons' visualization and diagnostic abilities. The big question for you: Are high-definition imaging and contrast enhancement mode worth it?

• High-definition video. Yes, HD's higher image resolution captures and displays more data than standard definition does, offering sharper, clearer, more detailed images of the surgical site. A drawback to buying HD equipment is that you have to replace all of the electronics it interacts with in your surgical suite, from your camera control unit to the data cabling to your monitors, in order to enjoy its full benefits. In the absence of studies providing conclusive proof of a clinical benefit, and given the higher costs and upgrade expenses of HD, HD remains largely a physician preference rather than a necessity. But it stands to reason that centers that intend to grow their GI businesses and maintain their equipment over the long term should seriously consider phasing in this technology.
• Contrast enhancement mode. This gives you the option of limiting the endoscope's illumination to only certain colors of the spectrum instead of the standard full spectrum. Some recent studies have shown that this method, also known by such proprietary names as "Narrow Band Imaging" and "Multi-band Imaging," can help surgeons to identify polyps and lesions that aren't visible under regular light and even to detect changes at the cellular level.

Contrast enhancement mode is available in standard-definition as well as high-definition endoscopes. If you're replacing standard-def scopes with other standard-def scopes, the equipment used to support this function will likely be able to carry over. But if you're upgrading to HD scopes, you'll need to purchase and install a new light source and new cabling to achieve contrast enhancement in the higher-resolution technology.

Time to trial
Once you and your surgeons have decided which scopes you want to compare, make arrangements with the vendors' representatives to set up a trial in your procedure room, or in 2 of them if there are enough demonstration models available. About 5 or 6 scopes per room, per day, should be sufficient to rotate from the room to reprocessing for an entire day's schedule without having to rely on your current equipment. And it shouldn't be just 1 day: At least 2 weeks may be necessary for each surgeon to get sustained experience with the equipment.

When you purchase scopes, the manufacturer will include any standard supporting accessories necessary to its operation and handling, but make sure you let them know how you're set up when you're arranging the trial, especially if you're trialing a different make of scope than you're currently using. For example, tell your rep what equipment you use to reprocess your scopes in the event that a specialized connector is needed for the disinfecting machine to flush their scope.

During the trials, your surgeons will be judging the endoscopes' ease of navigation, the images they deliver, and the ergonomics of their handles and controls. The feel of a scope is particularly important since endoscopists are prone to repetitive motion injuries.

As administrators overseeing the trials, you should keep an eye on compatibility issues and potential pitfalls that may result from a scope switch. Some questions to consider:

• If your video components serve multi-specialty uses, are the scopes you're trialing compatible with them?
• Do the surgeons' preferred accessories, such as forceps and snares, work well with the demo models, or will you have to buy new instruments that fit through a scope's channels?
• Will the scope be able to connect with and send data to your facility's electronic records system?
• If you've hard-wired the cables that connect the scope to the light source, video processor, electronic records system and other peripherals into the room to keep them off the floor, are they standard cables or proprietary ones that will require the rewiring of your procedure rooms?

How many scopes do you need?
You don't want to overspend your budget, but you run the risk of inefficiency if you don't have enough scopes. The vendor may suggest a par level, but remember to take that number simply as a guideline. We've found we can make do with fewer than they suggest.

To determine the optimal number of scopes for your facility, consider not only the volume of cases that require scopes, but also the average length of a case in comparison to how they are scheduled and how long it takes to reprocess a scope — a factor which may be influenced by how many people staff your central sterile department and the capacity of the reprocessing machines they have on hand.

With regard to scope service, our facility has gone 3 ways in the 9 years we've been open. As a startup, we signed onto a cost-per-procedure lease covered by a service contract. A few years later, when we purchased scopes, we decided to forgo service contracts, as we were then aware how we handled our scopes. At present, we've entered into a favorable service contract to cover our aging scopes. The right coverage can take a lot of risk off the table.

Scopes can be an expensive purchase, but with proper handling and maintenance you can extend the life of your investment. That's why manufacturer-sponsored in-services for your endoscopy personnel, including your reprocessing team, can represent a pretty big bang for your buck in lowering repair costs.