Becker's ASC Review

Executive Briefing: 56 Executive Briefing: Sponsored by: D ouglas G. Adler, MD, is an advanced endoscopist who performs up to 700 endoscopic retrograde cholangiopancreatography procedures annually. He first heard rumors of a fully disposable duodenoscope — the device used for ERCP — more than a decade ago. "This is a notion that has come and gone a few times, but now it's really here in our hands," Dr. Adler said. "It's sort of like how I imagine when they went from propeller planes to jet aircraft." Dr. Adler was the first physician to use the fully disposable duodenoscope from Ambu Inc., the world's leading single-use endoscope supplier, on a patient. Single-use duodenoscopes are brand new to the GI suite and only two models have obtained U.S. Food and Drug Administration 510(k) clearance since the agency recommended an industry switch to partially or fully disposable duodenoscopes in August 2019. These recommendations resulted from growing concern around multi- drug resistant bacteria transmission from contaminated devices. But the rationale for transitioning to single-use endoscopy extends beyond the perhaps obvious benefit of eliminating device-related infections and outbreaks. From clinical, patient and financial perspectives, single-use endoscopes offer healthcare organizations a more comprehensive way to improve outcomes and patient experience while lowering costs and improving efficiency. Quality performance in a portable platform More than 75 million endoscopies are performed in the U.S. annually. Endoscopes are comprised of long, often flexible, working channels that enable clinicians to diagnose and treat ailments in hollow cavities of the body, including the lungs, digestive tract, urinary system and uterus. While less invasive than surgery, endoscopy is not without its risks and endoscope performance is paramount to success. To illustrate this point, Dr. Adler likens using a duodenoscope for ERCP — arguably one of the most difficult endoscopic procedures — to driving a car, in that you only think about the vehicle if something is not working properly. After a while, "we weren't really focusing on the scope very much; we were mostly just doing the case," Dr. Adler said of his first trials of Ambu's duodenoscope. "It's really impressive, there's no other way to put it." Ali Tabatabai, MD, an intensivist in Baltimore, Md., said Ambu's single-use bronchoscopes have played a central role in his work throughout the ongoing COVID-19 pandemic. The combined single-use bronchoscope and closed-loop sampling system for bronchoalveolar lavage have also helped protect his colleagues from the virus during a time of heightened healthcare worker risk, he said. "Everything else being equal, the disposable scope gives you that added measure of safety," Dr. Tabatabai said. Ambu created the world's first single-use bronchoscope in 2009 and plans to introduce the fifth generation of that bronchoscope line later this year. Frost & Sullivan recently awarded Ambu the Global New Product Innovation Award and described the company as the "most innovative single-use endoscopy player in the market." Many institutions, Dr. Tabatabai added, lack a video tower for reusable bronchoscopes in every ICU, so essential staff may be redirected off the floor for extended periods to track down necessary equipment. Alternatively, Ambu's single-use bronchoscopes and compact display monitors are easily stored and are set up in a fraction of the time. Ambu's plug-and-play model has proven invaluable in minimizing treatment delay in intensive care. "The more pieces of equipment that you have in a setup, the greater the chances that something will be malfunctioning or not available," Dr. Tabatabai added. Large, cumbersome video towers and display systems make it harder to do inpatient consults as well, said Seth K. Bechis, MD, an associate clinical professor of urology at UC San Diego Health. The convenience and quality of Ambu's platform has enabled him and the residents in his hospital practice to perform cystoscopy for inpatient consults which might otherwise have required a separate outpatient clinic visit. "What I like is, every time you open a scope, you know it's going to have a brand-new deflection," Dr. Bechis said, referring to a urologist's ability to control the tip of a cystoscope, a function in reusable endoscopes that typically deteriorates over time. "The reliability of knowing every time that it's fresh out of the box, brand new, is very attractive." Easing patient concerns Faster set-up times, and eliminating the need for complex, time-consuming disinfection between procedures, reduces patient wait times and increases procedural volume both on the hospital floor and in outpatient clinics. Dr. Bechis has reduced patient appointment intervals from one hour to 15 minutes since he switched to exclusively using Ambu's single- use cystoscopes in one of his outpatient clinics, he said. In addition, he is able to offer cystoscopy procedures to patients in satellite clinics that do not have the capability to sterilize reusable scopes. "As hospitals branch out and continue to expand, there's an emphasis on providing good clinical services in the outpatient setting and satellite clinics," he said. "Having the single-use scope system has been huge." A natural evolution How a transition to single-use endoscopy improves clinician and patient experience while lowering costs and boosting operational efficiency

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