• Aerosols
• COVID-19
• Endoscopy
• Gastroscopy
• N95 respirators

• Endoscopy Upper GI Tract
• Hygiene
• Quality and logistical aspects
• Quality management

• MR/T041951/1 Medical Research Council
• Norgine
• Nottingham University Hospitals NHS Trust
• UK Research and Innovation

• COVID‐19
• Endo barrier
• esophagogastroduodenoscopy
• medical staff
• patient satisfaction

• adenosine triphosphate hygiene monitoring test
• endoscopic submucosal dissection
• esophagogastroduodenoscopy
• infection
• particle counter

In the highly contagious coronavirus disease 2019 pandemic, aerosol-generating procedures (AGPs) are associated with high-risk of transmission. Upper gastrointestinal endoscopy is a procedure with the potential to cause dissemination of bodily fluids. At present, there is no consensus that endoscopy is defined as an AGP. This review discusses the current evidence on this topic with additional management. Prevailing publications on coronavirus related to upper gastrointestinal endoscopy and aerosolization from the PubMed and Scopus databases were searched and reviewed. Comparative quantitative analyses showed a significant elevation of particle numbers, implying that aerosols were generated by upper gastrointestinal endoscopy. The associated source events have also been reported. To reduce the dispersion, certain protective measures have been developed. Endoscopic unit protocols are recommended for the concerned personnel. Therefore, upper gastrointestinal endoscopy should be classified as an AGP. Proper practices should be adopted by healthcare workers and patients.

• Aerosols
• COVID-19
• Gastroscopy
• Health personnel
• Respiratory protective devices

Background

As far as we know, there are no reports comparing the safety and cough frequency of transnasal bronchoscopy (TNB) with transoral bronchoscopy (TOB).

Methods

The subjects were 50 patients who underwent either TNB or TOB and completed the pain score questionnaire between May and November 2020. Complications, pain scores, and cough frequency (times per minute) were compared between the patients with TNB and TOB. A surgical mask was worn over the mouthpiece during the examination.

Results

Thirty-two and 18 patients underwent TNB and TOB, respectively. Between the two groups, there were no significant differences in examination time and frequency of serious complications. In pain scores, there were no significant differences in terms of anesthesia suffering, several pains during the examination, and availability of re-examination. The TNB group did not feel the prolonged examination time compared to the TOB group (p=0.04). Cough frequency was lower in the TNB group than in the TOB group (0.36 vs 0.73, p=0.027). Moreover, cough frequency in the 25 TNB patients who underwent thin bronchoscopy was significantly lower (0.19 vs 0.73, p<0.01).

Conclusions

TNB with a surgical mask was well tolerated and safe. Cough frequency in the transnasal thin bronchoscopy was extremely low, suggesting aerosol reduction can be expected.

• COVID-19
• airborne particle
• bronchoscopy
• coronavirus disease
• e-mask
• prevention
• respiratory protective devices

• Bronchoscopy/adverse effects
• Bronchoscopy/methods
• Carbon Dioxide
• Endoscopy
• Humans
• Masks/adverse effects
• Oxygen
• Respiratory Rate

Under the current pandemic situation of the coronavirus disease 2019 (COVID‐19), we have newly developed a commercially available device named Endomask to prevent the diffusion of droplets from subjects undergoing esophagogastroduodenoscopy (EGD). Herein, we evaluate the efficacy and safety of the device, and also evaluate the stress of the device on the operators and the subjects of EGD.

The efficacy of the device was evaluated using an experimental model that simulated the environment of EGD. The safety of the device was evaluated clinically by means of measuring the oxygen saturation and the expiratory carbonic dioxide partial pressure of subjects with our device during EGD. The stress of the device on the operability of the endoscopists and the respiration of the subjects were evaluated using questionnaires.

In the experiments with Endomask, the percentage of the area with simulated droplets was significantly reduced compared to that without our device (median, 0.24% vs. 6.96%, p = 0.009). The saturation of oxygen and the expiratory carbonic dioxide partial pressure of subjects with the device did not show significant change at any recording times. Neither the operators nor the subjects felt serious stress from examination with the device.

Endomask could remarkably and safely prevent the diffusion of droplets without serious stress. Endomask is expected to contribute to a reduction of the infectious risk of SARS‐CoV‐2 in endoscopy units during COVID‐19 pandemic.

• COVID-19
• children
• endoscopy
• healthcare
• pediatrics

This study aimed to assess the efficacy of a novel aerosol-exposure protection (AP) mask in preventing coronavirus disease in healthcare professionals during upper gastrointestinal endoscopy and to evaluate its clinical feasibility.

In Study 1, three healthy volunteers volitionally coughed with and without the AP mask in a cleanroom. Microparticles were visualized and counted with a specific measurement system and compared with and without the AP mask. In Study 2, 30 patients underwent endoscopic resection with the AP mask covering the face, and the SpO2 was measured throughout the procedure.

In Study 1, the median number of microparticles in volunteers 1, 2, and 3 with and without the AP mask was 8.5 and 110.0, 7.0 and 51.5, and 8.0 and 95.0, respectively (p<0.01). Using the AP mask, microparticles were reduced by approximately 92%. The median distances of microparticle scattering without the AP mask were 60, 0, and 68 in volunteers 1, 2, and 3, respectively. In Study 2, the mean SpO2 was 96.3%, and desaturation occurred in three patients.

The AP mask could provide protection from aerosol exposure and can be safely used for endoscopy in clinical practice.

• COVID-19
• Gastrointestinal endoscopy
• Personal protective equipment

• Asia
• COVID-19
• Endoscopy
• Personal protective equipment
• Severe acute respiratory syndrome coronavirus 2

• COVID-19
• Endoscopy
• Endoscopy, Gastrointestinal
• Humans
• Pandemics
• SARS-CoV-2
• Surveys and Questionnaires

• COVID-19
• SARS-CoV-2
• endoscopy
• infection prevention
• personal protective equipment
• surgical mask

• Humans
• Masks
• Personal Protective Equipment

Endoscopists are at high risk of allowing transmission of coronavirus disease 2019 (COVID-19) during gastrointestinal endoscopy (GIE) procedures under pandemic conditions. The main avenues of droplet-containing aerosol generated during GIE are the mouth, anus, and endoscopic forceps channel. Although the usefulness of personal protective equipment for preventing COVID-19 dissemination has been well reported, measures to address infected aerosol escaping during endoscopic forceps use have been neglected. Pathogen-contaminated aerosol from the endoscopic forceps channel, leading into the gastrointestinal lumen, has been confirmed and is a highly problematic source of infection. We developed a technique that entails covering the forceps entry/exit hole with a vinyl bag, thereby preventing contamination of the endoscopy room by the infected aerosol that escapes from this hole. The technique can be used in daily clinical endoscopic practice. Furthermore, this shielding technique is useful for all patients who undergo GIE, regardless of the purpose of the procedure such as for making a diagnosis, administering therapy, or in an urgent situation. In this letter, we introduce our novel, easily performed, inexpensive method of infection prevention by disallowing infected aerosol to escape from a COVID-19-infected patient into the air during a procedure that requires the use of endoscopic forceps.

• Vinyl bag
• Droplets
• Endoscopy
• COVID-19
• Infection
• Contamination

• Aerosol-generating procedures
• COVID-19 pandemic
• Pediatric endoscopy
• “Endoshield”

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which led to a worldwide pandemic that started in early 2020. Healthcare systems across the world encountered an unprecedented surge of COVID-19 patients resulting in more than half a million deaths globally. COVID-19 has affected multiple sub-specialties and procedure-related fields, including gastroenterology. Gastrointestinal (GI) endoscopy centers are specialized units where thousands of endoscopies are performed annually. A significant proportion of these procedures are affected due to the national and regional lockdowns across the globe. To adapt to this rapidly evolving situation, endoscopy centers have undergone significant changes and have taken unprecedented precautions to avoid the transmission of the virus. However, endoscopy centers are going through financial strain due to a reduction in the number of procedures from lockdowns and fear of virus transmission. Theoretically, endoscopies could add to the disease transmission as SARS-CoV-2 has shown to be present in the GI secretions. Multiple precautions such as mandatory use of face masks, safe distancing, use of barriers between the endoscopists and patients, negative pressure rooms, extended use of personal protective equipment, and volume reduction have been taken to decrease the risk of disease transmission by these centers. Moreover, pre-endoscopy COVID-19 testing has now become the norm. In this review, we highlight the significant changes assumed by the endoscopy center. Furthermore, we discuss cost-related concerns of pre-endoscopy COVID-19 testing, the downtime and delays related to the procedures, and effects of rescheduling. As the pandemic progresses through multiple phases, endoscopy centers should use a dynamic approach to adapt and strive to provide the best patient care.

• SARS-CoV-2 infection
• coronavirus
• coronavirus (2019-nCoV)
• endoscopy
• fellowship and training
• gastrointestinal disease
• pandemic (COVID-19)

Healthcare workers performing bronchoscopy, especially in urgent cases, may be at risk of aerosol-transmitted infection with severe acute respiratory syndrome coronavirus 2. Therefore, such healthcare workers require thorough protection from aerosol droplets. To this end, we developed a novel handmade protective barrier enclosure for performing flexible bronchoscopy. The use of this enclosure did not entail any special technique for handling the bronchoscope during bronchoscopy. The enclosure may be helpful in protecting bronchoscopists from the risk of aerosol-transmitted infections, including coronavirus disease 2019.

• Aerosol-transmitted infection
• Barrier enclosure
• Coronavirus disease 2019
• Flexible bronchoscopy
• Personal protective equipment

• Aerosols/adverse effects
• Bronchoscopy/instrumentation
• Bronchoscopy/methods
• COVID-19/prevention & control
• COVID-19/transmission
• Humans
• Infectious Disease Transmission, Patient-to-Professional/prevention & control
• Personal Protective Equipment
• Physicians

• COVID-19
• PPE and pandemic
• SARS-CoV 2
• best practices
• clinical practice guideline
• corona virus
• endoscopy

• Humans
• COVID-19
• Endoscopy, Gastrointestinal/standards
• Infection Control/standards
• Pandemics
• Personal Protective Equipment/standards
• SARS-CoV-2