Preventing Cross-Contamination in Endoscopy

In response to current incidents involving cross-contamination with conventional endoscopy, lately the focus seems to be less on enhancing image quality and more so on efficiency and cleanliness.

Endoscopy equipment, a minimally invasive medical tool first used in the 19th century, has expanded to a wider use today, with applications ranging from external organs such as the ear, nose, and throat to complex endoscopy of the gastrointestinal tract, respiratory tract, and spinal surgery. Endoscopy has evolved since its humble beginnings. Over the past decade advances have been made in the rapid evolution of endoscopic visual assessment of the bowel and its role in the management and prevention of colorectal cancer. Specialized endoscopes with larger channels, smaller diameters, enhanced imaging capabilities, and other unique differences are now becoming available to help doctors choose exactly the right tool for each patient’s care.

Endoscopes are also being made smaller and with more technology packed into each device. Enhanced resolution (high definition), increased maneuverability, and decreased size of insertion tube diameter are just a few of the features being marketed by OEMs. In addition, endoscope manufacturers continue to pay close attention to the cleaning and reprocessing of each endoscope model, ensuring that users have access to validated methods of disinfection for peace of mind. An additional paradigm shift is moving away from traditional eye piece (fiber) scopes to video equivalents that have a much clearer picture and higher resolution, such as video ureteroscopes. This allows the surgeon greater clarity and ease of performing a procedure.

Technological Advances
The advances and innovations in technology have brought a revolution in the field of endoscopy and abdominal imaging and have improved beyond the expectations of traditional imaging techniques and explorative surgeries. Increasing progress has recently been made in endoscopic technologies such as improvement in illumination source, narrow band imaging, and visualization of the vascular and tissue characterization with a focus on infection control for more precise diagnosis.

Disposable endoscopes. Lately, the focus seems to be less on enhancing image quality and more so on efficiency and cleanliness. In response to current incidents involving cross-contamination with conventional endoscopy, there has been development and testing of single use video endoscopes as well as a disposable sheath prototype for both a gastroscope and colonoscope. This endoscope allows complete isolation of the scope itself encapsulated with a disposable sheath system. The disposable sheath system includes a sheath cover and cuff which incorporates all working channels for suction, irrigation, and tool passage. This allows the contaminated part of the procedure, the disposable sheath, to be discarded after patient use reducing the risk of endoscopic bioburden cross-contamination and infections. As for the single use endoscope, upon completion of the procedure the entire scope is discarded.

Advances in flexible endoscopes. Flexible endoscopes for gastroenterology and pulmonology are continuing to evolve along multiple vectors in order to meet the simultaneous needs of doctors for better access to hard-to-reach parts of the anatomy, better image quality, and advanced modes of visualization, more ergonomic handling, and durability that holds up under heavy daily use. Significant advancements also have been made in flexible scope technologies. Leveraging distal-chip technology, for instance, the industry is migrating more fully to the use of digital imaging versus traditional coherent glass fiber endoscopes, such as video endoscope systems for ENT and GI applications, among others.

Improved rigid endoscopes. There have been significant advances in the light output of rigid endoscopes over the past 5–10 years. Other milestones have occurred in the functional aspects of rigid scopes, which have added new capabilities at times. A good example is the development of rigid rod-lens scopes with technology designed to enable surgeons to select a desired direction of view using an adjusting knob. Another example is development of scopes that are used with near-infrared and ultraviolet light sources in combination with optical imaging agents to enhance imaging and aid in treatment of certain disease states, or to assess perfusion.

LED illumination technology. More recently, LED technology is becoming the preferred light source for endoscopy because of its long life, stability, reliability, and ease of integration into endoscopy units. Combined with the rapid evolution of microelectronics and optics, LED illumination has enabled new advances and applications in the field. Its relatively long lifespan eliminates the requirement to change xenon sources during the life cycle of the endoscopy system. More modern LED systems allow for active CCT adjustment in the field. Having the white light consist of separate RGB lasers or LEDs allows the user to adjust the level of each visible color to their comfortable white or CCT level. This variable feature reduces surgeons’ eye strain and optimizes contrast of the tissue morphology under observation. The LED systems also can couple effectively with current RGB cameras, as the RGB wavelength can be precisely tuned for optimum signal-to-noise ratio.

Narrow band imaging. NBI, classified as an optical-digital method, is an advanced endoscopic imaging technology that has recently been developed, in which spectral bandwidth filters are used to improve the accuracy of diagnosis. Although endoscopy using NBI is remarkably useful for differential diagnosis of superficial gastric lesions that are identified under white light, there seems to be very little evidence to justify routine use of NBI during routine screening endoscopy. NBI processors with higher light intensities have been developed that may potentially improve detection rates and these newer-generation NBI processors are currently being launched commercially.

Assisting algorithms. Today, endoscopic visualization is significantly influenced by video algorithms that are usually part of the camera head and/or camera control unit. The goal of using such algorithms in endoscopic camera settings is to improve the image quality automatically to give the user the best performance. One of the biggest problems in the past for end users was the need to deal with defective pixel errors of the image sensor, which can be caused by issues such as cosmic radiation during shipment in an aircraft. Such errors can be disrupting and may interfere with a procedure. Modern cameras are equipped with dynamic pixel-error detection and correction that eliminate such pixel errors continuously.

Hybrid endoscopes. In an ongoing research project Hybrid Optical and Optoacoustic Endoscope for Esophageal Tracking (ESOTRAC), engineers and physicians have been aiming to develop a novel hybrid endoscopic instrument for early diagnosis and staging of esophageal cancer. The hybrid endoscope combines sensing of pathophysiological tissue signatures resolved by multispectral optoacoustic (photoacoustic) tomography (MSOT) with morphological disease signatures provided by optical coherence tomography (OCT).

Road Ahead
As time advances so does the technology. Every year newer versions of the tools that are smarter, smaller, lighter, and more accurate than before are launched. Recent improvements in technology have paved the way for miniaturized and disposable endoscopes. Globally, the endoscopy equipment market is likely to take a transformational leap forward with ongoing rapid technological advancements that will result in the market to generate revenue of USD 41,813.42 million by the end of 2021, growing at a CAGR of 6.12 percent between 2018 and 2021, according to Zion Market Research. Moreover, with the increase in demand for ground-breaking technologies, newer versions of endoscopes including capsule and robot-assisted endoscopes will gain traction in the near future.