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Reusable biopsy forceps: a prospective evaluation of cleaning, function, adequacy of tissue specimen, and durability
R A Kozarek1, F M Attia, S E Sumida
1Section of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA.
Background:
Recent studies have indicated that reusable biopsy forceps remain contaminated after reprocessing and can only be used a mean of 12 to 25 times without malfunction. Because this contradicts traditional endoscopic practice, our study investigated the ability to sterilize a type of commercially available biopsy forceps and prospectively evaluated their function in vivo until malfunction and/or breakage.
Methods:
Thirty reusable biopsy forceps were studied, 15 of which were contaminated for 5 trials each with 10(6) Bacillus stearothermophilus, and 15 of which were prospectively evaluated clinically over an 18-month period (9/98-3/00). Contaminated forceps were reprocessed by using a standard protocol and placed in a sterile bag containing soy broth. The latter was passed through a 0.2 micron filter and was subsequently cultured. In vivo data included biopsy site, size, adequacy, problems obtaining a biopsy specimen, and reasons for ultimate forceps failure.
Results:
After contamination, all biopsy forceps yielded a heavy growth of B stearothermophilus. No forceps, including 5 that were piecemeal dismantled with a wire cutter, had residual bacteria after reprocessing. In the in vivo study, 1507 biopsy sessions were undertaken in 1339 procedures. Forceps were categorized as new or like-new in 1259 of 1339 (94%) procedures, some loss of function but usable in 72 of 1339 (5.4%), and inadequate function or broken at use in 8 of 1339 (0.6%). Histologically, 1501 specimen sets were adequate (99.6%) and mean specimen size was 2.7 +/- 0.1 mm. Mechanical problems were noted in only 38 of 1507 (3%) sessions to include such things as sticky forceps, and the mean number of uses to malfunction or breakage was 91 +/- 15 (SEM) (range 19-132).
Conclusions:
This reusable biopsy forceps can be sterilized and used a mean of 91 times with adequate tissue sampling. Mechanical problems were minor to time of breakage. Contingent on acquisition and reprocessing costs as well as the number of procedures performed, this reusable forceps has the potential for significant cost savings.
Insights
Reusable biopsy forceps can be effectively sterilized and reused up to 91 times, maintaining adequate tissue sampling. This study demonstrates their potential for significant cost savings in endoscopic procedures.
Area of Science:
- Gastroenterology
- Endoscopic Devices
- Infection Control
Background:
- Reusable biopsy forceps may retain contamination after reprocessing.
- Previous estimates suggest limited use (12-25 times) before malfunction.
- This contradicts standard endoscopic practices.
Purpose of the Study:
- To evaluate the sterilizability of reusable biopsy forceps.
- To prospectively assess in vivo function until failure.
- To determine the functional lifespan and reliability of reusable biopsy forceps.
Main Methods:
- Sterilization efficacy tested using Bacillus stearothermophilus.
- Reprocessing followed a standard protocol.
- In vivo evaluation over 18 months tracked biopsy sessions, specimen adequacy, and forceps failure modes.
Main Results:
- All forceps were sterile after reprocessing.
- In vivo use: 94% remained new/like-new, 5.4% had minor function loss.
- Mean lifespan was 91 uses (range 19-132) with 0.6% failure rate.
- Specimen adequacy was 99.6% with a mean size of 2.7 mm.
Conclusions:
- Reusable biopsy forceps can be reliably sterilized and reused.
- Mean functional lifespan significantly exceeds previous estimates (91 uses).
- Potential for substantial cost savings in clinical practice.
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