Clinical Endoscopy

  • 제57권3호
  • /
  • Pages.335-341
  • /
  • 2024
  • /
  • 2234-2400(pISSN)
  • /
  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지
DOI QR코드

DOI QR Code

Aerosol protection using modified N95 respirator during upper gastrointestinal endoscopy: a randomized controlled trial

  • 투고 : 2022.12.27
  • 심사 : 2023.02.22
  • 발행 : 2024.05.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: The coronavirus disease 2019 pandemic has affected the worldwide practice of upper gastrointestinal endoscopy. Here we designed a modified N95 respirator with a channel for endoscope insertion and evaluated its efficacy in upper gastrointestinal endoscopy. Methods: Thirty patients scheduled for upper gastrointestinal endoscopy were randomized into the modified N95 (n=15) or control (n=15) group. The mask was placed on the patient after anesthesia administration and particles were counted every minute before (baseline) and during the procedure by a TSI AeroTrak particle counter (9306-04; TSI Inc.) and categorized by size (0.3, 0.5, 1, 3, 5, and 10 ㎛). Differences in particle counts between time points were recorded. Results: During the procedure, the modified N95 group displayed significantly smaller overall particle sizes than the control group (median [interquartile range], 231 [54-385] vs. 579 [213-1,379]×103/m3; p=0.056). However, the intervention group had a significant decrease in 0.3-㎛ particles (68 [-25 to 185] vs. 242 [72-588] ×103/m3; p=0.045). No adverse events occurred in either group. The device did not cause any inconvenience to the endoscopists or patients. Conclusions: This modified N95 respirator reduced the number of particles, especially 0.3-㎛ particles, generated during upper gastrointestinal endoscopy.

키워드

과제정보

We thank Mr. Asadavudh Buachum and Miss Kanyanat Changpan from the Occupational Health Division for their cooperation with the particle measurements and Dr. Saowalak Hunnangkul for her assistance with the statistical analysis.

참고문헌

  1. Tran K, Cimon K, Severn M, et al. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012;7:e35797.
  2. Klompas M, Baker M, Rhee C. What is an aerosol-generating proce dure? JAMA Surg 2021;156:113-114. https://doi.org/10.1001/jamasurg.2020.6643
  3. Rana SS. Risk of COVID-19 transmission during gastrointestinal endoscopy. J Dig Endosc 2020;11:27-30. https://doi.org/10.1055/s-0040-1712076
  4. 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.
  5. 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. https://doi.org/10.1002/jmv.25936
  6. Sagami R, Nishikiori H, Sato T, et al. Aerosols produced by upper gastrointestinal endoscopy: a quantitative evaluation. Am J Gastroenterol 2021;116:202-205. https://doi.org/10.14309/ajg.0000000000000983
  7. 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. https://doi.org/10.1055/a-1155-6229
  8. South African Gastroenterology Society (SAGES). SAGES position statement on endoscopy and PPE requirements during COVID-19 pandemic [Internet]. SAGES; 2020 [cited 2022 Jul 1]. Available from: https://www.sages.co.za/newsletter_SAGES/PPE_Requirements.pdf
  9. 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. https://doi.org/10.33192/Smj.2020.38
  10. 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. https://doi.org/10.33192/Smj.2021.90
  11. 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. https://doi.org/10.1016/j.vgie.2020.05.006
  12. Lazaridis N, Skamnelos A, Murino A, et al. "Double-surgical-maskwith-slit" method: reducing exposure to aerosol generation at upper gastrointestinal endoscopy during the COVID-19 pandemic. Endoscopy 2020;52:928-929. https://doi.org/10.1055/a-1198-5471
  13. Fujifilm. Fujifilm launches droplet-shielding Mouthpiece "B1" and Endoscope Cover "P1" [Internet]. Fujifilm; 2020 [cited 2022 Jan 22]. Available from: https://www.fujifilm.com/jp/en/news/hq/5477
  14. Kikuchi D, Ariyoshi D, Suzuki Y, et al. Possibility of new shielding device for upper gastrointestinal endoscopy. Endosc Int Open 2021;9:E1536-E1541. https://doi.org/10.1055/a-1523-8959
  15. Gao Y, Xie J, Ye LS, et al. Negative-pressure isolation mask for endoscopic examination during the coronavirus disease 2019 pandemic: a randomized controlled trial. Clin Transl Gastroenterol 2021;12:e00314.
  16. Lai HY. Aerosol box 2020 [Internet]. 2020 [cited 2022 Jun 15]. Available from: https://sites.google.com/view/aerosolbox/home?authuser=0
  17. Bar-On YM, Flamholz A, Phillips R, et al. SARS-CoV-2 (COVID-19) by the numbers. Elife 2020;9:e57309.
  18. American Society of Anesthesiologists. Continuum of depth of sedation: definition of general anesthesia and levels of sedation/ analgesia [Internet]. American Society of Anesthesiologists; 2019 [cited 2021 Dec 25]. Available from: https://www.asahq.org/standards-and-guidelines/continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedationanalgesia
  19. 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. https://doi.org/10.1016/j.vgie.2020.05.002
  20. 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. e4. https://doi.org/10.1053/j.gastro.2020.07.002
  21. Nampoolsuksan C, Chinswangwatanakul V, Methasate A, et al. Management of aerosol generation during upper gastrointestinal endoscopy. Clin Endosc 2022;55:588-593. https://doi.org/10.5946/ce.2022.062
  22. Phillips F, Crowley J, Warburton S, et al. Aerosol and droplet generation in upper and lower GI endoscopy: whole procedure and eventbased analysis. Gastrointest Endosc 2022;96:603-611. https://doi.org/10.1016/j.gie.2022.05.018
  23. Gregson FK, Shrimpton AJ, Hamilton F, et al. Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy. Gut 2022;71:871-878. https://doi.org/10.1136/gutjnl-2021-324588
  24. 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.