title: In vitro study and in vivo application of a reusable double-channel sphincterotome.
abstract: OBJECTIVE
  Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) has been deemed to be a "cost-prohibitive" procedure, based upon the cumulative costs of one-time-use accessories and current reimbursement plans. One-time-use sphincterotomes comprise a significant component of that cost and, accordingly, we evaluated the disability and clinical usefulness of a recently introduced reusable double-channel sphincterotome.
  
  
  METHODS
  We studied a reusable 6-Fr sphincterotome at baseline and following contamination with 10(6) Bacillus stearothermophilus. Reprocessing included a unique 30-minute ultrasonic cleaning step in lieu of manual cleaning, followed by steam sterilization. Parameters evaluated included sphincterotome function, electrical integrity, and our ability to sterilize the devices for three in vitro trials. In vivo studies included patient demographics and outcomes, procedural findings, and success rates, and the mean number of times the sphincterotome was used, functional grading at time of use, and reasons for sphincterotome malfunction.
  
  
  RESULTS
  Ten out of ten sphincterotomes maintained form, function, and electrical integrity in vitro, and all cultures were negative after sterilization. In the initial in vivo study, ten sphincterotomes were used in 50 patients (mean, 5 uses) with a 94% success rate. Reasons for sphincterotome failure included leak or breakage of the accessory port in 70%, wire fracture in 10%, incorrect wire bow in 10%, and clogged injection port in 10%. Following reconfiguration of the insertion-port polymer, an additional ten sphincterotomes were used in 110 patients (mean, 11 uses). Mechanical failure occurred primarily at the wire-insertion port, resulting in progressive friction with reuse. There were neither electrical nor infectious complications associated with reuse.
  
  
  CONCLUSIONS
  A reusable double-channel sphincterotome is available which can theoretically be reprocessed and sterilized without the manual cleaning step of the reprocessing process. Contingent upon both provider and patient, multiple reuse can be anticipated, and contingent upon purchase price and reprocessing costs, the potential for procedural cost savings is significant.
authors.affiliation: Section of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington 98111, USA. gasrak@vmmc.org
authors.forename: R A
authors.initials: RA
authors.lastname: Kozarek
authors.forename: S L
authors.initials: SL
authors.lastname: Raltz
authors.forename: J J
authors.initials: JJ
authors.lastname: Brandabur
authors.forename: D J
authors.initials: DJ
authors.lastname: Patterson
authors.forename: T J
authors.initials: TJ
authors.lastname: Ball
authors.forename: M G
authors.initials: MG
authors.lastname: Gluck
authors.forename: S E
authors.initials: SE
authors.lastname: Sumida
authors.forename: S K
authors.initials: SK
authors.lastname: Roach
authors.forename: D E
authors.initials: DE
authors.lastname: Drajpuch
authors.forename: D L
authors.initials: DL
authors.lastname: Irizarry
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics / Q000295:instrumentation*; D002779:Cholestasis / Q000473:pathology*; D004866:Equipment Contamination; D019544:Equipment Failure Analysis; D017743:Equipment Reuse / Q000191:economics; D005260:Female; D001411:Geobacillus stearothermophilus / Q000254:growth & development; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000191:economics / Q000295:instrumentation*; D013242:Sterilization / Q000191:economics