Abstract No. 90 Single-use versus reusable endoscopes for percutaneous biliary endoscopy with lithotripsy: technical metrics, clinical outcomes, and cost comparison

Abstract

Percutaneous biliary endoscopy (PBE) is increasingly used by interventional radiology (IR) to visualize and treat biliary pathology. Advances in endoscope technology have introduced single-use, disposable endoscopes to complement traditional, reusable endoscopes; however, data comparing the two technologies is limited. In this study, we compare the technical metrics, clinical outcomes, and costs between single-use and reusable endoscopes for use in PBE. In this IRB-approved, retrospective study, 67 PBE procedures were performed on 34 patients (62% male; mean age 65.9 [range 5-90] years) for stone removal from October 2014 to February 2020, using either reusable (n = 17 patients, 28 cases; Olympus URF-2 ureteroscope) or single-use endoscope (n = 17 patients, 39 cases; Boston Scientific LithoVue ureteroscope). Device metrics, technical and clinical success, complications, and cost-per-case were compared. Technical success was defined as biliary system access and identification of pathology, and clinical success required at least partial stone removal. Single-use endoscopy performed as well or better in several performance metrics compared to reusable endoscopy, including flexion, tip deflection, irrigation flow, and ease-of-use. Mean procedural time was similar between single-use (mean ± SD; 136.4 ± 44.6 minutes) and reusable (135.5 ± 51.2 minutes; P = 0.5) endoscopes, while mean fluoroscopy time was significantly lower with single-use endoscopes (11.7 ± 8.4 minutes) compared to reusable (17.6 ± 11.8 minutes; P = 0.01). Technical and clinical success with single-use endoscopes was 95% (n = 37) and 90% (n = 35), respectively, similar to reusable endoscope use at 93% (n = 26) and 75% (n = 21), respectively (all P > 0.05). One minor complication in the perioperative period occurred during reusable scope use, involving gallbladder wall perforation, whereby the biliary tube was replaced without further complications. Cost analysis demonstrated a lower cost-per-case for single-use LithoVue endoscope ($1500/case) compared to reusable Olympus endoscope ($2391/case; difference of $891/case), which was primarily due to costs for repair. This study supports disposable endoscopes as a safe and effective alternative to reusable endoscopes for patients undergoing PBE. Additionally, disposable endoscopes demonstrated significantly decreased fluoroscopy time compared to reusable endoscopes, offering the potential for lower patient radiation exposure, as well as a lower cost-per-case, which may lower financial barriers to starting or expanding PBE in an IR practice.