Clinical and Translational Research
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2020; 26(26): 3767-3779
Published online Jul 14, 2020. doi: 10.3748/wjg.v26.i26.3767
SpyGlass application for duodenoscope working channel inspection: Impact on the microbiological surveillance
Tao-Chieh Liu, Chen-Ling Peng, Hsiu-Po Wang, Hsin-Hung Huang, Wei-Kuo Chang
Tao-Chieh Liu, Wei-Kuo Chang, Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Chen-Ling Peng, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan
Hsiu-Po Wang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 114, Taiwan
Hsin-Hung Huang, Division of Gastroenterology, Cheng Hsin General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Author contributions: Liu TC, Peng CL and Chang WK contributed to design of the study, making critical revisions related to important intellectual content of the manuscript, and final approval of the version of the article to be published; Wang HP and Huang HH contributed to analysis and interpretation of data.
Supported by the Ministry of Defense-Medical Affairs Bureau, Tri-Service General Hospital, No. TSGH-D-109182.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Tri-Service General Hospital, National Defense Medical Center, Taiwan.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei-Kuo Chang, MD, PhD, Associate Professor, Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Chengong Road, Sec.2, Neihu, Taipei 114, Taiwan. weikuohome@hotmail.com
Received: February 16, 2020
Peer-review started: February 16, 2020
First decision: May 1, 2020
Revised: May 28, 2020
Accepted: June 23, 2020
Article in press: June 23, 2020
Published online: July 14, 2020
Abstract
BACKGROUND

Patient-ready duodenoscopes were designed with an assumed contamination rate of less than 0.4%; however, it has been reported that 5.4% of clinically used duodenoscopes remain contaminated with viable high-concern organisms despite following the manufacturer’s instructions. Visual inspection of working channels has been proposed as a quality control measure for endoscope reprocessing. There are few studies related to this issue.

AIM

To investigate the types, severity rate, and locations of abnormal visual inspection findings inside patient-ready duodenoscopes and their microbiological significance.

METHODS

Visual inspections of channels were performed in 19 patient-ready duodenoscopes using the SpyGlass visualization system in two endoscopy units of tertiary care teaching hospitals (Tri-Service General Hospital and National Taiwan University Hospital) in Taiwan. Inspections were recorded and reviewed to evaluate the presence of channel scratches, buckling, stains, debris, and fluids. These findings were used to analyze the relevance of microbiological surveillance.

RESULTS

Seventy-two abnormal visual inspection findings in the 19 duodenoscopes were found, including scratches (n = 10, 52.6%), buckling (n = 15, 78.9%), stains (n = 14, 73.7%), debris (n = 14, 73.7%), and fluids (n = 6, 31.6%). Duodenoscopes > 12 mo old had a significantly higher number of abnormal visual inspection findings than those ≤ 12 mo old (46 findings vs 26 findings, P < 0.001). Multivariable regression analyses demonstrated that the bending section had a significantly higher risk of being scratched, buckled, and stained, and accumulating debris than the insertion tube. Debris and fluids showed a significant positive correlation with microbiological contamination (P < 0.05). There was no significant positive Spearman’s correlation coefficient between negative bacterial cultures and debris, between that and fluids, and the concomitance of debris and fluids. This result demonstrated that the presence of fluid and debris was associated with positive cultures, but not negative cultures. Further multivariate analysis demonstrated that fluids, but not debris, is an independent factor for bacterial culture positivity.

CONCLUSION

In patient-ready duodenoscopes, scratches, buckling, stains, debris, and fluids inside the working channel are common, which increase the microbiological contamination susceptibility. The SpyGlass visualization system may be recommended to identify suboptimal reprocessing.

Keywords: Duodenoscope, Working channel, Visual inspection, Microbiological surveillance, Reprocessing, Endoscope reprocessing

Core tip: This study demonstrated that the common abnormal visual inspection findings of patient-ready duodenoscopes were scratches (52.6%), buckling (78.9%), stains (73.7%), debris (73.7%), and fluids (31.6%). The risk of duodenoscopes of being scratched, buckled, and stained, and accumulating debris was significantly higher at the bending section than at the insertion tube. The presence of debris and fluids is susceptible to microbiological contamination. Multivariate analysis demonstrated that fluids, but not debris, was an independent factor for bacterial culture positivity. Working channel inspection may be added to the current recommendations to identify suboptimal reprocessing or duodenoscopes requiring evaluation, repair, or replacement.