Device Overviews & Specifications - Comparative Data

Duodenoscopes; Gastroscopes; Choledochoscopes; Video Systems,

Endoscopic, Ingestible Camera
Published 3/1/2013

EXECUTIVE SUMMARY
Comparison Charts
Duodenoscopes; Gastroscopes; Choledochoscopes; Video Systems, Endoscopic, Ingestible Camera

Chart A: Duodenoscopes; Gastroscopes; Choledochoscopes

Chart B: Ingestible Camera Endoscopic Video Systems

This Product Comparison covers fiberoptic and video flexible duodenoscopes, gastroscopes, and choledochoscopes and lists the light sources and video processors that can be
used with them. Ingestible video capsules are included in a separate chart.
Gastroscopes are used to view and administer therapy to the interior of the esophagus and the stomach for diagnosing and managing upper-GI disorders (e.g., ulcers, lesions).
Therapeutic GI procedures performed through the scope’s working channels typically include biopsies, electrosurgery, and laser surgery.
Duodenoscopes are flexible endoscopes used for visual diagnosis, treatment, and documentation of diseases of the duodenum—the first segment of the small intestine. One
common duodenoscopic procedure is endoscopic retrograde cholangiopancreatography (ERCP), which is used to diagnose disorders of the pancreaticobiliary tree; disorders of the
pancreas can sometimes be diagnosed as well. The gallbladder, the pancreas, and the liver all contribute digestive juices through a common duct that opens into the duodenum at
the papilla of Vater (see Figure 1). In the ERCP procedure, the duodenoscope is advanced past the pyloric valve at the base of the stomach into the duodenum. After the
endoscope has been positioned, the papilla of Vater can be visualized and cannulated. A radiopaque liquid contrast medium is injected into the bile duct opposing the usual
direction of flow of the digestive juices (hence “retrograde”) for fluoroscopic imaging and radiographic recording of the pancreatic and common bile ducts. Duodenoscopes can
also be used to guide the placement of feeding tubes by following their advancement through, for example, the jejunum.
Choledochoscopes are small-caliber, flexible endoscopes that allow direct visualization of the pancreaticobiliary tree. These instruments are commonly inserted via the ERCP
channel of a duodenoscope. The endoscopist’s ability to sample lesions and pass therapeutic instruments through the choledochoscope permits endoscopic treatment for cases
in which abdominal surgery would have otherwise been the only option. Applications include visualizing and sampling defects and strictures and fragmenting and removing stones
from the biliary tree and gallbladder.

The following device terms and product codes as listed in ECRI Institute's Universal Medical Device Nomenclature SystemTM (UMDNSTM) are covered:

Cameras, Video, Ingestible [20-392]

Choledochoscopes [10-831]
Duodenoscopes [11-359]
Duodenoscopes, Video [17-654]
Gastroscopes, Flexible [11-857]
Gastroscopes, Flexible, Video [17-663]
Video Systems, Endoscopic, Ingestible Camera [20-391]

These devices are also called: upper-gastrointestinal (GI) endoscopes, capsule endoscopes, video capsule endoscopes (VCEs), wireless endoscopes, or endoscopy pills.

Comparison Charts
Duodenoscopes; Gastroscopes; Choledochoscopes; Video Systems, Endoscopic, Ingestible Camera

Chart A: Duodenoscopes; Gastroscopes; Choledochoscopes

Chart B: Ingestible Camera Endoscopic Video Systems

Scope of this Product Comparison

This Product Comparison covers fiberoptic and video flexible duodenoscopes, gastroscopes, and choledochoscopes and lists the light sources and video processors that can be used
with them. Ingestible video capsules are included in a separate chart.
These devices are also called: upper-gastrointestinal (GI) endoscopes, capsule endoscopes, video capsule endoscopes (VCEs), wireless endoscopes, or endoscopy pills.

Purpose
Gastroscopes are used to view and administer therapy to the interior of the esophagus and the stomach for diagnosing and managing upper-GI disorders (e.g., ulcers, lesions).
Therapeutic GI procedures performed through the scope’s working channels typically include biopsies, electrosurgery, and laser surgery.
Duodenoscopes are flexible endoscopes used for visual diagnosis, treatment, and documentation of diseases of the duodenum—the first
segment of the small intestine. One common duodenoscopic procedure is endoscopic retrograde cholangiopancreatography (ERCP), which
is used to diagnose disorders of the pancreaticobiliary tree; disorders of the pancreas can sometimes be diagnosed as well. The
gallbladder, the pancreas, and the liver all contribute digestive juices through a common duct that opens into the duodenum at the papilla
of Vater (see Figure 1). In the ERCP procedure, the duodenoscope is advanced past the pyloric valve at the base of the stomach into the
duodenum. After the endoscope has been positioned, the papilla of Vater can be visualized and cannulated. A radiopaque liquid contrast
medium is injected into the bile duct opposing the usual direction of flow of the digestive juices (hence “retrograde”) for fluoroscopic
imaging and radiographic recording of the pancreatic and common bile ducts. Duodenoscopes can also be used to guide the placement of
feeding tubes by following their advancement through, for example, the jejunum.
Choledochoscopes are small-caliber, flexible endoscopes that allow direct visualization of the pancreaticobiliary tree.

© 2015 ECRI Institute
These instruments are commonly inserted via the ERCP channel of a duodenoscope. The endoscopist’s ability to sample
lesions and pass therapeutic instruments through the choledochoscope permits endoscopic treatment for cases in
which abdominal surgery would have otherwise been the only option. Applications include visualizing and sampling
defects and strictures and fragmenting and removing stones from the biliary tree and gallbladder.
Electrosurgical procedures can be performed using duodenoscopes, gastroscopes, and choledochoscopes under direct
vision by passing high-frequency current through a snare (a wire loop) or a point electrode inserted through the biopsy
channel. For example, a snare that is attached to an electrosurgical unit and inserted through the biopsy channel can be
used to remove a polyp from the GI tract. The snare is tightened around the stalk of the polyp, and coagulating and
cutting currents sent through the snare sever the polyp from the intestinal wall. The free-floating polyp is suctioned into
the tip of the endoscope, and the entire instrument is withdrawn.
In a procedure known as papillotomy or sphincterotomy, a catheter is passed through the instrument channel of the
duodenoscope to remove stenosed tissue from the papilla, permitting passage of gallstones.
The endoscopy pill, used in capsule endoscopy (CE), is a capsule containing one or two tiny video cameras that a patient
swallows and passes through the GI tract; the endoscopy pill records images within the small intestine which are difficult
to capture with normal endoscopic procedures and aid physicians in diagnosing diseases within the small intestine.
Although some capsules permit real-time viewing of the esophagus and small intestine during the journey, the exact
location of the capsule cannot be pinpointed. Additionally, the capsule endoscope is unable to autonomously treat sources of obscure bleeding when they are identified. CE is usually
performed after other diagnostic methods (i.e., upper and lower endoscopic evaluations) have yielded inconclusive or negative results.

Principles of Operation
Flexible duodenoscopes, gastroscopes, and choledochoscopes consist of a control housing, a flexible insertion tube ranging from about 2.8 to 12.8 mm in diameter, and an umbilical
cord connecting the scope to the light source, to the suction and irrigation air pump, and, in the case of video scopes, to the video processor. The control housing, which is designed
to be held in one hand, includes controls for distal tip (bending section) angulation, suction, insufflation, and water delivery and for the working channel ports; in fiberoptic scopes, the
proximal housing also contains the eyepiece. Fiberoptic scopes have image and light bundles that are sealed within a single flexible sheath. The bending section, located at the distal
tip of the insertion tube, can be flexed up/down or left/right by using hand-activated controls on the proximal housing.
On choledochoscopes, the objective lens is located on the distal end of the insertion tube, providing forward viewing. On
gastroscopes, the viewing aperture is located either on the distal end of the insertion tube or on the side of the distal tip
for lateral viewing. On duodenoscopes, the viewing aperture is located on the side of the distal tip to facilitate the ERCP
procedure.
Fiberoptic endoscopes, also called fiberscopes, have two types of fiberoptic bundles connecting the proximal and distal
sections: one or more light guides, which transmit light from the light source to the distal tip of the scope for field
illumination, and an image guide behind the objective lens, which returns the reflected light to the eyepiece (see Figure
2). The light and image guides consist of 30,000 to 50,000 fibers constructed to carry light bidirectionally, even when
they are flexed. Image-guide fibers are arranged coherently so that the relative position of each fiber is the same at both
ends of the scope. A mosaic image is reconstructed at the eyepiece. The smaller the diameter of the individual image
fibers, the better the resolution of the image; however, diameters smaller than about 5 µm are difficult to manufacture
because of the fragility of the glass fibers. Light-guide fibers, by contrast, are not coherently arranged, nor are they
typically as thin as image fibers. Video cameras can also be attached to fiberoptic endoscopes in order to permit
onscreen display.
Video endoscopy is the transmission of electronic image
data through the scope to an external video processing unit.
The video endoscope uses a charge-coupled device (CCD)
located at the distal tip of the scope to obtain images. The
image data is transmitted through wires to the video
processor, where it is formatted for display on a color video monitor; the need for an image guide and eyepiece is
eliminated (see Figure 3). In flexible gastroscopes and duodenoscopes, this direct method typically provides a better video
image than the indirect method of coupling a video camera to a conventional fiberoptic ​endoscope’s eyepiece. The
images transmitted to the screen can be recorded on a videocassette or DVD, printed using a video printer, stored on a
diskette, or transmitted to another location for simultaneous viewing.
Typically, one or more working channels are available for the introduction of surgical instruments through the endoscope
(see Figure 2). Suction is used to clear stomach and duodenal contents to improve visualization and minimize the risk of
the patient aspirating fluid and debris during endoscope removal. Air and water channels enable lens washing,
insufflation, and site washing. Lens washing is necessary throughout the procedure and is accomplished using either a
pressurized system or a manual syringe-type pump. Insufflation, using either air or carbon dioxide, enlarges the lumen for
easier and safer introduction and advancement of the endoscope; visualization can also be improved because the
increased lumen volume allows for more precise positioning of the endoscope tip.

Ingestible Camera Endoscopic Video Systems

CE is a noninvasive method for evaluating and diagnosing unidentified causes of symptoms within the esophagus and
small intestine. The vitamin-sized capsule, approximately 26 mm long and 11 mm in diameter, houses a color video
camera, an image sensor, an ultra-low-power radio-frequency transmitter chip, one or more light sources, and a battery.
Some capsules have two cameras (one at each end). The capsule naturally passes through the digestive system and is
protected from stomach acid and corrosive enzymes by a biocompatible seal. Each capsule is a single-use device.
A sensor array, similar to the leads used in electrocardiography (ECG), is adhered to the chest and receives the capsule’s image transmissions. The data recorder, worn around the
waist under clothing, stores image information. Once removed from its holding assembly, the capsule is activated and begins transmitting to the data recorder at a rate of two images
per second. The patient ingests the capsule, and image acquisition continues as long as the battery has power, capturing approximately 50,000 images in a 6- to 8-hour period.
During the examination, the patient is free to carry out his or her daily business but should avoid highly physical activity. The patient returns the data recorder to the facility upon
completion of the examination. The capsule is naturally excreted from the body, usually after 24 hr, and does not require recovery. Software on the workstation processes the image
data to produce a video of the small intestine, which the physician can view, edit, and archive, saving individual images and short video clips. Although CE is able to visualize deeper
into the GI tract than conventional endoscopy, image quality is sometimes inferior and physicians are unable to stop the camera or change viewing angles.
One model listed in the chart is used solely for imaging of the esophagus. This model transmits 18 images per second and has a battery life of only 30 minutes because a capsule will

© 2015 ECRI Institute
pass through the esophagus much more quickly than the small intestine.
Some software permits real-time viewing of the examination, but the image quality is not as clear as it is after processing. Localization software allows physicians to track the
progression of the capsule through the bowel during video capture, which may help physicians pinpoint the location of abnormalities. Some systems can detect the color red to help
physicians locate sources of bleeding.

Reported Problems
Although slight, the risk of complications (e.g., perforation of the GI tract) or death during endoscopic procedures does exist. Insufflation should be performed carefully because it has
been implicated in GI tract perforations. Other reported complications include ​cardiac arrhythmias and aspiration of stomach contents following extubation. Special care in
manipulating the scope is required in cases of GI bleeding—especially in the esophagus, where, because of restricted space, visibility is not as good as in the stomach. Breakage of
the distal-tip control wires within the endoscope has occurred, freezing the tip into a “J” shape and making removal hazardous.
Percutaneous endoscopic gastrostomy (PEG) is used to place a feeding tube into a patient without performing an open laparotomy. PEGs may lead to complications, such as the
development of fistulas, when PEG tubes are improperly inserted or become dislodged or clogged.
To minimize costly repairs, personnel should be educated on properly using, handling, cleaning, and storing flexible endoscopes. Striking the distal tip against a hard surface or
bending or twisting the scope with excessive force can damage the scope’s lens. If the scope’s delicate exterior sheath or the working channel is nicked or punctured by endoscopic
instruments, fluids can enter the inside of the scope and come in contact with the light fibers or CCD, as well as with mechanical components. In fiberoptic scopes, this can degrade
the image quality and angulation capability; in video scopes, this can result in an immediate loss of the video image. However, the majority of damage from fluid can be avoided if
leaks are detected early by properly leak testing the scope during reprocessing.
Improper reprocessing of flexible endoscopes and their accessories can increase the risk of spreading infection among patients. There has been debate over the need for high-level
disinfection (HLD) or sterilization of some endoscopes. Generally, this issue is addressed by each facility’s infection control and risk management departments and the decision is
usually based on clinical guidelines and use of the device. However, sometimes endoscope manufacturers specifically recommend either HLD or sterilization for a particular
endoscope. Flexible endoscopes require low-temperature sterilization such as ethylene oxide, gas plasma, and liquid chemical sterilization to prevent damage to heat sensitive
components. Units dedicated to high-level disinfection of flexible endoscopes are known as automated endoscope reprocessors (AERs).
Ethylene oxide (EtO) sterilization is safe and effective for scopes, although several hours of aeration time are required before reuse. Germicidal solutions, such as glutaraldehyde, are
often used for high-level disinfection, either as a substitute for or in conjunction with EtO sterilization. Glutaraldehyde residues are toxic and can have deleterious effects on patient
tissue if the scope is not properly rinsed. Staff must be aware of the risk of occupational glutaraldehyde exposure.
Hydrogen peroxide is an oxidizing agent used for high-level disinfection. Failure to rinse the instrument completely after disinfection may lead to pseudomembrane-like enteritis and
colitis in patients. Peracetic acid, or peroxyacetic acid, is an oxidizing agent also used for high-level disinfection and sterilization but it can corrode copper, brass, bronze, steel, and
galvanized iron; effects can be reduced by pH modifications. Peracetic acid is unstable when diluted, although it can be combined with hydrogen peroxide in supplier-specified
proportions to achieve high-level disinfection. Peracetic acid is also being used as a sterilant in systems in order to avoid the reuse of chemical solutions and rinse water common in
disinfectors and washers. Orthophthalaldehyde, also called CIDEX OPA, has mycobacterial activity and stability over a wide range of pH levels. It is being used as a replacement for
glutaraldehyde and is used primarily as a liquid germicidal agent for scopes.
Although CE is generally regarded as less stressful than conventional endoscopy, there are several risks and problems associated with this procedure. Interpretation of CE images is
associated with a slight learning curve because the bowel is viewed in a semicollapsed state and anatomic structures are magnified significantly differently than with conventional
endoscopes. The absence of insufflation to distend the bowel makes the bowel difficult to see, and some portions of collapsed bowel may be obscured entirely.
In some patients, advancement of the capsule may be so slow that the capsule’s battery is depleted before it reaches the stomach or the small intestine. In rare cases, the capsule
may get trapped by strictures or diverticulae, possibly leading to bowel obstruction. Therefore, individuals with suspected or known strictures (e.g., Crohn’s disease) should not be
recommended for CE examination. If the patient cannot visually confirm that the capsule has been excreted, abdominal x-rays may be needed to locate the device. In the most
serious cases, capsule retention may require endoscopic or surgical removal. The passage of a nonimaging, biodegradable patency capsule may be recommended beforehand for
patients with suspected strictures in order to determine their risk of capsule retention.
Undergoing a magnetic resonance imaging (MRI) exam while the capsule is still in the patient’s bowel may result in serious damage to the intestinal tract or abdominal cavity. Close
proximity to MRI scanners should also be avoided because the radio-interference may result in the loss of images and require a repeat procedure. Some studies have suggested
cardiac pacemakers may be a contraindication for CE procedures; however, more recent studies have shown CE in patients with pacemakers causes no negative effects and is
reasonably safe.

Purchase Considerations
Included in the accompanying comparison charts are ECRI Institute’s recommendations for minimum performance requirements. Chart A covers duodenoscopes, choledochoscopes,
and gastroscopes; recommended specifications have been categorized into three groups—choledochoscopes, duodenoscopes, and gastroscopes. Chart B covers ingestible camera
endoscopic video systems. Each category provides the minimum recommended requirements for each type of scope.

Duodenoscopes, Gastroscopes, and Choledochoscopes

The optical quality of the endoscope image is important; it is determined by (1) the ability of the fiberoptic cables and the light source to adequately illuminate the area under view and
(2) the ability of the fiberoptic lens system or video system to transmit a clear, bright image of the area to the eyepiece with as little distortion as possible. Endoscopes vary in their
image brightness and resolution, depth of focus, magnification, color differentiation, angle of vision, and field of view. While both videoscopes and fiberscopes depend on the light
guide to illuminate the area under view, videoscopes depend on the number of pixels on the CCD to display a clear, accurate representation of the structures under view.
Videoscopes and fiberscopes with cameras depend on the ability of image processors to transmit clear images to the viewing screen. ECRI Institute recommends videoscope
technology, which yields better image quality and avoids the “honeycombing” effect sometimes created by fiberoptics.
ECRI Institute recommends that the scope have at least one working channel with an inner diameter large enough to permit catheter insertion (about 2 mm). Graduation or length
markings in cm are also recommended to provide a reference for use during instrument insertion. Tip deflection should be greater than 90° in all directions. All endoscopes should be
compatible with multiple light sources; ECRI Institute prefers that all endoscopes be compatible with multiple reprocessors as well. Lens washing is recommended, as it permits
cleaning of the lens without removing the scope.

Ingestible Camera Endoscopic Video Systems

The capsule’s rate of travel depends on the patient’s peristalsis; therefore, the battery life should be long enough to permit visualization of the entire small intestine. ECRI Institute
recommends the capsule battery life be at least 8 hours. The external data recorder set should be able to receive image transmissions throughout the life of the capsule; therefore,
ECRI Institute recommends that data recorder set battery life be at least 8 hours as well. Additionally, capsules should transmit at least two images per second.

Other Considerations
Endoscopy service suites need to assess the means by which the scope can be cleaned and must review their endoscope reprocessing protocol and ensure that it coincides with the

© 2015 ECRI Institute
scope manufacturer’s reprocessing recommendations. It is important to remember that endoscope reprocessing instructions are model specific, i.e., different endoscope models
from the same manufacturer may have different reprocessing recommendations and guidelines. If EtO gas sterilization is the preferred reprocessing procedure, the purchase of
additional scopes may be needed to fulfill daily caseload requirements. Many facilities choose to automate part of their reprocessing with high-level liquid disinfecting or sterilizing
units.
When reviewing high-level disinfection or sterilization, users should consult the operator manual as well as the facility’s infection control and risk management departments. When
selecting an endoscope, facilities should consider the device’s sensitivity to heat, the time and temperature of rinsing required, the reuse life of the cleaning solution (e.g., single use,
21 days), and whether to use manual or automatic processing. If users decided on automatic reprocessing, facilities should check compatibility of the endoscope with the AERs or
sterilizers currently in use at the facility. Users should also verify that they have proper channel connectors (when applicable) and reprocessing accessories required to adequately
reprocess the scope. Shelf life, disposal restrictions, and minimum effective concentration of the cleaning solution should also be considered, as well as safety issues (e.g., eye or
respiratory irritation, skin staining) and cost per cycle.
Facilities should consider the educational options provided by the manufacturer. Preventive maintenance training can avoid costly repairs to delicate components.
Although it is gaining popularity in the medical community, CE is a relatively new technology and therefore is not eligible for reimbursement by all insurance companies. It is
recommended that facilities confirm that the patient meets the stipulated criteria before beginning the CE examination.

Environmental Considerations
As a result of increasing concerns over the environment and the conservation of resources, many manufacturers have adopted green shipping and production methods, as well as
features that improve the energy efficiency of their products or make them more recyclable. In addition, healthcare facilities and device manufacturers have begun to adopt green
initiatives that promote building designs and work practices that reduce waste and encourage the use of recycled materials.
Hospitals should look for manufacturers who offer take-back or trade-in programs. If a supplier does not offer such an arrangement, the hospital must absorb the costs of disposing
of the system according to local environmental protection laws when it is replaced.

Cost Containment
Service contracts for endoscopes vary greatly among suppliers and can cost anywhere from 6% to 13% of the scope’s list price per year, depending on the age, type, and condition of
the scope. In addition, some suppliers offer different levels of coverage depending on whether accidental damage will be covered and whether there is a price cap for repairs.
Service-contract options should be discussed with each supplier being considered to determine their cost-effectiveness.
Costs for the liquid disinfectant or sterilant used in endoscope reprocessing machines should be considered as an ongoing operational cost of the scope. Other costs associated with
gastroscopes, duodenoscopes, and choledochoscopes include hand instruments (disposable or reusable) and disposables (e.g., biopsy port covers).
Most suppliers offer additional video hardware, such as camera adapters, image processors, monitors, and image-archiving equipment.
The cost of single-use capsules needed for CE will far exceed the initial capital outlay. The average list price for one capsule is $400-500. Annual service contracts for the workstation
typically reflect 5-10% of the equipment list price.

Stage of Development
Recent developments have concentrated on image improvement. Video enhancements include motion-blur compensation and three-dimensional visualization.
Although gastroscopy has been used on older children and adolescents, the development of endoscopic instruments with smaller insertion tube diameters—typically less than 8 mm—
now allows examination of young children and infants.
Endoscopic ultrasound (EUS), explored by researchers to detect GI diseases such as esophageal cancer, gastric disease, and rectal cancer, allows physicians to evaluate and correctly
stage most GI cancers by deploying transducers to image submucosal tissues. Ultrasound probes, which are designed to pass through an endoscope’s working channel, produce
sound waves to create viewable images of endoscopically visible lesions in the upper-GI tract and other parts of the digestive system. They may also allow endoscopists to more
accurately calculate the dimensions of a tumor mass, including depth of penetration. The use of ultrasound probes has been recently supplanted by endoscopic ultrasound scopes—
hybrid endoscopes with ultrasound transducers. A radial ultrasound endoscope produces a 360°, cross-sectional image or slice while a curvilinear array ultrasound endoscope
produces an image in a single plane parallel to the long axis of the scope. When combined with fine needle aspiration (FNA), EUS provides an alternative to exploratory surgery for the
removal of tissue samples from abdominal and other organs. EUS-guided FNA can also be utilized for drainage, injection, and painkilling therapeutic procedures. EUS-guided FNA is
now part of the investigative algorithms for patients with pancreatic, esophageal, and rectal cancer.
Cap-assisted endoscopy, widely used for the treatment of early gastric cancer and the detection of lesions situated in blind areas of the GI tract, is being explored for the use in
patients with Billroth II gastrectomy.
Future trends will most likely involve continued development of diagnostic capabilities through improved image quality and expansion of the range of anatomic features that can be
seen. Researchers are investigating the application of computer-based imaging systems to GI endoscopy procedures. Such systems are intended to provide image enhancement,
online measurements, and immediate comparison with previously acquired images that have the same pathology.
One visualization system is specifically designed for cholangioscopy. The system includes a dedicated video system consisting of a camera, light source, and monitor. A standard
duodenoscope is used with the system along with a disposable access catheter, through which a disposable fiberoptic probe is delivered into the bile duct. This system may provide
advantages over a standard ERCP system as the scope is inserted directly into the bile duct and the system can be operated by a single physician (traditionally, a cholangioscopy
requires one physician to operate the duodenoscope and an assistant to steer the cholangioscope). This device has not been evaluated by ECRI Institute.
Future developments in capsule endoscopy will aim to address the shortcomings of CE (e.g., limited image quality). Methods for steering the capsule (i.e., with an external magnetic
device) are in development, which may lead to more efficient imaging procedures. Currently, CE is performed as a diagnostic procedure, but researchers are developing techniques to
equip the capsule with therapeutic capabilities, such as drug delivery systems.

BIBLIOGRAPHY
​Adler DG, Gostout CJ. Wireless capsule endoscopy. Hosp Physician 2003 May;39(5):14-22.
Berci G, ed. Endoscopy. New York: Appleton-Century-Crofts; 1976.
Bogardus ST Jr, Hanan I, Ruchim M, et al. “Mother-baby” biliary endoscopy: the University of Chicago experience. Am J Gastroenterol 1995 Jan;91(1):105-10.
Caulfield M, Wyllie R, Sivak MV Jr, et al. Upper gastrointestinal tract endoscopy in the pediatric patient. J Pediatr 1989 Sep;115(3):339-45.
Cotton PB, Williams CB. Practical gastrointestinal endoscopy: the fundamentals. 6th ed. New York: Wiley-Blackwell; 2008.
Dierdorf SF. The physics of fiberoptic endoscopy. Mt Sinai J Med 1995 Jan;62(1):3-9.
ECRI Institute. Capsule endoscopy for diagnosis of obscure small-bowel bleeding. In: Target [database online]. No. 819. 2007 Jun [cited 2013 Jan 14]. Available from Internet:
http://www.target.ecri.org.

© 2015 ECRI Institute
 Capsule endoscopy to screen for Barrett’s esophagus in high-risk patients. In: Target [database online]. No. 964. 2009 25 Mar [cited 2013 Jan 14]. Available from Internet:
http://www.target.ecri.org.
Choosing a low-temperature sterilization technology [guidance article]. Health Devices 1999 Nov;28(11):430-55.
Clear channels: ensuring effective endoscope reprocessing. [guidance article]. Health Devices 2010 Oct;39(10):350-9.
Liquid disinfecting and sterilizing reprocessors used for flexible endoscopes [evaluation update]. Health Devices 1994 Dec;23(12):477-81.
Reducing endoscopic contamination levels: are liquid disinfecting and sterilizing reprocessors the solution? [clinical perspective]. Health Devices 1994 Jun;23(6):212-3.
Studies of CT colonography report varying rates of diagnostic accuracy. Health Technology Trends 2004 Jul;16(7):1-4, 8.

Holland P. Know your scopes. Mater Manage Health Care 1997 Jun;6(6):27, 30, 32.
Lee YT. Cap-assisted endoscopic retrograde cholangiopancreatography in a patient with a Billroth II gastrectomy. Endoscopy 2004 Jul;36(7):666.
Nawras AT, Catalano MF, Alsolaiman MM, et al. Overtube-assisted ERCP in patients with altered gastric and esophageal anatomy. Gastrointest Endosc 2002 Sep;56(3):426-30.
Pelargonio G, Dello Russo A, Pace M, et al. Use of video capsule endoscopy in a patient with an implantable cardiac defibrillator. Europace 2006 Dec;8(12):1062-3.
Rey JF, Ladas S, Alhassani A, et al. European Society of Gastrointestinal Endoscopy (ESGE) video capsule endoscopy: update to guidelines. Endoscopy 2006;39(10):1047-53.
Westerhof J, Koornstra JJ, Weersma RK. Capsule endoscopy: a review from the clinician’s perspectives. Minerva Gastroenterol Dietol 2008 Jun;54(2):189-207.
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RESOURCE LIST
​Comparison Charts
Duodenoscopes; Gastroscopes; Choledochoscopes; Video Systems, Endoscopic, Ingestible Camera

Chart A: Duodenoscopes; Gastroscopes; Choledochoscopes

Chart B: Ingestible Camera Endoscopic Video Systems

Request for Proposal Templates

Duodenoscopes; Gastroscopes; Choledochoscopes; Video Systems, Endoscopic, Ingestible Camera

Chart A: Duodenoscopes; Gastroscopes; Choledochoscopes

Chart B: Ingestible Camera Endoscopic Video Systems

RELATED RESOURCES

Arthroscopes
Bronchoscopes, Flexible; Video
​Colonoscopes; Sigmoidoscopes
Flexible Endoscope Reprocessors, Automatic
Insufflators, Laparoscopic
Irrigation/Distention Systems, Arthroscopic
Laparoscopes
Light Sources, Fiberoptic
Sterilizing Units, Ethylene Oxide
Video Endoscopy Systems

TOPICS AND METADATA

Topics
Technology Selection
Caresetting
Endoscopy Facility
;
Hospital Inpatient
;
Hospital Outpatient
;
Ambulatory Surgery Center
Roles
Materials Manager/Procurement Manager
Information Type
Comparative Data
UMDNS
Duodenoscopes [11-359]
Duodenoscopes, Video [17-654]
Gastroscopes, Flexible [11-857]
Gastroscopes, Flexible, Video [17-663]
Choledochoscopes [10-831]
Cameras, Video, Ingestible [20-392]
Video Systems, Endoscopic, Ingestible Camera [20-391]

© 2015 ECRI Institute