A performance, safety and cost comparison of reusable versus disposable endoscopic biopsy forceps: A prospective randomized trial

Introduction: Safety, performance and cost must be considered when choosing between using disposable or reusable biopsy forceps. Biopsy forceps, which break mucosal membranes, are classified as critical instruments and if contaminated, may place patients at risk of infection. Adequate cleaning and sterilization is difficult to achieve due to the four-layered tubular design of a biopsy forceps. Methods: 4 Wilson-Cook Maxum® reusable forceps (Wilson-Cook, Winston-Salem, NC) and 54 Microvasive Radial Jaw™ single-use forceps (Microvasive, Natick, MA) were randomly used by endoscopists blinded to the choice of forceps. Reusable forceps were used once a day and reused on subsequent days after appropriate cleaning and sterilization until mechanical failure developed. Single use forceps were used once and discarded. Experienced endoscopists performed all biopsies during regularly scheduled upper and lower endoscopies. Immediately after completing the endoscopy, the endoscopist completed a five-part questionnaire assessing forceps performance. Total costs were determined using the following formula: Purchase price/number of uses + reprocessing costs. Reprocessing costs included labor, cleaning supplies, and implementation of hospital infection control policy. There were no reprocessing costs incurred for single-use forceps. At the conclusion of the study, each reusable forceps was dismantled and the forceps' components were examined under light microscopy for the presence of contamination. Sterilization testing was also performed. Results: 107 biopsy sessions were performed: 54 with single-use forceps and 53 with reusable forceps. The average number of uses per reusable biopsy forceps was 13.25 (Range 10-17). The overall performance rating of the reusable and single use forceps were 71% and 97%, respectively. The unit cost per reusable forceps was $350. Reprocessing costs were $11.77 per use. Total cost per use of reusable forceps and disposable forceps were $38.19 and $35.00, respectively. Under light microscopy, all reusable forceps were noted to be contaminated with both human debris and cleaning residue. Conclusions: Experienced gastroenterologists reported better performance with single use, disposable biopsy forceps than with reusable forceps. The total cost of reusable forceps was directly proportional to the number of uses. When reprocessing costs are considered, disposable forceps were less expensive than reusable forceps. Single use forceps may be safer to use by preventing iatrogenic infection.