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Duodenoscope Procedure
Health care providers use duodenoscopes in endoscopic retrograde cholangiopancreatography (ERCP). These procedures diagnose and treat diseases in the pancreas and bile ducts. But design flaws made them difficult to clean. This led to several outbreaks of antibiotic-resistant “superbug” infections and scope redesigns.
Featured Speaker:
Learn more about Juan Tejada, MD
Juan Tejada, MD
Juan Tejada, MD graduated from medical school from the Pontificia Universidad Catolica Madre y Maestra. He has completed a residency at The Brooklyn Hospital Center, and is also completing his fellowship in gastroenterology there. He is a member of the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, and the American College of Physicians.Learn more about Juan Tejada, MD
Transcription:
Duodenoscope Procedure
Joey Wahler (Host): A single use duo Denoscope is a potentially lifesaving procedure that diagnosis and treats problems in the pancreas and bile ducts. So we're discussing this procedure. This is Memorial Health Radio, a podcast from Memorial Health System. Thanks for listening. I'm Joey Wahler. Our. Dr. Juan Tejada, a gastroenterologist with a specialty in advanced interventional endoscopy with Memorial Health System. Dr. Tejada, thanks for joining us.
Dr Juan Tejada: Thank you. Thank you so much for inviting me today.
Joey Wahler (Host): Yes. Great to have you. And so, first, specifically, what conditions is this duo Deniscope, single procedure used for typically?
Dr Juan Tejada: Typically for Biliatal obstructions, including benign and malignant obstructions. Including the benign obstructions are stones that gets stuck in this common bio duct. That is the communication between the liver and the testing. And these conditions can be life threatening because they can cause infections and they can cause also, severe abdominal pain with elevation in Liver enzymes. But also, it's used to treat malignant obstruction, including cancer, especially of the pancreas.
Joey Wahler (Host): Now we'll get into some specifics, of course, in a moment about how it all works, but I'm glad you mentioned pancreatic cancer because we hear so much about how it's one of the most difficult cancers to fight. So how does this procedure help in that battle?
Dr Juan Tejada: When we talk about pancreatic cancer, we definitely need to stage the tumor. There is a procedure or the best way to stage it is within those topical ultrasound, but the best way to treat the obstruction is with the dua denoscope. In this case, the single use, not just help with the decompression of this doc, to the mass, which allowed the oncologist and also the surgeons proceed with the treatment after the procedure, but also the decrease or minimization of the risk of infection, cross contamination that used to be secondary to the use of reusable scopes.
It's completely eliminated with this single use in dose scope because the single use in dose scope, the risk of cross contamination is 0% because it's a completely, a sterile scope brand new used for one patient in specific.
Joey Wahler (Host): And I'm glad you mentioned that now, because one of my first questions was going to be what we mean by single use. You've just explained that. So let's start from ground zero, so to speak. And have you explain what a duo denoscope is and how it works?
Dr Juan Tejada: The denoscope is different scopes from the regular one that we know where we perform endoscopies and colonoscopies. The denoscope has a camera at the size of the scope in the tip that allows or facilitate the visualization of the anatomical part, which is where the common bowel duct drained from the liver in the small bowel.
Joey Wahler (Host): And so give people an idea, if you would, doctor just simply putting layman's terms, what this piece of equipment looks like and what it does.
Dr Juan Tejada: It's the tube with the camera in the tip, very similar to the scopes that we are used to. But as I told you before, has a camera on the side, through these working channels, which is next to the camera. We can actually pass instruments that are gonna allow us the access to this small, common bile duct, which the opening is about one millimeter in size. It's very difficult if we have patients with a normal anatomies or patients with different, kind of situations, including tumors to pass this wire without this duo denoscope, which is a specialist scopes for these kind of cases.
Joey Wahler (Host): Gotcha. Now a duo denoscope also has an elevator mechanism to perform very delicate procedures. How does that function?
Dr Juan Tejada: That is, one of the characteristic of duo denscope that has this piece in the tip that allows the instrument to be positioned in the direction of the bile duct, which is very challenging. Because as I told you before, it's one millimeter in size, the opening, but also the anatomy can change a lot, the position. That is why we need a flexible scope, but also a tip with the elevator to try to redirect those instrument in the place that we want to go through.
Joey Wahler (Host): And the fact that it has that elevator mechanism where you can go beyond just looking, but actually working, does that make it considered robotic surgery in a sense or not necessarily?
Dr Juan Tejada: It's not a robotic surgery because this is purely managed by the human hands. The only difference is between the robotic and this endoscopy is, we don't use a robot during endoscopies. We just use the scope and we manipulate the scope through the wheels, which are in our hands.
Joey Wahler (Host): Understood now, this is a relatively new procedure. So from your experience, how has it evolved and improved during the time it's been available?
Dr Juan Tejada: The procedure is actually not practically new. The procedure has been for a long time. The new part of the whole process is the scope. Which is a disposable scope. It's a scope that, we can use to perform the same ERCP or procedure for the cannulation of the common bilre duct in treatment of obstruction without use a reusable scope that has some bacterias that can grow in the device because the reusable scopes are very difficult to clean. While the single use doesn't need any cleaning process because it's a completely sterile scope, brand new ready for one patient individually.
Joey Wahler (Host): Well, that's what I meant by the way is the fact that it's this type of scope that is relatively new to be used as you point out with a procedure that of course has been around for quite some time. But to your point, because of the fact that it is again, as we've mentioned single use, you're saying that infection has basically been either eliminated or certainly the chances are cut way down.
Dr Juan Tejada: That's right, but also the expenses in the cleaning process of the scopes has been also eliminated because doesn't require any reprocessing, doesn't require any very tedious, more than a hundred steps, reprocessing process. Those are the things that we actually can take at advantage because we have a brand new scope ready to use, and we don't have to wait for the scopes to be clean, to start the next procedure.
Joey Wahler (Host): And so for instance, in the case of pancreatic cancer, what are the benefits that a patient suffering from that would receive by virtue of this procedure?
Dr Juan Tejada: Most of the patients with the pancreatic cancer needs to have a stent placement. These stent placement are through the scope, the working channel, which in reusable scope. When it's contaminated, we can actually introduce infection. The infection risk cross contamination is about 15%, studies already have been done. And we can eliminate that risk in a patient that is so critical that has already upon chronic mass cancer patient. And if we eliminate this 15% risk, we already on the right side of the story.
Joey Wahler (Host): So you've talked about eliminating contamination and infection right there. You mentioned earlier that this enables you to get into very tight spaces. And so is there any downside potentially, are there any risks involved? I mean, there are always risks involved or just about anything in terms of a procedure, but in this case, what would they be?
Dr Juan Tejada: The risk of the procedures are a standard, even with the single use, meaning the risk of pancreatitis, perforations are already, present even though with the reusable scopes. I haven't seen any downfall in the use of the single use compared with the previous scopes. What is very important is the risk of infection or cross contamination is completely eliminated by using the single use.
Joey Wahler (Host): And based on what you see in your practice, what would you say to people about how common this is? How many of these you do give people an idea of that?
Dr Juan Tejada: We do over 300 ERCPs in a year, out of 50 of these procedures, at least 15%. One of the patients are gonna have a cross contamination. We already eliminate that with a single use. We also treat in these conditions and we don't have to worry about the processing or the scope get damaged or broken because we have a brand new scope ready, which is gonna decrease the waiting time for the patient is our procedure that sometimes it needs to be done in an emergency basis. So we already have the scope ready. And again, the risk of cross contamination is already eliminated.
Joey Wahler (Host): And when you say ERCP, just explain to our audience, please. What that stands for?
Dr Juan Tejada: ERCP stands for endoscopic retrograde cholangiopancreatography. That means we are introducing a catheter through the common bile duct from the mobile inside of the liver. And we are trying or place a stent in case of pancreatic masses that gives obstruction or remove a stones from the common bowel duct that can also cause infection due to the obstruction.
Joey Wahler (Host): And so this am I right, is considered to be minimally invasive?
Dr Juan Tejada: Yes. Minimal invasive procedures that doesn't require any open surgery or any further intervention.
Joey Wahler (Host): And so is it similar to other scopes done by gastro doctors where you're in and out the same day?
Dr Juan Tejada: Yes, mostly it's outpatient procedure, but again, this has to be performed by somebody that is already trained after the regular gastroenterology training. That is why it's very important to make notice that this procedure has to be performed by somebody that is already capable to perform at least more than a hundred of these type of procedures in one year.
Joey Wahler (Host): And of course that would include you, which is why we're talking to you about it. So, in closing here, what would you say to our audience, to you as an MD specializing in this? What doctor is to you the most exciting part of this particular procedure in terms of helping people?
Dr Juan Tejada: The value of the single use in helping to perform this very complex procedure, decreasing the complications due to the cross contaminations is invaluable too. Because we are not just doing a procedure that is a life saving, but also we decreasing the complications from the procedure. It's also one of the big aspect of this process. And when we talk about change in technology, we always want to make sure that we take in consideration the human being behind the process.
Joey Wahler (Host): Very good distinctions made by you right there in closing. And so folks we trust you are now more familiar with the benefits of a single use duo denoscope. Dr. Juan Tejada. Thanks so much again.
Dr Juan Tejada: Thank you.
Joey Wahler (Host): And for more information or to connect with a provider, please do visit mhsystem.org. Again, that's m hsystem.org. Please remember to subscribe, rate and review this podcast and all the other Memorial Health System podcast as well. If you found this one helpful, please do share it on your social. And thanks for listening to Memorial Health Radio, a podcast from Memorial Health System, hoping your health is good health. I'm Joey Wahler.
Duodenoscope Procedure
Joey Wahler (Host): A single use duo Denoscope is a potentially lifesaving procedure that diagnosis and treats problems in the pancreas and bile ducts. So we're discussing this procedure. This is Memorial Health Radio, a podcast from Memorial Health System. Thanks for listening. I'm Joey Wahler. Our. Dr. Juan Tejada, a gastroenterologist with a specialty in advanced interventional endoscopy with Memorial Health System. Dr. Tejada, thanks for joining us.
Dr Juan Tejada: Thank you. Thank you so much for inviting me today.
Joey Wahler (Host): Yes. Great to have you. And so, first, specifically, what conditions is this duo Deniscope, single procedure used for typically?
Dr Juan Tejada: Typically for Biliatal obstructions, including benign and malignant obstructions. Including the benign obstructions are stones that gets stuck in this common bio duct. That is the communication between the liver and the testing. And these conditions can be life threatening because they can cause infections and they can cause also, severe abdominal pain with elevation in Liver enzymes. But also, it's used to treat malignant obstruction, including cancer, especially of the pancreas.
Joey Wahler (Host): Now we'll get into some specifics, of course, in a moment about how it all works, but I'm glad you mentioned pancreatic cancer because we hear so much about how it's one of the most difficult cancers to fight. So how does this procedure help in that battle?
Dr Juan Tejada: When we talk about pancreatic cancer, we definitely need to stage the tumor. There is a procedure or the best way to stage it is within those topical ultrasound, but the best way to treat the obstruction is with the dua denoscope. In this case, the single use, not just help with the decompression of this doc, to the mass, which allowed the oncologist and also the surgeons proceed with the treatment after the procedure, but also the decrease or minimization of the risk of infection, cross contamination that used to be secondary to the use of reusable scopes.
It's completely eliminated with this single use in dose scope because the single use in dose scope, the risk of cross contamination is 0% because it's a completely, a sterile scope brand new used for one patient in specific.
Joey Wahler (Host): And I'm glad you mentioned that now, because one of my first questions was going to be what we mean by single use. You've just explained that. So let's start from ground zero, so to speak. And have you explain what a duo denoscope is and how it works?
Dr Juan Tejada: The denoscope is different scopes from the regular one that we know where we perform endoscopies and colonoscopies. The denoscope has a camera at the size of the scope in the tip that allows or facilitate the visualization of the anatomical part, which is where the common bowel duct drained from the liver in the small bowel.
Joey Wahler (Host): And so give people an idea, if you would, doctor just simply putting layman's terms, what this piece of equipment looks like and what it does.
Dr Juan Tejada: It's the tube with the camera in the tip, very similar to the scopes that we are used to. But as I told you before, has a camera on the side, through these working channels, which is next to the camera. We can actually pass instruments that are gonna allow us the access to this small, common bile duct, which the opening is about one millimeter in size. It's very difficult if we have patients with a normal anatomies or patients with different, kind of situations, including tumors to pass this wire without this duo denoscope, which is a specialist scopes for these kind of cases.
Joey Wahler (Host): Gotcha. Now a duo denoscope also has an elevator mechanism to perform very delicate procedures. How does that function?
Dr Juan Tejada: That is, one of the characteristic of duo denscope that has this piece in the tip that allows the instrument to be positioned in the direction of the bile duct, which is very challenging. Because as I told you before, it's one millimeter in size, the opening, but also the anatomy can change a lot, the position. That is why we need a flexible scope, but also a tip with the elevator to try to redirect those instrument in the place that we want to go through.
Joey Wahler (Host): And the fact that it has that elevator mechanism where you can go beyond just looking, but actually working, does that make it considered robotic surgery in a sense or not necessarily?
Dr Juan Tejada: It's not a robotic surgery because this is purely managed by the human hands. The only difference is between the robotic and this endoscopy is, we don't use a robot during endoscopies. We just use the scope and we manipulate the scope through the wheels, which are in our hands.
Joey Wahler (Host): Understood now, this is a relatively new procedure. So from your experience, how has it evolved and improved during the time it's been available?
Dr Juan Tejada: The procedure is actually not practically new. The procedure has been for a long time. The new part of the whole process is the scope. Which is a disposable scope. It's a scope that, we can use to perform the same ERCP or procedure for the cannulation of the common bilre duct in treatment of obstruction without use a reusable scope that has some bacterias that can grow in the device because the reusable scopes are very difficult to clean. While the single use doesn't need any cleaning process because it's a completely sterile scope, brand new ready for one patient individually.
Joey Wahler (Host): Well, that's what I meant by the way is the fact that it's this type of scope that is relatively new to be used as you point out with a procedure that of course has been around for quite some time. But to your point, because of the fact that it is again, as we've mentioned single use, you're saying that infection has basically been either eliminated or certainly the chances are cut way down.
Dr Juan Tejada: That's right, but also the expenses in the cleaning process of the scopes has been also eliminated because doesn't require any reprocessing, doesn't require any very tedious, more than a hundred steps, reprocessing process. Those are the things that we actually can take at advantage because we have a brand new scope ready to use, and we don't have to wait for the scopes to be clean, to start the next procedure.
Joey Wahler (Host): And so for instance, in the case of pancreatic cancer, what are the benefits that a patient suffering from that would receive by virtue of this procedure?
Dr Juan Tejada: Most of the patients with the pancreatic cancer needs to have a stent placement. These stent placement are through the scope, the working channel, which in reusable scope. When it's contaminated, we can actually introduce infection. The infection risk cross contamination is about 15%, studies already have been done. And we can eliminate that risk in a patient that is so critical that has already upon chronic mass cancer patient. And if we eliminate this 15% risk, we already on the right side of the story.
Joey Wahler (Host): So you've talked about eliminating contamination and infection right there. You mentioned earlier that this enables you to get into very tight spaces. And so is there any downside potentially, are there any risks involved? I mean, there are always risks involved or just about anything in terms of a procedure, but in this case, what would they be?
Dr Juan Tejada: The risk of the procedures are a standard, even with the single use, meaning the risk of pancreatitis, perforations are already, present even though with the reusable scopes. I haven't seen any downfall in the use of the single use compared with the previous scopes. What is very important is the risk of infection or cross contamination is completely eliminated by using the single use.
Joey Wahler (Host): And based on what you see in your practice, what would you say to people about how common this is? How many of these you do give people an idea of that?
Dr Juan Tejada: We do over 300 ERCPs in a year, out of 50 of these procedures, at least 15%. One of the patients are gonna have a cross contamination. We already eliminate that with a single use. We also treat in these conditions and we don't have to worry about the processing or the scope get damaged or broken because we have a brand new scope ready, which is gonna decrease the waiting time for the patient is our procedure that sometimes it needs to be done in an emergency basis. So we already have the scope ready. And again, the risk of cross contamination is already eliminated.
Joey Wahler (Host): And when you say ERCP, just explain to our audience, please. What that stands for?
Dr Juan Tejada: ERCP stands for endoscopic retrograde cholangiopancreatography. That means we are introducing a catheter through the common bile duct from the mobile inside of the liver. And we are trying or place a stent in case of pancreatic masses that gives obstruction or remove a stones from the common bowel duct that can also cause infection due to the obstruction.
Joey Wahler (Host): And so this am I right, is considered to be minimally invasive?
Dr Juan Tejada: Yes. Minimal invasive procedures that doesn't require any open surgery or any further intervention.
Joey Wahler (Host): And so is it similar to other scopes done by gastro doctors where you're in and out the same day?
Dr Juan Tejada: Yes, mostly it's outpatient procedure, but again, this has to be performed by somebody that is already trained after the regular gastroenterology training. That is why it's very important to make notice that this procedure has to be performed by somebody that is already capable to perform at least more than a hundred of these type of procedures in one year.
Joey Wahler (Host): And of course that would include you, which is why we're talking to you about it. So, in closing here, what would you say to our audience, to you as an MD specializing in this? What doctor is to you the most exciting part of this particular procedure in terms of helping people?
Dr Juan Tejada: The value of the single use in helping to perform this very complex procedure, decreasing the complications due to the cross contaminations is invaluable too. Because we are not just doing a procedure that is a life saving, but also we decreasing the complications from the procedure. It's also one of the big aspect of this process. And when we talk about change in technology, we always want to make sure that we take in consideration the human being behind the process.
Joey Wahler (Host): Very good distinctions made by you right there in closing. And so folks we trust you are now more familiar with the benefits of a single use duo denoscope. Dr. Juan Tejada. Thanks so much again.
Dr Juan Tejada: Thank you.
Joey Wahler (Host): And for more information or to connect with a provider, please do visit mhsystem.org. Again, that's m hsystem.org. Please remember to subscribe, rate and review this podcast and all the other Memorial Health System podcast as well. If you found this one helpful, please do share it on your social. And thanks for listening to Memorial Health Radio, a podcast from Memorial Health System, hoping your health is good health. I'm Joey Wahler.