Single-use flexible endoscopes and endoscopic sheaths protect patients against cross-contamination, and reduce scope reprocessing and maintenance costs. While they're not yet widely used, the exciting potential of these devices may be opening the door to endoscopy's next big thing.

A disposable development
It's been nearly 50 years since the first flexible endoscopy was performed. Besides the miniaturization of components, the scope has seen relatively few changes in its basic construction, even as its camera and optics have advanced by leaps and bounds.

That may be changing, thanks in part to updated guidelines for flexible endoscope reprocessing published last month by the American Society for Gastrointestinal Endoscopy and the Society for Healthcare Epidemiology of America that cited continuing, and seemingly epidemic, occurrences of endoscopy-related infections. The guidelines call for strict adherence to proper reprocessing technique.

Can single-use flexible endoscopes make those concerns moot? The devices may seem like a radical innovation, but considering that the No. 1 patient risk in colonoscopy is infection, it makes practical sense as a preventive measure. One common design involves a reusable fiber-optic bundle that is slid into and fully contained by a flexible disposable catheter.

The single biggest advantage single-use scopes offer is that they all but eliminate the risk of cross-contamination between patients due to faulty reprocessing techniques or equipment. Not needing to manually clean and machine-disinfect endoscopes also lets you lighten the load on your central sterile team in terms of labor and chemical exposure.

You stand to improve your physicians' productivity as well, since always having a patient-ready scope on hand means that even the busy endoscopist won't have to wait for one to emerge from the reprocessing cycle. Plus, disposable scopes don't require ongoing maintenance and repair, potentially cutting thousands of dollars in service costs from your budget.

It must be noted, however, that reality still lags to a certain extent behind the ideal. At present, disposable endoscopy comprises more investigational instruments than products that have reached the market. Making such a device a cost-efficient alternative to traditional reusable scopes is another obstacle for manufacturers.

For you and your physicians, perhaps the main question is whether adopting disposable scopes would bring redundant, if convenient, equipment. Such systems aren't yet likely to be able to replace all the functions of traditional scopes. For example, it may excel in diagnostic use for polyp detection, but can instruments be passed through it for therapeutic procedures? Will physicians accept the feel of its handling over the scopes they're familiar with?

This alternative solution isn't cost-free, of course. While single-use scopes may mean you don't have to maintain a cabinet of reprocessable scopes, you will have to stock your supply room with a sufficient inventory of the disposable components to support your GI service.

You also have to consider the cost of throwing away single-use scopes. One big concern is that the time and labor involved in scope reprocessing are simply being traded for dumping tens of thousands of disposable components into the landfill, or into costly regulated medical waste at 3 to 5 pounds each, year after year. When considering the possibilities of single-use flexible endoscopes, you've got to take a big step back and look at what they'll cost on all fronts.

A sheath solution
Another option that can help to increase endoscopic safety and efficiency is a disposable plastic sheath that covers a reusable scope and lines its internal channel. The narrow sleeve shields the scope from the patient and vice versa without compromising the scope's visualization or function.

Endoscopic sheathing systems are available for a range of upper GI scope platforms, including laryngoscopes for anesthesia providers, esophagoscopes for gastroenterologists, bronchoscopes for pulmonologists and rhinoscopes for ENT specialists. The simple and compact solution is adaptable to the OR, procedure room or physician's office.

While they're also available for urology's ureteroscopes and cystoscopes, they're not available for colonoscopy. The scopes mentioned above are very small technologies, 1.7mm to 2mm in diameter, but the greater length and diameter of the flexible endoscopes used in the lower gastrointestinal tract — not to mention the different motion required in its scoping procedures — mean they're not yet a practical option for that specialty.

Endoscope sheathing has been around longer than single-use endoscope technology, and has stood the test of time as a safe option. Sheathed endoscopes are well-tolerated by patients, even those undergoing upper GI examination or treatment with minimal sedation. The sheaths' elastic material, thoroughly leak-tested like surgical gloves, has proven durable enough to resist tears or breaks.

The sheaths tend to be a proprietary component of a specific endoscopic system, not a universally compatible accessory to any manufacturer's scopes. So in order to sheath your scopes for use, it's necessary to purchase the sheath manufacturer's scopes, light source, video processor and monitor as well. This exclusivity may have limited the development's widespread adoption in facilities with existing endoscopic systems.

As with single-use scopes, the main advantage of endoscopic sheathing is the role it can play in infection prevention by eliminating cross-contamination between patients. Every patient essentially gets a brand-new, sterile-processed scope, and the physician always has a scope on hand, ready to use, without having to wait for reprocessing.

It's possible that the sheaths can even reduce the need for costly scope maintenance. While it's often presumed that the majority of a scope's repairs are the result of a physician's use during a procedure, they actually originate more often from a lack of conscientious care and handling by clinical and reprocessing staff between cases. Reduced reprocessing, and fewer sets of hands on the delicate instruments, might lead to less damage and reduced service costs.

A big plus
If the performance of single-use flexible endoscopes and endoscopic sheaths deliver the same level of results that standard systems do, without asking physicians to change how they practice or you to spend significantly more money, there is definitely a place in your facility for the technology. Any advance that lets facilities always have a clean scope at the ready and holds down reprocessing costs is a big plus worth considering.