Environmental and health outcomes of single-use versus reusable duodenoscopes
Le NNT, Hernandez LV, Vakil N, Guda N, Patnode C, Jolliet O. Environmental and health outcomes of single-use versus reusable duodenoscopes. Gastrointest Endosc. 2022;96(6):1002-1008. doi:10.1016/j.gie.2022.06.014
Background and aims: The large-scale effects of duodenoscopes on the environment and public health have not been quantified. Our aim was to perform an exploratory Life Cycle Assessment (LCA) comparing environmental and human health effects of single-use (SD) and reusable duodenoscopes (RD).
Methods: We evaluated three duodenoscopes: 1) conventional RD; 2) RD with disposable endcaps; and 3) SD. The primary outcomes were impacts on climate change and human health, complemented by multiple environmental impacts.
Results: Performing endoscopic retrograde cholangiopancreatography (ERCP) with SD releases between 36.3 and 71.5 kg of CO2 equivalent, which is 24 to 47 times greater than using a RD (1.53 kg CO2) or a RD with disposable endcaps (1.54 kg CO2). Most of the impact of SD comes from its manufacturing, which accounts for 91% to 96% of its greenhouse gas emission. The human health impact of RD becomes comparable to the SD lower bound if disposable endcaps or other design modifications can reduce serious infection rate below a target rate of 23 cases per year (0.0046%).
Limitations: Our model was based on several assumptions that will require real-world validation.
Conclusion: Although SDs may provide incremental public health benefit compared to RD, it comes at a substantially higher cost to the environment. As infection rate continues to decrease from more regimented cleaning protocols and enhanced designs such as disposable endcaps to facilitate cleaning, the negative impact to human health from contaminated RDs could be comparable to SDs.