Novel Negative Pressure Protective Box in Upper Digestive Endoscopy: A Prospective Case Series

Abstract

In the context of the Severe Acute Respiratory Syndrome Coronavirus 2 pandemic, we have developed a novel negative pressure aerosol protector for upper endoscopy (TRACEY). TRACEY is the first endoscopic enclosure to have passed stringent testing for aerosol protection. The following describes its clinical use in a single-center prospective case series. Overall, 15 patients were included. All endoscopic procedures were successful without premature removal of TRACEY. In addition, its use did not lead to significant patient discomfort, technical hinderance, or adverse events. TRACEY seems to offer a safe and easy to use aerosol protection for upper endoscopy and a potential Severe Acute Respiratory Syndrome Coronavirus 2 mitigation strategy in endoscopy.

The comparison of aerosol exposures to endoscopy personnel performing diagnostic upper gastrointestinal endoscopy in patients with and without head box: A randomized control trial

“…16 In their box design, they had a built-in suction port to keep negative pressure in the head box and did not have the opening window for patient airway management. 16 In contrast, our head box did not connect to negative suction and had an opening for safe airway management. This proof-of-concept study confirms the safety and efficacy of the head box to prevent arosolization from patient's mouth at both nurse anesthetist and endoscopist positions.…”

“…A previous study from Canada confirmed the safety of the head box with negative pressure in 15 patients. They showed that this tool did not result in patient discomfort, technical problems in EGD, or adverse events 16 . In their box design, they had a built‐in suction port to keep negative pressure in the head box and did not have the opening window for patient airway management 16 .…”

“…They showed that this tool did not result in patient discomfort, technical problems in EGD, or adverse events 16 . In their box design, they had a built‐in suction port to keep negative pressure in the head box and did not have the opening window for patient airway management 16 . In contrast, our head box did not connect to negative suction and had an opening for safe airway management.…”

Simple and innovative methods of minimizing risk of aerosol generation during endoscopy

“… 2 , 4 - 11 Many are variations of the head enclosures, including boxes made from Perspex referred to as Endoshield, 2 Endoscopic shield, 5 and Endoprotector, 6 and some with negative pressure. 4 , 7 Other methods are modifications of the mouth guard. An innovative device that is commercially available, the B1 mouthpiece (MPC-ST; Fujifilm, Tokyo, Japan), utilizes a sponge-fitted mouth guard with a slit for the endoscope attached to a face shield.…”