Clin Endosc.  2021 Sep;54(5):688-693. 10.5946/ce.2021.082.

“Endoshield”: A Physical Protective Box for Pediatric Endoscopy during the COVID-19 Pandemic

Affiliations
  • 1Division of Gastroenterology and Hepatology, Department of Pediatrics, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • 2Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
  • 3Faculty of Architecture, Khon Kaen University, Khon Kaen, Thailand
  • 4Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand

Abstract

Background/Aims
The coronavirus disease (COVID)-19 pandemic presents challenges for gastrointestinal endoscopy. Although the virus is transmitted through contact and droplets, aerosol-generating procedures produce aerosols that can spread through airborne routes. Several gastrointestinal societies have released statements to protect patients and health care providers (HCPs). This study describes a barrier box that may be used as an adjunctive device in addition to personal protective equipment during endoscopies.
Methods
A transparent acrylic box called “Endoshield” was created to place over patient’s head and shoulders and was tested for its ease of use for the endoscopist and suitability for patient size and position.
Results
Twelve children (66.67%, male) with a median age of 9 years (range, 2–11 years) underwent emergency or urgent endoscopy between April and June 2020 during the COVID-19 outbreak. The most common presenting symptom was life-threatening gastrointestinal bleeding (8/12, 66.67%), while the rest had urgent symptoms (4/12, 33.33%). The “Endoshield” was suitable for all patient positions (left lateral position: 9/12, 75% and supine position: 3/12, 25%). The patients and HCPs were followed up for their symptoms on day 14, and none of them had any symptoms of concern.
Conclusions
The “Endoshield” is affordable, reusable, and suitable for both positions.

Keyword

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

Figure

  • Fig. 1. A three-dimensional schematic of “Endoshield”. Ⓐ Wall A: Consists of a curved plastic board for covering the patient’s head and shoulders. A transparent, thin, and soft plastic sheet (not shown in the Figure) was attached to the front of the wall to minimize droplet and aerosol distribution. Ⓑ Wall B: It is a wall for the endoscope insertion, with a small round opening, 4 cm in diameter and 15 cm above the bottom of the wall. Ⓒ Wall C: It is the wall for airway equipment, with a semicircular port 10 cm in diameter in the base of the wall. The design allows the respiratory support apparatus from the patient to pass through the port to connect with the anesthesiology machines. Ⓓ and Ⓔ Wall D and E: They are the top and back wall with no specific features.

  • Fig. 2. Use of the “Endoshield” during a gastrointestinal endoscopy. After sedation was established, “Endoshield” was applied to the patient by placing it over their head and shoulders. The endoscope was inserted through a small round opening, 4 cm in diameter and 15 cm above the bottom of the wall. The respiratory support apparatus from the patient pass through the port to connect with the anesthesiology machines via a semicircular port 10 cm in diameter.


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