Environmental and health outcomes of single-use versus reusable duodenoscopes

      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 comparing environmental and human health effects of single-use duodenoscopes (SDs) and reusable duodenoscopes (RDs).


      We evaluated 3 duodenoscopes: conventional RDs, RDs with disposable endcaps, and SDs. The primary outcomes were impacts on climate change and human health, complemented by multiple environmental impacts.


      Performing ERCP with SDs releases between 36.3 and 71.5 kg of CO2 equivalent, which is 24 to 47 times greater than using an RD (1.53 kg CO2) or an RD with disposable endcaps (1.54 kg CO2). Most of the impact of SDs comes from its manufacturing, which accounts for 91% to 96% of its greenhouse gas emission. The human health impact of RDs becomes comparable with the SD lower bound if disposable endcaps or other design modifications can reduce serious infection rates below a target rate of 23 cases per year (.0046%).


      Although SDs may provide incremental public health benefit compared with RDs, it comes at a substantially higher cost to the environment. As infection rates continue 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 with SDs.

      Graphical abstract


      FDA (U.S. Food and Drug Administration), GHG (greenhouse gas), LCA (life cycle assessment), RD (reusable duodenoscope), SD (single-use duodenoscope)
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      Linked Article

      • Single-use duodenoscopes: How concerned should we be about the environment?
        Gastrointestinal EndoscopyVol. 96Issue 6
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          Infection outbreaks related to contaminated duodenoscopes have caused considerable concern. Worldwide, 490 cases were reported between 2008 and 2018, and 32 patients died as a consequence.1 Although the overall mortality is extremely low (approximately 1:150,000),2 transmission of infection and death seem avoidable. Most outbreaks were attributed to nonadherence to the cleaning protocol, but duodenoscope design flaws were also identified.3,4 Consequently, industry and regulators looked for solutions to negate even the smallest risk of infection.
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