Reusable biopsy forceps: a prospective evaluation of cleaning, function, adequacy of tissue specimen, and durability

Background: Recent studies have indicated that reusable biopsy forceps rema in contaminated after reprocessing and can only be used a mean of 12 to 25 times without malfunction. Because this contradicts traditional endoscopic practice, our study investigated the ability to sterilize a type of commerc ially available biopsy forceps and prospectively evaluated their function i n vivo until malfunction and/or breakage. Methods: Thirty reusable biopsy forceps were studied, 15 of which were cont aminated for 5 trials e;ach with 10(6) Bacillus stearothermophilus, and 15 of which were prospectively evaluated clinically over an 18-month period (9 /98-3/00). Contaminated forceps were reprocessed by using a standard protoc ol and placed in a sterile bag containing soy broth. The latter was passed through a 0.2 mu filter and was subsequently cultured. In vivo data include d biopsy site, size, adequacy, problems obtaining a biopsy specimen, and re asons for ultimate forceps failure. Results: After contamination, all biopsy forceps yielded a heavy growth of B stearothermophilus. No forceps, including 5 that were piecemeal dismantle d with a wire cutter, had residual bacteria after reprocessing. In the in v ivo study, 1507 biopsy sessions were undertaken in 1339 procedures. Forceps were categorized as new or like-new in 1259 of 1339 (94%) procedures, some loss of function but usable in 72 of 1339 (5.4%), and inadequate function or broken at use in 8 of 1339 (0.6%). Histologically, 1501 specimen sets we re adequate (99.6%) and mean specimen size was 2.7 +/- 0.1 mim. Mechanical problems were noted in only 38 of 1507 (3%) sessions to include such things as sticky forceps, and the mean number of uses to malfunction or breakage was 91 +/- 15 (SEM) (range 19-132). Conclusions:This reusable biopsy forceps can be sterilized and used a mean of 91 times with adequate tissue sampling. Mechanical problems were minor t o time of breakage. Contingent on acquisition and reprocessing costs as wel l as the number of procedures performed, this reusable forceps has the pote ntial for significant cost savings.