International Delphi Consensus Study on disposable single-use endoscopy: A path to clinical adoption.

Alessandro Repici, Kareem Khalaf, Edoardo Troncone, Sharmila Subramaniam, Cesare Hassan, Pradeep Bhandari

Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2024;56(2):322-329

PMID: 37558571

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND/OBJECTIVE

Increasing infectious rate estimates and low microbiological surveillance affect safety of gastrointestinal endoscopy globally. Single use endoscopes and accessories have been claimed to improve safety, but there is lack of data on their indication and sustainability. We aimed to identify a series of best practice recommendations for the use of single use endoscopes and accessories using a modified Delphi.

METHODS/DESIGN

Consensus statements for the use of single use endoscopy and accessories were developed using a modified Delphi process, utilizing an international endoscopist expert panel of 62 experts from 33 nations. The main steps in the process were selecting the consensus group, conducting systematic literature reviews, developing statements, and anonymous voting on the statements until consensus was reached. High-risk patients were defined as those with multi-drug-resistant infections, immunosuppressive medication or chemotherapy, post-transplantation, or with severe neutropenia.

RESULTS

Of the 26 statements that were voted upon through two rounds, 17 statements reached consensus. Category 1: single use accessories (8 statements), related to defining recommendations for the use of single use accessories in all patient populations or high-risk patients. Category 2: clinical indication for single use endoscopes (9 statements), including indications to high-risk patients, protecting the endoscope apparatus and contamination measures in endoscopy units. Category 3: technical factors (4 statements), related to superior performance and technical specifications with the new innovation. Category 4: environmental issues (2 statements), concerning mechanisms that reduce the detrimental burden to the environment. Category 5: financial implications (3 statements), related to healthcare policies, cost neutrality and other financial associations of single use endoscopy.

CONCLUSIONS

This is the first international initiative in determining clinical indications for single use endoscopy and accessories. The study's findings should serve as a framework for future physicians to guide future research and aid the proper evidence-based indications for the implementation of single use endoscopes in clinical practice.

Address: Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy; Humanitas Clinical and Research Centre -IRCCS-, Endoscopy Unit, Rozzano, Italy.; Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy; Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected].; Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Rome, Italy.; Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.; Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK; School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.

DOI: 10.1016/j.dld.2023.07.026

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MeSH Terms: Humans, Delphi Technique, Endoscopy, Gastrointestinal, Consensus