The evolution of single-use duodenoscope utilization at a large-volume endoscopic retrograde cholangiopancreatography tertiary care center

Abstract

Background and aims: Previous studies have shown promising outcomes with single-use duodenoscopes, often examining only 1 version. The aim of this study was to evaluate the long-term outcomes across multiple models at a large referral center. Methods: Endoscopic retrograde cholangiopancreatography (ERCP) cases (July 2020-September 2023) were retrospectively reviewed to assess technical success, defined as successful cannulation without switching devices. A 3-tier system guided the use of single-use duodenoscopes: recommended for drug-resistant cases (Tier 1), considered for immunosuppressed patients (Tier 2), and discouraged in routine cases (Tier 3). Results: Of 8375 ERCPs, 267 (3.2%) involved single-use duodenoscopes (Tier 1, 25%; Tier 2, 54%; and Tier 3, 21%). The majority focused on the biliary system (91%), with 9% targeting the pancreatic duct. Technical success was achieved in 94%. Technical failures were primarily due to poor imaging (53%) and inadequate maneuverability (47%). Adverse events were reported in 3% of cases. A gradual increase was observed in ERCPs using single-use duodenoscopes, from 2.6% in 2020 to 4.7% in 2023, alongside a notable decrease in Tier 3 usage from 29% to 14%. The use for native papillae rose from 9.8% to 21%, while pancreatic duct interventions dropped significantly from 15% to 4.8%. Junior faculty performed 84% of procedures, reporting greater satisfaction than senior faculty. Improvements in scope stiffness, image stability, and elevator functionality were noted with newer iterations. Conclusions: This study offers real-world evidence of successful single-use duodenoscope integration into a high-volume practice, with growing use and increased endoscopist satisfaction over time.