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

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Repici A.; Khalaf K.; Troncone E.; Subramaniam S.; Hassan C.; Bhandari P.; AABAKKEN L.; ABERE S.; AKROUSH M.W.; AL-LEHIBI A.; ALBÉNIZ E.; ALKANDARI A.; ALMADI M.A.; ANDERLONI A.; BAPAYE A.; BERTRAND N.; BICK B.; BISSCHOPS R.; BOURKE M.J.; BROWN J.F.; BRUNO M.J.; CHIU P.W.Y.; CROAGH D.; de MOURA E.G.H.; DENZER U.; EMURA F.; FABBRI C.; FEDOROV E.; FOCKENS P.; GABRIELLI A.; HAEFNER M.; HUCL T.; IBRAHIM M.; IJOMA U.; KAFFES A.; KASHIN S.; KHASHAB M.A.; KHOR C.; LALEMAN W.; LAW R.; LOLLO G.; MAY G.R.; DESALEGN MEKONNEN H.; MOON J.H.; MUSAH Y.; MUTHUSAMY V.R.; MUTIGNANI M.; MWACHIRO M.; NAVARRETE C.; NEUHAUS H.; NIETO J.M.; ONYIA C.; OYELEKE G.K.; PEREZ-MIRANDA M.; PONNUDURAI R.; RAJU G.S.; REDDY D.N.; RÖSCH T.; SAITO Y.; SETHI A.; SHARMA P.; SIDDIQUI U.D.; TARANTINO I.; HOOFT J.V.; WALLACE M.B.; WEBSTER G.; YAHAGI N.; YUSOFF I.

Journal: Digestive and Liver Disease

Publisher: Elsevier B.V.

Publication Date: February 2024

Volume / Issue: Volume 56 / Issue 2

Pages: 322–329

ISSN: 15908658

DOI: 10.1016/j.dld.2023.07.026

Scopus: View on Scopus

PubMed: 37558571

Document Type: Article

Access: All Open Access; Bronze Open Access; Green Open Access

Authors and Affiliations

Repici A., Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy, Humanitas Clinical and Research Centre -IRCCS-, Endoscopy Unit, Rozzano, Italy; Khalaf K., Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy, Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Troncone E., Department of Systems Medicine, Gastroenterology Unit, University of Rome “Tor Vergata”, Rome, Italy; Subramaniam S., Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom; Hassan C., Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Rozzano, Italy, Humanitas Clinical and Research Centre -IRCCS-, Endoscopy Unit, Rozzano, Italy; Bhandari P., Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom; AABAKKEN L., GI Endoscopy Unit, OUS, Rikshospitalet University Hospital, Oslo, Norway; ABERE S., Internal Medicine, Rivers State University Teaching Hospital, Port Harcourt, Nigeria; AKROUSH M.W., Prince Hamzeh Hospital, University of Jordan, Amman, Jordan; AL-LEHIBI A., King Fahad Medical City, Riyadh, Saudi Arabia; ALBÉNIZ E., Complejo Hospitalario de Navarra, Navarrabiomed Research Institute, Public University of Navarra, Navarra, IdiSNA, Spain; ALKANDARI A., Thanyan Alghanim Center for Gastroenterology and Hepatology, Alamiri Hospital, Kuwait, Kuwait; ALMADI M.A., King Saud University, Riyadh, Saudi Arabia; ANDERLONI A., Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy; BAPAYE A., Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Maharashtra, Pune, India; BERTRAND N., Department of Endoscopy Unit, Private Hospital Jean Mermoz, Lyon, France; BICK B., Division of Gastroenterology and Hepatology, Rockford Gastroenterology Associates, IL, United States; BISSCHOPS R., Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium; BOURKE M.J., Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia; BROWN J.F., Pharmacy and Biomedical Sciences, Portsmouth University, Portsmouth, United Kingdom; BRUNO M.J., Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands; CHIU P.W.Y., Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong; CROAGH D., Department of Surgery, The University of Melbourne, Melbourne, Australia; de MOURA E.G.H., Clinics Hospital of the São Paulo University Medical School, Gastrointestinal Endoscopy Unit, Brazil; DENZER U., Gastroenterology and Endocrinology, University Hospital Marburg, Marburg, Germany; EMURA F., Gastroenterology Division, Universidad de La Sabana, Chía, Colombia; FABBRI C., Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Forlì Cesena, Italy; FEDOROV E., Laboratory of Surgical Gastroenterology and Endoscopy, Institute of Clinical Surgery of the Pirogov Russian National Research Medical University, Moscow, Russian Federation; FOCKENS P., Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands; GABRIELLI A., Università Politecnica delle Marche, Ancona, Italy; HAEFNER M., Krankenhaus der Barmherzigen Schwestern, Department of Internal Medicine II, Vienna, Austria; HUCL T., Department of Hepatology and Gastroenterology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic; IBRAHIM M., Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt; IJOMA U., University of Nigeria Teaching Hospital – Gastroenterology Unit, Department of Medicine, Enugu, Nigeria; KAFFES A., AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital, Sydney, Australia; KASHIN S., Department of Gastroenterology, Yaroslavl Oncology Hospital, Yaroslavl, Russian Federation; KHASHAB M.A., Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, United States; KHOR C., Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore; LALEMAN W., Department of Liver and Biliopancreatic Disorders, University Hospitals Leuven, Leuven, Belgium; LAW R., Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States; LOLLO G., Department of Gastroenterology and Hepatology, Ospedale Regionale di Bellinzona e Valli, Ticino, Bellinzona, Switzerland; MAY G.R., Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; DESALEGN MEKONNEN H., Medical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia; MOON J.H., Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, South Korea; MUSAH Y., Department of Internal Medicine, College of Medicine and Health Sciences, Afe Babalola University, Ido-Ekiti, Nigeria; MUTHUSAMY V.R., Division of Digestive Diseases, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; MUTIGNANI M., Digestive and Interventional Endoscopy Unit, Azienda Socio Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy; MWACHIRO M., Department of Surgery, Tenwek Hospital, Bomet, Kenya; NAVARRETE C., Servicio de Cirugía Endoscópica Hospital San Borja Arriarán de Santiago. Departamento de Cirugía, Clinica Santa Maria, Santiago, Chile; NEUHAUS H., Department of General Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany; NIETO J.M., Borland-Groover Clinic, Jacksonville, FL, United States; ONYIA C., University of Nigeria Teaching Hospital Enugu, Nigeria; OYELEKE G.K., Department of Medicine, College of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria; PEREZ-MIRANDA M., Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain; PONNUDURAI R., Prince Court Medical Centre, 39 Jalan Kia Peng, Kuala Lumpur, Malaysia; RAJU G.S., Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States; REDDY D.N., Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad, India; RÖSCH T., Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany; SAITO Y., Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; SETHI A., Columbia University Irving Medical Center, New York, NY, United States; SHARMA P., Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas School of Medicine, Kansas, United States; Division of Gastroenterology, Veteran Affairs Medical Center, KansasMissouri, United States; SIDDIQUI U.D., Section of Gastroenterology, Hepatology, and Nutrition, Center for Endoscopic Research and Therapeutics and Advanced Endoscopy Training, University of Chicago, 35700 South Maryland Avenue MC 8043, Chicago, IL, United States; TARANTINO I., Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy; HOOFT J.V., Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, Netherlands; WALLACE M.B., Fred C. Andersen Professor of Medicine, Mayo Clinic, Chief of Gastroenterology and Hepatology: Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates; WEBSTER G., Pancreatobiliary Medicine, University College London Hospitals, London, United Kingdom; YAHAGI N., Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan; YUSOFF I., Faculty of Dentistry and Medicine, University of Western Australia, Australia, Australia

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. © 2023 Editrice Gastroenterologica Italiana S.r.l.

Keywords

Delphi; Multi drug resistant organism; Single use endoscopy; Sustainability; Consensus; Delphi Technique; Endoscopy, Gastrointestinal; Humans; Article; Delphi study; environmental impact; evidence based practice; health care cost; health care policy; high risk patient; human; systematic review; treatment indication; gastrointestinal endoscopy

Citation Information

Scopus Citations: 8

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