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Single pediatric center experience with single-use duodenoscopes
Sapna Khemka1, Micah Morris1, Colin Winkie1
1Division of Gastroenterology, Hepatology & Nutrition, Nationwide Children's Hospital, Columbus, Ohio, United States.
Insights
Single-use duodenoscopes show promise for pediatric ERCP, offering high success and low complication rates. This reduces infection risk compared to reusable scopes, simplifying maintenance.
Area of Science:
- Gastroenterology
- Pediatric Endoscopy
- Infection Control
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is vital for hepato-pancreato-biliary conditions.
- Pediatric ERCP presents unique infection control challenges, with reusable duodenoscopes linked to multidrug-resistant organism (MDRO) transmission.
- Single-use duodenoscopes are emerging as a potential solution to mitigate infection risks.
Purpose of the Study:
- To evaluate the initial experience and safety of single-use duodenoscopes in pediatric ERCP.
- To assess technical success rates and complication profiles associated with single-use duodenoscopes in a pediatric population.
Main Methods:
- Retrospective chart review of pediatric patients undergoing ERCP with a single-use duodenoscope (EXALT™ Model D).
- Data collected included demographics, procedural details, ERCP complexity scores, and post-procedure complications.
- Descriptive statistics were employed for data analysis.
Main Results:
- Twenty-eight pediatric patients (mean age 16) underwent ERCP with single-use duodenoscopes.
- 100% technical success for biliary cannulation was achieved, with most procedures being ASGE grade 1 or 2.
- A 14% complication rate was observed (abdominal pain, pancreatitis, cholangitis), with no MDRO infections or post-procedure bleeding.
Conclusions:
- Single-use duodenoscopes are effective and safe for pediatric ERCP, demonstrating high success and low complication rates.
- They present a promising alternative to reusable duodenoscopes, particularly for reducing infection transmission and simplifying scope management.
- Further research is needed for younger patients and higher ASGE grades, alongside cost-benefit analyses for broader adoption.
Background:
Endoscopic retrograde cholangiopancreatography (ERCP) is a key diagnostic and therapeutic tool for hepato-pancreato-biliary conditions. Although widely performed in adults, ERCP in pediatric populations is less common and poses unique challenges, particularly concerning infection control. Reusable duodenoscopes have been linked to patient-to-patient transmission of multidrug-resistant organisms (MDROs), leading to increased interest in single-use duodenoscopes. This study describes the initial experience using single-use duodenoscopes in ERCP at a single pediatric quaternary care center.
Methods:
A retrospective chart review was conducted on all patients who underwent ERCP with the EXALT™ Model D single-use duodenoscope at a single pediatric center from November 1, 2022, to April 15, 2025. Demographics, procedural details, ERCP complexity scores, and post-procedure complications were collected. Descriptive statistics were used for analysis.
Results:
Twenty-eight patients (mean age 16 years; 64% female) underwent ERCP with a single-use duodenoscope. Biliary cannulation was successful in 100% of cases. Most procedures were ASGE grade 1 or 2. Stone extraction was performed in 27 cases, stent removal in 25, and new stent placement in 3. Complications occurred in 4 patients (14%): abdominal pain (n = 2), post-ERCP pancreatitis (n = 1), and cholangitis (n = 1), with no cases of post-procedure bleeding or MDRO infections. No procedures required conversion to reusable duodenoscopes.
Conclusions:
Single-use duodenoscopes were effective and safe for ERCP in a pediatric cohort, achieving high technical success and low complication rates. While more studies are needed, particularly in younger or smaller patients and at higher ASGE grades (3 and 4), single-use duodenoscopes may offer a promising alternative to reusable devices, especially in reducing infection risk and simplifying scope maintenance. Broader adoption may depend on the development of pediatric-specific devices and cost-benefit analyses in varying clinical settings.
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