Bronchoscopy, laryngoscopy, and esophagoscopy during the COVID‐19 pandemic

Abstract

Background: The United States now has the highest death toll due to COVID-19. Many otolaryngology procedures, including laryngoscopy, bronchoscopy, and esophagoscopy, place otolaryngologists at increased risk of coronavirus transmission due to close contact with respiratory droplets and aerosolization from the procedure. The aim of this study is to provide an overview of guidelines on how to perform these procedures during the coronavirus pandemic.Methods: Literature review was performed. Articles citing laryngoscopy, bronchoscopy, esophagoscopy use with regard to COVID-19 were included.Results: Laryngoscopy, bronchoscopy, and esophagoscopy are all used in both emergent and elective situations. Understanding the risk stratification of cases and the varied necessity of personal protective equipment is important in protecting patients and health care workers. Conclusions: Summary guidelines based on the literature available at this time are presented in order to decrease transmission of the virus and protect those involved.

Coronavirus Disease-19

“… 5 Most studies universally recommend the following PPE: N95 mask or powered air-purifying respirators (PAPRs), gloves, gown, eye shield (or goggles), and cap. 1 , 5 , 11 , 15 , 16 It also has been suggested that the patients wear a mask covering the mouth during flexible laryngoscopy to reduce aerosolization from phonatory maneuvers and in case of coughing or sneezing. At this time, transoral rigid laryngoscopy and mirror laryngoscopy are discouraged unless flexible laryngoscopy cannot be performed due to the increased risk of gagging and coughing as well as the need for patients to phonate with the mouth uncovered to allow visualization of the larynx.…”

“…This suggests there is significant risk associated with elective surgery in seemingly asymptomatic patients who are infected with COVID-19. For this reason, many investigators have suggested preoperative COVID-19 testing, 15 , 26 , 27 , 28 although it is a subject of some debate. Some investigators advocate for a negative test within 48 hours followed by self-quarantine until the time of surgery, whereas others favor a negative test 48 hours from the time of surgery, and a point-of-care negative test on the day of surgery.…”

“…Finally, some investigators have advocated for the use of specific air containment setups, including plastic draping, smoke evacuator tubing, or specifically designed negative pressure box. 15 , 34 , 35 , 36 …”

ESSD Commentary on Dysphagia Management During COVID Pandemia

“…In deciding when instrumental assessment should be performed, swallowing experts should guarantee that the procedure avoids the following: COVID-19 infection of the examiner COVID-19 infection of the patient being examined as well as the incoming patients examined using the same instruments and/or in the same environment [ 7 ]. Instrumental assessment of swallowing (Videofluoroscopic Swallow Study, Fiberoptic Endoscopic Evaluation of Swallowing, Manometry) is performed only if appropriate cleaning and processing of the instruments according COVID-19 conditions can be guaranteed [ 8 – 10 ]. In both COVID+ve and COVID−ve patients, instrumental assessment of swallowing (Videofluoroscopic Swallow Study, Fiberoptic Endoscopic Evaluation of Swallowing, Manometry) is performed only if a potential life-threatening underlying disease is suspected, clinical assessment has not provided enough diagnostic information for effective treatment to be prescribed to the patients and the clinical situation does not allow the clinical decision to be postponed.…”

“…Instrumental assessment of swallowing (Videofluoroscopic Swallow Study, Fiberoptic Endoscopic Evaluation of Swallowing, Manometry) is performed only if appropriate cleaning and processing of the instruments according COVID-19 conditions can be guaranteed [ 8 – 10 ].…”