Colonoscopy can be a complex process, but in performance it simply comes down to visualizing the colon and maneuvering the scope. The gastrointestinal market offers a range of accessories that claim they will improve a physician's polyp detection rate, but if you're in the market for flexible endoscopes, focus on the main goals: a sharp view and easy, efficient movement.
- Image is everything. The quality of the image a scope delivers is the factor that matters most to most physicians in choosing an endoscope. Unless you're literally conducting a side-by-side comparison of competing systems, which could prove logistically and technically difficult, you might not be able to see a difference between scopes' visualization abilities during successive trials. You'll have to trust your surgeons' insights on the issue, but if they're happy with the image, they'll be happy with the scope. Recent advances such as wider-angle or even retroscopic views have been drawing a lot of attention, though they haven't been conclusively proven to improve care and may carry a learning curve for the most effective use.
- Task at hand. For some endoscope users, the feel of the scope is an important consideration, since better ergonomics mean more efficient operation. Most scopes are built the same way, but a compact, lightweight control head that fits in your left hand, with the dials and buttons exactly where you're used to them, makes flexing the scope tip up, down, left and right easy. If your scopes are going to be shared by a group of physicians, it makes sense to select a model whose control configuration is acceptable to most of them.
While the flexibility of a scope shouldn't make or break a purchasing decision the way that visualization would, it is another factor in the feel of a scope. New scopes tend to be stiff, then soften with use. While this "breaking-in period" makes it difficult to gauge a scope's eventual consistency, it's not advisable to select a scope that's overly stiff or overly flexible on day one.
- Upgradable option. Every few years, manufacturers introduce a next-generation scope featuring incremental improvements in imaging and maneuverability. Since most scopes can provide you with at the very least 10 years of use, it's not uncommon for them to outlive the newness of their technologies. If your center owns a stock of them outright, you're not likely to abandon your investment that quickly for advances that might not amount to significantly better patient care.
But if the cutting edge is important to your center and your physicians, leasing endoscopes from the manufacturer might be a cost-effective option. Many hospitals I've operated at lease their scopes, and after the contracted lease period ends, they return them in exchange for the latest models. This is a convenient way to regularly upgrade your technology.
Fuse Generation 2
Pricing: not disclosed
FYI: Leveraging 3 high-definition cameras at the distal tip, EndoChoice's Fuse Generation 2 system provides physicians with a panoramic 330 ? field of view and a 4K ultra-HD viewing experience, now available as a single integrated image on 1 monitor, not 3. This advance enables physicians to see 94% more of the GI tract at once than they would through traditional flexible endoscopes. The company additionally promotes a recent study in The Lancet Oncology, which demonstrated Fuse's ability to detect 69% more adenomatous polyps. The Generation 2's insertion tube has been slimmed down without compromising the functionality of its instrument channel, and redesigned for more tactile feedback, better handling and less looping.
FYI: Part of Olympus's Evis Exera family of technology, the PCF-H190DL/I smaller-diameter colonoscope now incorporates ScopeGuide, a real-time 3D visualization technology that allows users to visualize the position and configuration of the colonoscope during insertion in order to improve procedural efficiency and increase patient comfort during the procedure. This slim scope delivers 170 ? high-definition image quality in both white light and narrow band imaging modes for closer, more detailed examination. Responsive insertion technology combines 3 proprietary insertion technologies high-force transmission, passive bending and variable stiffness to improve scope handling, insertability and ergonomics. A waterproof connector design minimizes the effort required for setup prior to and in between cases.
Fujifilm Medical Systems USA
EC-600WL Video Colonoscope
Pricing: not disclosed
FYI: Fujifilm's EC-600WL endoscope comes equipped with CMOS image sensor technology, which converts analog signals to digital ones for clear, smooth, high-resolution video that is less susceptible to image noise. Capturing digital video at 60 frames per second, this imaging technology delivers high-definition still images with less blurring. A close-focus lens system is able to observe and produce clear images even at a distance of 2 mm with less peripheral distortion. The scope has been designed for increased flexibility at the distal end for smoother insertion, to which improved torque and insertion power transmission also contribute. A lightweight design with easily manipulated control dials and a water jet function boost case ergonomics and efficiency.
i10 Series HD+ Colonoscopes
FYI: The i10 line of high-definition endoscopes from Pentax Medical feature megapixel CCD chips for image clarity and detail. The scopes are available in standard and slim sizes (the EC38-i10L's insertion tube has an outer diameter of 13.2 mm, the EC34-i10L's is 11.6 mm), with both featuring a 3.8 mm channel for efficient suction power and instrument accessibility. The lightweight control body offers increased ergonomic comfort and minimized repetitive-use fatigue, with redesigned angulation knobs that enable easy one-handed control and repositioned buttons that facilitate more intuitive access. Re-engineered controls also deliver the efficient use of torque and insertion tube stiffness to put improved scope steering and advancing in surgeons' hands.
Endoscopes are delicate instruments and mishandling them can prove costly. Here are a few tips to avoid the handling errors that can damage these fragile tools.
- Like a baby. Ask staff to dedicate themselves to proper endoscope handling techniques, from the time a scope is pulled for the first case until the endoscope storage cabinet is clicked shut at day's end. Tell them to carry and handle endoscopes with the same care that they would a newborn.
- Safe storage. Hang scopes in well-ventilated storage cabinets. Keep insertion tubes straight to prevent moisture from pooling within the tube and to protect the angulation system and internal channels. Unlock dials and place variable stiffness scopes into neutral position. To maximize airflow through a scope's tubes and inner channels, remove its water-resistant cap and valves.
- Color code clean endoscopes. As long as flexible endoscopes have been reprocessed within 5 days of use, it's OK to use them, says AORN, whose recommended practices for cleaning and processing flexible scopes no longer require reprocessing immediately before use. But keeping track of when each scope was reprocessed can be confusing when you're reprocessing dozens every day. Here's a simple solution: Attach a colored paper clip to the lip of the biopsy channel of every scope after it's been reprocessed. Each day gets a different color. Create a flip chart that tells the reprocessing department staff which color scopes hanging in the cabinet need to be reprocessed that day.
- Along for the ride. Transport scopes from procedure rooms to reprocessing areas in covered plastic containers. The containers protect the scope from damage during transport and prevent cross-contamination. Ensure the container is big enough the scope should be coiled loosely in the container to prevent buckling of the insertion tube. Place transportation containers on a large cart to make the commute easier. Some manufacturers sell reversible container liners labeled "clean" on one side and "dirty" on the other to notify staff of the scope's status.