First time ever: successful operation with a single-use endoscope on immunodepressed child

Single-use endoscopes are the new boundary of instruments in terms of innovation. They have been recently introduced in the clinic and used so far only on adult patients. Until now. In the world, it is the first time that an immunodepressed child had a successful insertion of a single-use endoscope.

The advantage of a single-use endoscope is that, since they do not have to be ‘sanitized’ and ‘reprocessed’ they do not expose to the danger of infections during endoscopic procedures. That’s why they turned out to be so useful in immunodepressed patients, like the child of this case.


A single-use endoscope, the great utility during COVID-19 emergency

Given the high costs, they are reserved for immunodepressed adult patients and have come back of great use in the middle of the pandemic emergency from COVID-19.

At the Policlinico Universitario A. Gemelli IRCCS (Italy) the disposable endoscope Exalt has been successfully used for the first time also on a pediatric immunodepressed child with congenital immunodeficiency. Thanks to the UOC team of Digestive Surgical Endoscopy directed by Professor Guido Costamagna, Professor of General Surgery at the Catholic University in Rome, this operation was possible-

Below, the official communication by Policlinico Gemelli.


Exalt, the single-use endoscope

Exalt is the name of the brand-new disposable endoscope model and was first used in the world at Policlinico Gemelli. It has been used to assist a 7-year-old child suffering from biliary narrowing who was dilated with this high-tech instrument, explains the note.

The most important thing about these disposable instruments (the one used is Boston Scientific’s Exalt Model-D) is that, although expensive, they overcome all the problems linked to the meticulous disinfection and reprocessing that traditional endoscopes undergo after each use. When operating immunodepressed patients, such as the little patient admitted to the Policlinico Gemelli suffering from a very rare form of congenital immunodeficiency (DOCK8 deficiency, Dedicator of Cytokinesis 8), this fact is very important.

This rare disease exposed this child to a very high risk of infection.


Primary sclerosing cholangitis and single-use endoscope

The patient had developed primary sclerosing cholangitis while waiting for a hematopoietic stem cell transplant (marrow transplant). This is a disease that affects the biliary tract that causes bile to flow from the liver to the gallbladder and then to the duodenum and a narrowing of the biliary sphincter, to be treated by biliary sphinctomy using the ERCP (Endoscopic retrograde cholangiopancreatography) procedure, i.e. an incision of the outlet of the biliary tract in the duodenum, which is performed in endoscopy.

It is a delicate operation but necessary to prevent the stagnation of bile in the biliary tract. This may cause a possible infection (cholangitis), very dangerous in immunodepressed children, continues the official note of the polyclinic.

The endoscopic surgery was performed at the beginning of this month and the little one, assisted in collaboration with the doctors of the Pediatric Oncology Unit of Policlinico Gemelli, was discharged in excellent condition 48 hours after the treatment.


Policlinico Gemelli: the statement of Professor Costamagna on the single-use endoscope

“So far the Exalt single-use duodenoscope has been used only on adult patients”, explains Professor Guido Costamagna director of the UO of Digestive Surgical Endoscopy Department. At Policlinico Gemelli, the medical staff have had it available since last March and they used it to treat two COVID-19 patients, in the middle of the pandemic.

“For the first time in the world, we used this disposable endoscope on a 7-year-old girl weighing just 24 kilos.”

The single-use endoscope (a duodenoscope, precisely) represents a still expensive device, but certainly very useful in selected cases, such as immunodepressed patients. According to our experience, Exalt can be used safely even in small pediatric patients”.

The Exalt Model-D, the world’s first ‘single-use’ endoscope was awarded by the US Food and Drug Administration (FDA) with the Breakthrough Device Designation last December and received the CE mark in January this year, concludes the official note.

Each year, 1.5 million ERCP procedures are performed worldwide, 500,000 of which are performed in Europe.


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Primary Sclerosing Cholangitis



Official Website of Policlinico Gemelli

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