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Table 2 Duodenoscope sampling methods

From: A narrative review on current duodenoscope reprocessing techniques and novel developments

Method Principle Current status Advantages Disadvantages References
Flush Release of bacteria through fluid flush Clinically applied Least complex sampling technique Obsolete due to increased recovery with flush brush flush protocols [64, 66, 68]
Flush Brush flush (CDC, FDA, ASM protocol)* Release of bacteria through dual fluid flush and mechanical removal Clinically applied Can be considered as the current standard method of endoscope sampling Requires two persons for sampling and is too laborious for general implementation [61, 65, 67]
Flush brush flush (other protocols) Release of bacteria through dual fluid flush and mechanical removal, uses different brushes and/or flushing fluid Only applied in experimental models The CDC, FDA and ASM protocol is outperformed in regard of Gram-negative bacteria recovered Not tested in a clinical setting and a uniform protocol is still lacking [63,64,65]
Pump assisted Uses a peristaltic pump to increase shear stress at the lumen surface to remove bacteria Clinically applied More bacterial recovery compared to the flush method Requires a peristaltic pump [66]
Turbulent fluid flow Adds turbulent air droplets to the flushing fluid to achieve high shear stress at the lumen surface to remove bacteria Only applied in experimental models More bacterial recovery compared to the flush method and the CDC flush brush flush method Requires a device to generate turbulent flow [67]
Tensioactive agents A tensioactive agents is added to decrease surface tension of the sampling fluid thus aiding bacterial removal Only applied in experimental models Only requires addition of a tensioactive agent to the sampling fluid Limited data are available and have reported conflicting results in regards of efficacy [63, 68]
  1. *CDC Centers for Disease Control and Prevention, FDA United States Food and Drug Administration, ASM American Society for Microbiology