Clinical Efficacy of Novel Patient-Covering Negative-Pressure Box for Shielding Virus Transmission during Esophagogastroduodenoscopy: A Prospective Observational Study

Abstract

Esophagogastroduodenoscopy (EGD) has a high risk of virus transmission during the current coronavirus disease 2019 era, and preventive measures are under investigation. We investigated the effectiveness of a newly developed patient-covering negative-pressure box system (Endo barrier®) (EB) for EGD. Eighty consecutive unsedated patients who underwent screening EGD with EB use were prospectively enrolled. To examine the aerosol ratio before, during, and after EGD, 0.3- and 0.5-μm aerosols were measured every 60 s using an optical counter. Moreover, the degree of contamination of the examiners’ goggles and vinyl gowns was assessed before and after EGD using a rapid adenosine triphosphate (ATP) test for simulated droplets. Data were available in 73 patients and showed that 0.3- and 0.5-μm particles did not increase in 95.8% (70/73) and 94.5% (69/73) of patients during EGD under EB. There were no significant differences in the total 0.3- or 0.5-μm particle counts before versus after EGD. The difference in the ATP levels before and after EGD was −0.6 ± 16.6 relative light units (RLU) on goggles and 1.59 ± 19.9 RLU on gowns (both within the cutoff value). EB use during EGD may provide a certain preventive effect against aerosols and droplets, decreasing examiners’ exposure to viruses.

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

“…1A ), and a scaffolding covered by a transparent plastic ( Fig. 1B ) similar to the one reported by Fujihara et al 4 However, there were several issues encountered with these methods, such as making procedures cumbersome, claustrophobic, and uncomfortable for patients, especially if performed without sedation. Currently, we are using the mask technique as described by Maruyama et al, 3 which we devised independently without prior knowledge of their publication.…”

“…To date, there have been several publications that have reported the various strategies to minimize hazards of AGPs, particularly in upper gastrointestinal endoscopies. 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.…”

“… 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.…”

The use of Endo barrier for prevention of COVID‐19 infection enables upper gastrointestinal endoscopy with high patient satisfaction in private clinic

“…Endo barrier can be effective in preventing the spread of droplets and aerosols generated by patients undergoing EGD by using continuous suction. 4 , 5 …”

Special Issue “The Next Generation of Upper Gastrointestinal Endoscopy”

“…Fujiwara et al also responded quickly to ensure the safety of endoscopists from the unprecedented situation of the COVID-19 pandemic. They developed a patient-covering negative-pressure box system (EB) and investigated whether it could reduce the exposure of aerosols and droplets to the endoscopist during upper gastrointestinal endoscopy [ 7 ]. They evaluated the amount of aerosol dispersed outside the EB during upper gastrointestinal endoscopy using a handheld optical particle counter, and the amount of droplets adhering to the endoscopist was evaluated by the ATP contamination.…”