Subscribe to RSS
DOI: 10.1055/a-1336-2766
Intraluminal gas escape from biopsy valves and endoscopic devices during endoscopy: caution advised during the COVID-19 era
Abstract
Background and study aims The risk of aerosolization of body fluids during endoscopic procedures should be evaluated during the COVID-19 era, as this may contribute to serious disease transmission. Here, we aimed to investigate if use of endoscopic tools during flexible endoscopy may permit gas leakage from the scope or tools.
Material and methods Using a fresh 35-cm porcine rectal segment, a colonoscope tip, and manometer were placed intraluminally at opposite ends of the segment. The colonoscope handle, including the biopsy valve, was submerged in a water bath. Sequentially, various endoscopic devices (forceps, clips, snares, endoscopic submucosal dissection (ESD) knives) were inserted into the biopsy valve, simultaneously submerging the device handle in a water bath. The bowel was slowly inflated up to 74.7 mmHg (40 inH2O) and presence of gas leakage, leak pressure, and gas leakage volume were measured.
Results Gas leakage was observed from the biopsy valve upon insertion and removal of all endoscopic device tips with jaws, even at 0 mmHg (60/60 trials). The insertion angle of the tool affected extent of gas leakage. In addition, gas leakage was observed from the device handles (8 of 10 devices) with continuous gas leakage at low pressures, especially two snares at 0 mmHg, and an injectable ESD knife at 0.7 ± 0.8 mmHg).
Conclusions Gas leakage from the biopsy valve and device handles commonly occur during endoscopic procedures. We recommend protective measures be considered during use of any tools during endoscopy.
Publication History
Received: 06 August 2020
Accepted: 23 November 2020
Article published online:
19 February 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Judson SD, Munster VJ. Nosocomial transmission of emerging viruses via aerosol-generating medical procedures. Viruses 2019; 11: 940
- 2 van-Deremalen N, Bushmaker T, Morris DH. et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020; 382: 1564-1567
- 3 Soetikno R, Teoh AY, Kaltenbach T. et al. Considerations in performing endoscopy during the COVID-19 pandemic. Gastrointest Endosc 2020; 92: 176-183
- 4 Repici A, Maselli R, Colombo M. et al. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointest Endosc 2020; 92: 192-197
- 5 An P, Huang X, Wan X. et al. ERCP during the pandemic of COVID-19 in Wuhan, China. Gastrointest Endosc 2020; 92: 448-454
- 6 Wu D, Wu T, Liu Q. et al. The SARS-CoV-2 outbreak: What we know. Int J Infect Dis 2020; 94: 44-48
- 7 Xiao F, Tang M, Zheng X. et al. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology 2020; 158: 1831-1833
- 8 Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020; 158: 1518-1519
- 9 Marchese M, Capannolo A, Lombardi L. et al. Use of a modified ventilation mask to avoid aerosolizing spread of droplets for short endoscopic procedures during Coronavirus Covid-19 outbreak. Gastrointest Endosc 2020; 92: 439-440
- 10 Neven L, Sanja SS, Lucija VJ. et al. Plexiglass barrier box to improve ERCP safety during the COVID-19 pandemic. Gastrointest Endosc 2020; 92: 428-429
- 11 Mele A, Spada E, Sagliocca L. et al. Risk of parenterally transmitted hepatitis following exposure to surgery or other invasive procedures results from the hepatitis surveillance system in Italy. J Hepatol 2001; 35: 284-289
- 12 Kovaleva J, Peters FT, van der Mei HC. et al. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 2013; 26: 231-254
- 13 Zietsman M, Phan LT, Jones RM. Potential for occupational exposures to pathogens during bronchoscopy procedures. J Occup Environ Hyg 2019; 16: 707-716
- 14 Lentz RJ, Colt H. Summarizing societal guidelines regarding bronchoscopy during the COVID-19 pandemic. Respirology 2020; 25: 574-577
- 15 Lavoie J, Marchand G, Cloutier Y. et al. Evaluation of bioaerosol exposures during hospital bronchoscopy examinations. Environment Sci Proc Impacts 2015; 17: 288-299
- 16 Johnston ER, Habib-Bein N, Dueker JM. et al. Risk of bacterial exposure to the endoscopistʼs face during endoscopy. Gastrointest Endosc 2019; 89: 818-824
- 17 Zhang Y, Zhang X, Liu L. et al. Suggestions of infection prevention and control in digestive endoscopy during current 2019-nCoV pneumonia outbreak in Wuhan, Hubei province, China. Endoscopy 2020; 52: 312-314
- 18 Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol 2012; 107: 345-360
- 19 Cavaliere K, Levine C, Wander P. et al. Management of upper GI bleeding in patients with COVID-19 pneumonia. Gastrointest Endosc 2020; 92: 454-455
- 20 Ehlken H, Schachschal G, Mann O. et al. Waiting times for endotherapy of early malignancy: No problem?. Gastrointest Endosc 2020; 92: 424-426
- 21 Alp E, Bijl D, Bleichrodt RP. et al. Surgical smoke and infection control. J Hosp Infect 2006; 62: 1-5
- 22 Castro Filho EC, Castro R, Fernandes FF. et al. Gastrointestinal endoscopy during COVID-19 pandemic: an updated review of guidelines and statements from international and national societies. Gastrointest Endosc 2020; 92: 440-445
- 23 World Health Organization. Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19): Interim Guidance, 19. 2020 Available from: https://apps.who.int/iris/handle/10665/331215
- 24 Chen JH, Yu Y, Yang Z. et al. Intraluminal pressure patterns in the human colon assessed by high-resolution manometry. Sci Rep 2017; 7: 41436
- 25 Hirota M, Miyazaki Y, Takahashi T. et al. Dynamic article: steady pressure CO2 colonoscopy; its feasibility and underlying mechanism. Dis Colon Rectum 2014; 57: 1120-1128
- 26 Kato M, Nakajima K, Yamada T. et al. Esophageal submucosal dissection under steady pressure automatically controlled endoscopy (SPACE): a clinical feasibility study. Endoscopy 2014; 46: 680-684
- 27 Mukai S, Itoi T, Baron TH. et al. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci 2017; 24: 537-549
- 28 Mintz Y, Arezzo A, Boni L. et al. A low cost, safe and effective method for smoke evacuation in laparoscopic surgery for suspected coronavirus patients. Ann Surg 2020; 272: 7-8