Single-use duodenoscopes: is performance enough? Time to include sustainability as a prerequisite in clinical practice

Overall, the risk of infection after endoscopic procedures is clinically negligible if proper adherence to disinfection guidelines is ensured [1]. Recently, duodenoscope-associated infections (DAIs) have been referred as a major concern, especially those due to multidrug-resistant organisms (MDROs) [2]. Although duodenoscope-associated MDRO infections are associated with an increased morbimortality, most of them are also avoidable events. In fact, the complex design of duodenoscopes increases bacterial and biofilm harboring, resulting in higher post-procedural infection rates compared with other endoscopes [3]. As a result, this has led to the development of multiple strategies to reduce DAIs, including the improvement of reprocessing and maintenance techniques. However, these measures are far from being perfect and have been demonstrated to be somewhat insufficient [4]. Subsequently, disposable distal end cap attachments and single-use duodenoscopes have emerged as alternative strategies.