Expert sit-down blog series - Endoscopy trends in 2023

From sustainability to staff shortages and education, the question of where endoscopy is heading remains. From a medical devices perspective, endoscopy continues to witness a number of important innovations that contribute to even better clinical outcomes. At the same time, there are still significant opportunities for further improving patient safety and infection prevention in the field.

We speak to Ulrike Beilenhoff, ESGENA Scientific Secretary, who shares insights on innovations and opportunities that already shaped and will contribute to further improve patient safety and infection prevention in 2023. 

It is clear that sustainability is becoming increasingly important for endoscope manufacturers. Ulrike, is this consideration also true for other health care professionals in the field?

Yes, it is important and it is under discussion. Though the available data is limited, we know that a lot of waste is produced in endoscopy – we are the third highest producer of hazardous waste^[1] after surgery and ICU departments. Single-use devices account for a big proportion of that waste.

In 2022, ESGE and ESGENA published the position statement “Reducing the environmental footprint of gastrointestinal endoscopy”, in which they advocate to raise awareness for the ecological footprint of GI endoscopy and provide guidance on how to reduce its environmental impact.^[2] It is crucial that we see this from different areas – the position statement tackles topics like waste, produce production, but also quality improvements. The intention is to help stimulate discussion and also help generate ideas for advancing sustainability in endoscopy.

Can you please elaborate on what role single-use versus reusable endoscopes will play in the endoscopy suite of 2023?

One important point that has to be taken into account when talking about single-use devices or reusable devices is the shortage of staff we have in reprocessing and endoscope units. Endoscope repossessing includes a lot of time consuming manual steps. Though some initiatives have already been developed to have automated systems available, the majority of steps are still done manually.

For that reason, staff has to have a lot of deep knowledge about the endoscope construction, the channel systems, how they get access to the different channels. They also need to know about hygiene infection control, process chemicals and repossessing systems. The education of the staff who performs the cleaning steps is the most important, because this directly influences patient safety. I think that is a point we have to take into account when we speak about reusable or single-use devices.

What do you think with regards to the development of sterilizable duodenoscopes? Will this become the new norm?

I don’t believe it is possible to switch entirely from reusable to single-use endoscopes, and that is also what the ESGE and ESGENA position statement presents. Endoscopes used for the GI tract and even in bronchoscopy are inserted via natural orifices in the mouth, and the throat is highly contaminated with germs. We take a lot of germs with the endoscope down to our target organ, to the stomach, or even to the bilio- pancreatic tract. Even if you insert a sterile endoscope, the endoscope will never be entirely sterile when you insert it back into the patient's body.

Though if we clean and disinfect an endoscope properly, I'm sure that we can provide a safe endoscope – that is the key point. Another point is that switching entirely to single-use endoscopes may be possible in rich countries, but what is with poorer countries or where money is scarcely available in the health system? This introduces an economic and ethical discussion.

Curious to learn more? Listen to Ulrike Beilenhoff’s full conversation with Paul Caesar, Head of hygiene, Infection Control and Reprocessing at PENTAX Medical EMEA, in our latest podcast episode. 

[1] Vaccari M, Tudor T, Perteghella A. Costs associated with the management of waste from healthcare facilities: An analysis at national and site level. Waste Manag Res 2018; 36: 39-47. doi:10.1177/0734242X17739968

[2] de Santiago Enrique Rodríguez et al.: Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement; Endoscopy 2022; 54 | © 2022. European Society of Gastrointestinal Endoscopy. All rights reserved.