Aerosols Produced by Upper Gastrointestinal Endoscopy: A Quantitative Evaluation

Sagami, Ryota; Nishikiori, Hidefumi; Sato, Takao; Tsuji, Hiroaki; Ono, Masami; Togo, Kazumi; Fukuda, Kensuke; Okamoto, Kazushi; Ogawa, Ryo; Mizukami, Kazuhiro; Okimoto, Tadayoshi; Kodama, Masaaki; Amano, Yuji; Murakami, Kazunari

doi:10.14309/ajg.0000000000000983

Cited by 48 publications

(66 citation statements)

References 15 publications

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“…Our sample size was relatively small, and 14 out of the 15 participants had a BMI >40 kg m −2 . It is possible that these patients with higher BMI may have generated more aerosol than leaner patients (as was suggested by the study of Sagami and colleagues), 26 but this effect is likely to apply both for the baseline cough measurements and during endoscopy and so is controlled for in our study design looking at relative levels of airborne particles. It is not possible to extrapolate our findings to patients with active respiratory disease or COVID-19 infection as all participants were screened for COVID-19 and had no acute illness.…”

Section: Discussionmentioning

confidence: 99%

“… 25 This would preclude detection of the aerosol generated by breathing or even a volitional cough over the background particle count (likely mostly inorganic ‘dust’ rather than bioaerosol). Importantly, the high temporal resolution (1 Hz measurements of airborne particles) in combination with the low background aerosol concentration enables the definitive attribution of specific respiratory or procedural events as being the source of the aerosol (rather than attempting to make the link by inference when using a minute-by-minute analysis 26 ).…”

Section: Discussionmentioning

confidence: 99%

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Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy

Gregson

Shrimpton

Hamilton

et al. 2021

Gut

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ObjectiveTo determine if oesophago-gastro-duodenoscopy (OGD) generates increased levels of aerosol in conscious patients and identify the source events.DesignA prospective, environmental aerosol monitoring study, undertaken in an ultraclean environment, on patients undergoing OGD. Sampling was performed 20 cm away from the patient’s mouth using an optical particle sizer. Aerosol levels during OGD were compared with tidal breathing and voluntary coughs within subject.ResultsPatients undergoing bariatric surgical assessment were recruited (mean body mass index 44 and mean age 40 years, n=15). A low background particle concentration in theatres (3 L−1) enabled detection of aerosol generation by tidal breathing (mean particle concentration 118 L−1). Aerosol recording during OGD showed an average particle number concentration of 595 L−1 with a wide range (3–4320 L−1). Bioaerosol-generating events, namely, coughing or burping, were common. Coughing was evoked in 60% of the endoscopies, with a greater peak concentration and a greater total number of sampled particles than the patient’s reference voluntary coughs (11 710 vs 2320 L−1 and 780 vs 191 particles, n=9 and p=0.008). Endoscopies with coughs generated a higher level of aerosol than tidal breathing, whereas those without coughs were not different to the background. Burps also generated increased aerosol concentration, similar to those recorded during voluntary coughs. The insertion and removal of the endoscope were not aerosol generating unless a cough was triggered.ConclusionCoughing evoked during OGD is the main source of the increased aerosol levels, and therefore, OGD should be regarded as a procedure with high risk of producing respiratory aerosols. OGD should be conducted with airborne personal protective equipment and appropriate precautions in those patients who are at risk of having COVID-19 or other respiratory pathogens.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy

Gregson

Shrimpton

Hamilton

et al. 2021

Gut

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“…To prevent SARS-CoV-2 infection during endoscopic procedures, the international GIE societies have published several guidelines and position statements focused on endoscopy during the pandemic [7][8][9]. Sagami et al recently confirmed that upper GIE is an aerosol-generating procedure [10]. Thus, as recommended by the established guidelines and statements, the deferment of elective endoscopies should be considered during the pandemic, and urgent endoscopies, such as those for acute gastrointestinal bleeding (GIB), should be performed by well-trained staff to minimize the risk of disease transmission [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Acute Upper Gastrointestinal Bleeding in Xingtai City

Duan

Liu

et al. 2021

Gastroenterology Research and Practice

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Background and Aims. The coronavirus disease 2019 (COVID-19) has severely impacted the daily practice of gastrointestinal endoscopy worldwide. Most endoscopy centers in China were shut down in late January 2020. We investigated the impact of the shutdown on acute upper gastrointestinal bleeding (AUGIB) events in Xingtai City, Hebei Province, China. Methods. A web-based survey collected information on gastroscopy workload and AUGIB events. The study period was from 4 weeks before to 4 weeks after lockdown initiation in Xingtai City. Fourteen public gastrointestinal endoscopy centers performing emergency endoscopies were contacted via e-mail to collect weekly emergency gastroscopy volumes and the number of AUGIB events. AUGIB was defined as recent melena, hematemesis, or both, with an endoscopically visible source of bleeding. Results. Twelve (85.7%) of the 14 surveyed gastrointestinal endoscopy centers in the city- and county-level hospitals responded. Altogether, 4,045 and 1,077 gastroscopy procedures were performed 4 weeks before and after lockdown initiation (73.4% reduction), respectively. Peptic ulcer-related AUGIB and variceal AUGIB events showed a 58.5% and 52.9% decline, respectively, compared with pre-COVID-19 data. Although the absolute number of AUGIB events decreased during the pandemic (from 149 to 66), the likelihood of detecting AUGIB during gastroscopy increased (3.68% (pre-COVID-19 period) versus 6.13% (COVID-19 period); P < 0.05 ). Conclusion. The COVID-19 pandemic resulted in a considerable reduction in gastroscopy workload and AUGIB events; however, the likelihood of detecting AUGIB increased significantly during gastroscopies.

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“…The ongoing COVID-19 pandemic has posed a major challenge to the delivery of typical healthcare services worldwide. For gastroenterologists, the COVID-19 pandemic has compromised the availability of routine and even emergency endoscopy services because upper endoscopy is considered to be an aerosol-generating procedure 1 . A study from New York, one of the epicenters of the COVID-19 pandemic, showed that cases of upper gastrointestinal bleeding (UGIB) were more severe after the COVID-19 outbreak 2 .…”

Section: Introductionmentioning

confidence: 99%

Impact of first wave of COVID-19 on outcomes of hospitalization for upper gastrointestinal bleeding in Hong Kong: a population-based study

2021

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Background and study aims The COVID-19 pandemic has caused a major disruption in the healthcare system. This study determined the impact of the first wave of COVID-19 on the number and outcome of patients hospitalized for upper gastrointestinal bleeding (UGIB) in Hong Kong. Patients and methods Records of all patients hospitalized for UGIB in Hong Kong public hospitals between October 2018 and June 2020 were retrieved. The number and characteristics of patients hospitalized for UGIB after COVID-19 was compared by autoregressive integrated moving average (ARIMA) model prediction and historical cohort. Results Since the first local case of COVID-19, there was an initial drop in UGIB hospitalizations (observed 29.8 vs predicted 35.5 per week; P = 0.05) followed by a rebound (39.8 vs 26.7 per week; P < 0.01) with a turning point at week 14 (Petitt’s test, P < 0.001). There was a negative association between the number of COVID-19 cases and the number of patients hospitalized for UGIB (Pearson correlation –0.53, P < 0.001). Patients admitted after the outbreak of COVID-19 had lower hemoglobin (7.5 vs baseline 8.3 g/dL; P < 0.01) and a greater need for blood transfusion (64.5 % vs baseline 50.4 %; P < 0.01), but similar rates of all-cause mortality (6.9 % vs 7.1 %; P = 0.82) and rebleeding (6.7 % vs 5.1 %; P = 0.11). There was also a higher proportion of patients with variceal bleeding (10.5 % vs baseline 5.3 %; P < 0 .01). Conclusions There was a dynamic change in the number of patients hospitalized for UGIB in Hong Kong during the first wave of the COVID-19 outbreak, with more obvious impact during the initial phase only.

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Aerosols Produced by Upper Gastrointestinal Endoscopy: A Quantitative Evaluation

Cited by 48 publications

References 15 publications

Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy

Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy

Impact of the COVID-19 Pandemic on Acute Upper Gastrointestinal Bleeding in Xingtai City

Impact of first wave of COVID-19 on outcomes of hospitalization for upper gastrointestinal bleeding in Hong Kong: a population-based study

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