Technological review: developments in innovative duodenoscopes

ERCP is an endoscopic and radiographic procedure that permits diagnostic evaluation and therapeutic options for diseases of the pancreatobiliary system. ERCP uses a side-viewing duodenoscope to accomplish these tasks. The duodenoscope universally has an elevator mechanism at the distal tip to assist in cannulation and therapy at the biliary or pancreatic duct orifice. This recessed elevator mechanism makes reprocessing more complex and more difficult than other endoscopes without an elevator mechanism. The aim of this article is to review the risk of infection transmission from duodenoscopes, to describe the developments in innovative duodenoscope design, and to describe key decision points that individual institutions may consider to inform decision-making regarding the adoption and integration of U.S. Food and Drug Administration (FDA)-approved innovative duodenoscopes.