Aerosol and droplet generation in upper and lower GI endoscopy: whole procedure and event-based analysis

Phillips, Frank; Crowley, Jane; Warburton, Samantha; Gordon, George S. D.; Parra‐Blanco, Adolfo

doi:10.1016/j.gie.2022.05.018

Cited by 17 publications

(46 citation statements)

References 26 publications

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“…The methodology used for this study is based on that we developed for a previous 'baseline' study of aerosol generation in digestive endoscopy (1). This is a prospective observational study.…”

Section: Methodsmentioning

confidence: 99%

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Air filtration mitigates aerosol levels both during and after OGD procedures

Phillips

Crowley

Warburton

et al. 2022

Preprint

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Objectives: Upper GI endoscopies are aerosol generating procedures (AGPs), increasing risk of spreading airborne pathogens. We aim to quantify mitigation of airborne particles via improved ventilation, specifically laminar flow theatres and portable HEPA filters, during and after upper GI endoscopies. Methods: This observational study included patients undergoing routine oral gastroscopy in a standard endoscopy room with 15-17 air changes per hour, a standard endoscopy room with portable HEPA filtration unit, and a laminar flow theatre with 300 air changes per hour. A particle counter (diameter range 0.3um-25um) took measurements 10cm from the mouth. Three analyses were performed: whole procedure particle counts, event-based counts and air clearance estimation using post-procedure counts. Results: Compared to a standard endoscopy room, for whole procedures we observe a 28.5x reduction in particle counts in laminar flow (p<0.001) but no significant effect of HEPA filtration(p=0.50). For event analysis we observe for lateral flow theatres reduction in particles >5um for oral extubation (12.2x,p<0.01), reduction in particles <5um for coughing/gagging (6.9x ,p<0.05) and reduction for all sizes in anaesthetic throat spray (8.4x,p<0.01) but no significant effect of HEPA filtration. However, we find that in the fallow period between procedures HEPA filtration reduces particle clearance times by 40%. Conclusions: Laminar flow theatres are highly effective at dispersing aerosols immediately after production and should be considered for high-risk cases where patients are actively infectious or supply of PPE is limited. Portable HEPA filers can safely reduce fallow time between procedures by 40%.

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Section: Methodsmentioning

confidence: 99%

“…Sedation conditions vary across patients from only using Xylocaine throat spray to use of Midazolam. However, previous studies including our own have not found significant effect on aerosol production (1,14). We also analyse data from aerosol-producing events using a background subtraction approach described in our previous methodology (1).…”

Section: Methodsmentioning

confidence: 99%

Air filtration mitigates aerosol levels both during and after OGD procedures

Phillips

Crowley

Warburton

et al. 2022

Preprint

Self Cite

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“…8 Some numerical statistical studies were conducted to prove this theory. [9][10][11][12] Aerosols from patients undergoing upper gastrointestinal endoscopy were measured by a handheld optical particle counter before, during, and after the procedure. Particle sizes were reported to be in the range of 0.3 to 10 μm.…”

Section: Upper Gastrointestinal Endoscopy Is An Aerosol-generating Pr...mentioning

confidence: 99%

“…Particle sizes were reported to be in the range of 0.3 to 10 μm. [10][11][12] Sagami et al 9 compared conscious sedated upper gastrointestinal endoscopy with non-endoscopy as a control group, in the same plastic enclosure and positive-pressure environment. They reported a significant increase in the number of particles during and after the procedure in the endoscopy group.…”

Section: Upper Gastrointestinal Endoscopy Is An Aerosol-generating Pr...mentioning

confidence: 99%

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Management of aerosol generation during upper gastrointestinal endoscopy

et al. 2022

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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.

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Shielding device for endoscopic procedures during lower gastrointestinal endoscopy

et al. 2022

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Objectives The coronavirus pandemic significantly impacted endoscopic practice. During lower gastrointestinal endoscopy, infectious substances disseminate; therefore, we developed an infection control device (STEP‐L) for lower gastrointestinal endoscopy and examined its usefulness. Methods STEP‐L wraps around the patient's buttocks and covers the endoscope. Using lower endoscopy training models, three endoscopists performed 18 colonoscopies with STEP‐L (group S) and without (group C). Endoscopic insertion time and pigmented areas of gloves and diapers after the examination were compared between both groups. Results Insertion of the endoscope up to the cecum was possible in all 18 examinations. The insertion time to the cecum was 52.4 ± 19.0 s in group S and 53.9 ± 13.3 s in group C. The pigmented areas of the gloves measured 39,108.0 ± 16,155.3 pixels in group C, but were significantly reduced to 2610.5 ± 4333.8 pixels in group S (p < 0.05). The pigmented areas of the diapers measured 2280.9 ± 3285.2 pixels in group C, but were significantly reduced to 138.0 ± 82.9 pixels in group S (p < 0.05). Conclusions Using STEP‐L does not change the insertion time, and is technically feasible. STEP‐L significantly reduces the adhesion of virtual pollutants to the surroundings, suggesting that this device is useful for infection control during lower gastrointestinal endoscopy.

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Aerosol and droplet generation in upper and lower GI endoscopy: whole procedure and event-based analysis

Cited by 17 publications

References 26 publications

Air filtration mitigates aerosol levels both during and after OGD procedures

Air filtration mitigates aerosol levels both during and after OGD procedures

Management of aerosol generation during upper gastrointestinal endoscopy

Shielding device for endoscopic procedures during lower gastrointestinal endoscopy

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