1. Boston Scientific’s Radial Jaw Biopsy Forceps. Ms. Curran says the single use (not reusable) stainless steel tipped forceps cost the ASC about $10 apiece, but saves the cost of cleaning and reprocessing the reusable Merrimack formerly used. Single use accessories also eliminate the risk of cross-contamination.
“Many companies make them and each has its own beneficial features, but we like the design of the Boston Scientific model, which takes a very clean, adequate size bite of tissue and doesn’t rip it away,” she says. “It’s easy to use and works well.”
2. Carr-Locke Injection Needles by US Endoscopy. These needles are used in endoscopy procedures for injecting medications during the procedure. They are named after their inventor, Dr. David Carr-Locke, and manufactured by US Endoscopy.
“We inject medications to stop bleeding, we tattoo lesions by injecting ink and we inject mucosa with saline solution to raise polyps, making them easier to remove,” Ms. Curran says.
She points out that some needles don’t function well, particularly if there is twisting in the scope. “This one opens and closes regardless of the twisting in the colon,” she says. “Some other needles have a plastic sheath and the needle can poke through and damage the scope or injure the patient. The Carr-Locke is radiopaque and can be seen under the fluoroscope. It is one of few needles that work well in a side viewing scope.”
She says her ASC pays about $35 for the needles.
3. Cold snare forceps. Dr. Reichheld says cold snare polypectomy has been recommended over the electrocautery method of polyp removal for smaller polyps, excising polyps under 10 mm in size with a low risk of bleeding and perforation.
“Hot snaring (biopsy polyectomy) can burn or char right through the colon wall and cause pain, localized infection or perforation,” he says. “With cold snaring, this never really happens. The cold snaring method gets small polyps more completely, is equally safe with better efficacy. It also costs less and avoids the cost of a cautery pad and use of a cautery wire and machine.”
4. Guardus Overtube by US Endoscopy. This product is used over a gastroscope to protect the airway when removing a foreign body from a stomach, such as a food impaction or a swallowed object.
“We’ve had cases where people have swallowed coins, and even a toothbrush,” says Ms. Curran. “We recently removed a dental drill from the stomach of someone who was having a root canal. But food impactions are more common.
“The overtube is used to keep objects from falling into the trachea when removing them from the stomach or esophagus. We also use overtubes for placing a small bowel camera capsule in patients with swallowing problems. If they are unable to swallow the camera capsule, we can place it in the stomach for them, protecting the airway by using the overtube.”
5. High-definition endoscopes. Dr. Reichheld calls these high-end products “a new standard everyone should strive to meet. They likely reduce the time it takes to get into the depths of colon and produce a higher quality exam. The key point is this is something patients are becoming savvy about as the latest big thing in endoscopic technology and will ask for them.”
He says Olympus, Pentax and Fuji, best known for their cameras and lenses, but long known for their high-quality scopes, produce the best of these new products.
“It will take a few years to show that these new technologies are having a huge impact, but I believe they will be shown to improve quality of care and efficiency.”
He points out that new model scopes by Olympus and Pentax offer specialized imaging through specified wave lengths of light that can highlight features not as visible to the naked eye. Olympus calls it “narrow band imaging.”
“I believe it will improve polyp detection and has been proven to detection of abnormalities within esophageal disorders,” he says.
The new colonoscopies cost $35,000-$40,000.
6. MD Technologies Environ-Mate DM6000 Suction-Drain System. Endoscopy units require continuous suction of bodily fluids during endoscopies. Suction is connected to the endoscope to remove any excess bodily fluids to obtain better visualization. Ms. Curran says unlike the suction systems in hospitals and some endocenters, this system drains directly into a sewage system.
“Most suction systems in hospitals have disposable containers which need to be changed after each procedure,” she says. “Exposure to those fluids in the containers could be hazardous. And these plastic containers when full must be disposed in hazardous waste areas, which can be expensive. But we’re not exposed to any fluids at all with this system. Everything goes into a canister in the wall, which empties into the sewage system, similar to a toilet plumbing. There’s no risk of exposure to bodily fluids and a huge savings on the cost of disposal and the time and effort to change the containers.”
She says the initial investment of $35,000 in the system, including a central vacuum system, saves the ASC about $16,000 annually. “The lack of exposure is the real benefit, though,” she says.
7. Olympus180 Series FlushingScopes. Ms. Curran says many gastroenterologists used to wash away blood or stool particles by using a syringe to irrigate through the biopsy channel. That tends to be inefficient and increases the chance of exposure to bodily fluids. She says the Olympus flushing system attaches a bottle of sterile water and tubing to the endoscope.
“Anytime the doctor wants to irrigate, washing away blood or stool to get a better visual, he or she can step on the foot pedal to flush and clean the area,” she says. The system costs around $1,600.
“The doctors love it,” she says. “It definitely allows the physician to do a much more thorough examination and it’s a time saver. The cost of the Olympus flushing system can easily be justified by the benefits of a better exam.”
James Reichheld, MD, agrees. Dr. Reichheld says an automated lavage (wash) machine can improve procedures.
“It washes the lining of the colon to offer a better view,” he says. “This used to be done manually by staff. But in the last several years he has routinely used this machine, which plugs into the scope and provides a nice firm jet of water. It’s freed a staff member from doing manual washes and you get a better exam in less time. I use it with every colonoscopy.”
8. Polyp traps. Ms. Curran prefers MD Technologies’ polyp trap. This $1.99 product collects snare-removed polyps that have been suctioned through the endoscope.
“The polyps are very easy to retrieve using this system and almost impossible to lose,” she says. “They’re simple and inexpensive with a great design.”
Dr. Reichheld recommends using a simple baleen trap to retrieve excised polyps, such as the version produced by NM Beale Company, which arrive in trays.
“It’s a small pocket of net in the suction tubing so when the polyp is retrieved, it’s caught in the net,” he says. “So there’s no worry about losing a polyp in the suction system. It’s easy to use and very inexpensive.”
Contact becker@beckersasc.com.
