Reusable vs Single-Use Duodenoscopes: The Environmental Cost- Endoscopy Feb.26

Introduction

Duodenoscope-related infection outbreaks—largely linked to reprocessing failures—drove the development of single-use duodenoscopes to eliminate cross-contamination risk. The safety argument is compelling. But ERCP already sits in a resource- and waste-heavy environment, and healthcare is increasingly being held accountable for its environmental impact.

This study tackles a question many endoscopy leaders are now facing:

If we move to disposable duodenoscopes, what is the environmental cost—and is universal single-use sustainable?

Problem statement

The clinical trade-off is no longer just infection control vs cost. It now includes a third axis: environmental responsibility.

Single-use devices are incinerated as biomedical waste, and many are made predominantly from plastics and resins. Until now, we have lacked high-resolution data on:

• what these scopes are actually made of, and
• where the main carbon burden comes from (manufacturing vs transport vs disposal vs reprocessing).

What the study did:

A single-center team compared:

• one reusable duodenoscope, and
• two single-use duodenoscopes from different manufacturers (A and B).

They did two things:

1. Material composition testing (what metals and plastics are inside).

2. Life-cycle assessment (LCA): a “cradle-to-grave” carbon footprint estimate covering production, transport, reprocessing (for reusable), and end-of-life disposal (incineration for single-use).

They modeled three real-world strategies over the usable lifetime of one reusable scope:

• All reusable
• All single-use
• Reusable with selective single-use (e.g., MDRO colonization/urgent cases)

Key findings clinicians should understand

1) Reusable scopes are mostly metal; single-use scopes are mostly plastic

Reusable duodenoscopes are largely built from metal alloys (high recyclability).

Single-use devices are largely made of plastic polymers/resins (high incineration burden), and composition varies by manufacturer.

2) The major environmental hit for single-use is not transport—it’s disposal

Because single-use scopes are biomedical waste, they are typically incinerated, and this step becomes a dominant driver of emissions.

3) Universal single-use creates a very large environmental footprint

Across the modeled lifetime of one reusable scope, switching to “all single-use” produced dramatically higher total carbon emissions than staying reusable.

4) “Selective single-use” is a compromise strategy

Using single-use scopes only for higher-risk situations (e.g., MDRO colonized patients, urgent cases where reprocessing logistics are limiting) reduces the environmental burden substantially compared with universal single-use—while still targeting the safety benefit where it’s most relevant.

5) Not all single-use scopes are equal

The two single-use devices differed in per-scope carbon footprint, driven by differences in materials used. This supports the authors’ call for carbon footprint labeling to enable greener procurement decisions.

Clinical interpretation

This is not an “anti single-use” paper. It is a systems-level warning:

If we default to universal single-use duodenoscopes—especially in high-volume ERCP centers—the environmental cost becomes difficult to justify without strong patient-outcome benefits.

A more balanced approach emerges:

• Keep reusable as the default, with optimal reprocessing and/or improved designs (e.g., disposable components/endcaps), and
• reserve single-use for carefully defined indications where the infection-control advantage is highest.

Conclusion

Single-use duodenoscopes reduce cross-contamination risk, but universal adoption carries a substantial environmental burden—largely driven by plastic-heavy composition and mandatory incineration. The most realistic path forward is selective use plus better reprocessing and device design, supported by transparent carbon footprint labeling so endoscopy units can make informed, sustainable choices.

Optional GastroAGI “Clinician Takeaway”

Single-use duodenoscopes improve infection control, but universal adoption is environmentally costly—selective use may be the most responsible compromise.