The Efficacy and Safety of Disposable Endoscopes in Reducing Persistent Microbial Contamination: A Systematic Review and Meta-Analysis Comparing Technical Performance with Reusable Endoscopes

Endoscopy is essential for diagnosis and treatment, but reusable endoscopes pose contamination risks despite strict cleaning. Disposable endoscopes may reduce this risk. This systematic review and meta-analysis evaluated their effectiveness in minimizing microbial contamination compared to reusable endoscopes. We searched PubMed, Web of Science, and Scopus up to March 1, 2024, for cohort, case-control, and RCTs comparing reusable and disposable endoscopes in terms of performance and contamination. Data were analysed using mean difference and risk ratio with 95% CI. Publication bias was assessed using the LFK index, and heterogeneity was evaluated with I2 and Cochran's Q test. This meta-analysis included 15 studies; disposable endoscopes were used by 2571 participants, reusable ones by 5607. The latter was found to have a 25% higher complication risk (RR:1.25, 95% CI:1.08--1.44). The fever incidence was greatly lower in the disposable group (RR:0.38, 95% CI: 0.20--0.72). No meaningful differences were found in the hospital stay (MD:-0.14, 95% CI: -0.39-0.11). Significant differences were not shown by positive urine cultures (RR:1.93, 95% CI: 0.03-123.15) or urosepsis rates (RR:0.45, 95% CI:0.16-1.27). Disposable endoscopes have notably reduced fever risk in comparison to reusable ones. However, urosepsis rates, positive urine cultures, and hospital stay showed no differences. Consideration of cost and environmental impact is recommended. Our findings suggest that disposable endoscopes may lower the risk of minor infections and complications, including fever, compared to reusable devices. However, these results should be interpreted cautiously due to limited studies, heterogeneity, and possible publication bias. No significant differences were found in severe complications or hospital stay. Decisions on endoscope use should consider not only clinical outcomes but also institutional factors such as cost-effectiveness, case volume, and sterilization capacity. High-volume centres may favour reusables for economic reasons, while disposables may suit low-volume or under-resourced settings by reducing reprocessing risks. Patient safety should remain the key priority, guided by available evidence and facility capabilities. In conclusion, while disposable endoscopes present a promising alternative for infection control and may help in reducing certain minor complications, their extensive adoption requires a nuanced approach. Future research should be focusing on large-scale, well-designed studies with uniform outcome reporting, longer follow-up periods, and comprehensive environmental and economic analyses to provide more definitive guidance for clinical practice worldwide and healthcare policy.