Clin Endosc.  2022 Sep;55(5):588-593. 10.5946/ce.2022.062.

Management of aerosol generation during upper gastrointestinal endoscopy

Affiliations
  • 1Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Abstract

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.

Keyword

Aerosols; Barrier; COVID-19; Healthcare worker; Upper gastrointestinal endoscopy

Figure

  • Fig. 1. Illustration of tools for preventing aerosols from upper gastrointestinal endoscopy. (A) Acrylic box. (B) Acrylic face shield. (C) Plastic sheet. (D) Double surgical mask. (E) B1. (F) P1. (G) Shielding device for endoscopic procedures.


Cited by  1 articles

Aerosol protection using modified N95 respirator during upper gastrointestinal endoscopy: a randomized controlled trial
Chawisa Nampoolsuksan, Thawatchai Akaraviputh, Asada Methasate, Jirawat Swangsri, Atthaphorn Trakarnsanga, Chainarong Phalanusitthepha, Thammawat Parakonthun, Voraboot Taweerutchana, Nicha Srisuworanan, Tharathorn Suwatthanarak, Thikhamporn Tawantanakorn, Varut Lohsiriwat, Vitoon Chinswangwatanakul
Clin Endosc. 2024;57(3):335-341.    doi: 10.5946/ce.2023.018.


Reference

1. Sultan S, Siddique SM, Singh S, et al. AGA rapid review and guideline for SARS-CoV2 testing and endoscopy post-vaccination: 2021 update. Gastroenterology. 2021; 161:1011–1029.
2. Kutti-Sridharan G, Vegunta R, Vegunta R, et al. SARS-CoV2 in different body fluids, risks of transmission, and preventing COVID-19: a comprehensive evidence-based review. Int J Prev Med. 2020; 11:97.
3. Peng L, Liu J, Xu W, et al. SARS-CoV-2 can be detected in urine, blood, anal swabs, and oropharyngeal swabs specimens. J Med Virol. 2020; 92:1676–1680.
4. Taweerutchana V, Suwatthanarak T, Methasate A, et al. Laparoscopic surgery produced less surgical smoke and contamination comparing with open surgery: the pilot study in fresh cadaveric experiment in COVID-19 pandemic. BMC Surg. 2021; 21:422.
5. Rana SS. Risk of COVID-19 transmission during gastrointestinal endoscopy. J Dig Endosc. 2020; 11:27–30.
6. Tran K, Cimon K, Severn M, et al. Aerosol-generating procedures and risk of transmission of acute respiratory infections: a systematic review. CADTH Technol Overv. 2013; 3:e3201.
7. Klompas M, Baker M, Rhee C. What is an aerosol-generating procedure? JAMA Surg. 2021; 156:113–114.
8. Centers for Disease Control and Prevention. Which procedures are considered aerosol generating procedures in healthcare settings? [Internet]. Atlanta (GA): Centers for Disease Control and Prevention;2021. [cited 2022 Jan 11]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html.
9. Sagami R, Nishikiori H, Sato T, et al. Aerosols produced by upper gastrointestinal endoscopy: a quantitative evaluation. Am J Gastroenterol. 2021; 116:202–205.
10. Chan SM, Ma TW, Chong MK, et al. A proof of concept study: esophagogastroduodenoscopy is an aerosol-generating procedure and continuous oral suction during the procedure reduces the amount of aerosol generated. Gastroenterology. 2020; 159:1949–1951.
11. Gregson FKA, Shrimpton AJ, Hamilton F, et al. Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy. Gut. 2021; 71:871–878.
12. Phillips F, Crowley J, Warburton S, et al. Aerosol and droplet generation in upper and lower gastrointestinal endoscopy: whole procedure and event-based analysis. Gastrointest Endosc. 2022; 96:603–611.
13. Lai HY. Aerosol box [Internet]. 2020 [cited 2022 Jan 10]. Available from: https://sites.google.com/view/aerosolbox/home?authuser=0.
14. Sagami R, Nishikiori H, Sato T, et al. Endoscopic shield: barrier enclosure during the endoscopy to prevent aerosol droplets during the COVID-19 pandemic. VideoGIE. 2020; 5:445–448.
15. Campos S, Carreira C, Marques PP, et al. Endoprotector: protective box for safe endoscopy use during COVID-19 outbreak. Endosc Int Open. 2020; 8:E817–E821.
16. Charoenwat B, Sirirattanakul S, Hangnak K, et al. “Endoshield”: a physical protective box for pediatric endoscopy during the COVID-19 pandemic. Clin Endosc. 2021; 54:688–693.
17. Kitiyakara T, Kamalaporn P, Poolsombat A, et al. Leak-testing of an endoscopic aerosol box for preventing SARS-CoV-2 infection during upper gastrointestinal endoscopy. Siriraj Med J. 2021; 73:702–709.
18. Aponte Martín DM, Corso C, Fuentes C, et al. Use of a new face shield for patients of the endoscopy unit to avoid aerosol exchange in the COVID-19 era. VideoGIE. 2020; 5:522–524.
19. Sabbagh L, Huertas M, Preciado J, et al. New protection barrier for endoscopic procedures in the era of pandemic COVID-19. VideoGIE. 2020; 5:614–617.
20. Lazaridis N, Skamnelos A, Murino A, et al. “Double-surgical-mask-with-slit” method: reducing exposure to aerosol generation at upper gastrointestinal endoscopy during the COVID-19 pandemic. Endoscopy. 2020; 52:928–929.
21. Fujifilm Corporation. Fujifilm launches droplet-shielding mouthpiece “B1” and endoscope cover “P1” [Internet]. Tokyo: Fujifilm Corp;2020. [cited 2021 Dec 25]. Available from: https://www.fujifilm.com/jp/en/news/hq/5477.
22. Kikuchi D, Ariyoshi D, Suzuki Y, et al. Possibility of new shielding device for upper gastrointestinal endoscopy. Endosc Int Open. 2021; 9:E1536–E1541.
23. Gralnek IM, Hassan C, Beilenhoff U, et al. ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy. 2020; 52:483–490.
24. South African Gastroenterology Society (SAGES). SAGES position statement on endoscopy and PPE requirements during COVID-19 pandemic [Internet]. Mowbray: SAGES;2020. [cited 2022 Jan 3]. Available from: https://www.sages.co.za/newsletter_SAGES/PPE_Requirements.pdf.
25. Hennessy B, Vicari J, Bernstein B, et al. Guidance for resuming GI endoscopy and practice operations after the COVID-19 pandemic. Gastrointest Endosc. 2020; 92:743–747.
26. Leddin D, Armstrong D, Raja Ali RA, et al. Personal protective equipment for endoscopy in low-resource settings during the COVID-19 pandemic: guidance from the World Gastroenterology Organisation. J Clin Gastroenterol. 2020; 54:833–840.
27. Kongkam P, Tiankanon K, Ratanalert S, et al. The practice of endoscopy during the COVID-19 pandemic: recommendations from the Thai Association for Gastrointestinal Endoscopy (TAGE) in collaboration with the Endoscopy Nurse Society (Thailand). Siriraj Med J. 2020; 72:283–286.
28. Antonelli G, Karsensten JG, Bhat P, et al. Resuming endoscopy during COVID-19 pandemic: ESGE, WEO and WGO Joint Cascade Guideline for resource limited settings. Endosc Int Open. 2021; 9:E543–E551.
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr