Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea.
Department of Occupational and Environmental Medicine, Ajou University School of Medicine, Suwon, Korea.
Surg Endosc. 2021 Aug;35(8):4520-4527. doi: 10.1007/s00464-020-07966-x. Epub 2020 Sep 22.
Although it has been proven that various volatile organic compounds (VOCs) are produced during surgery, there have been no studies focusing specifically on endoscopy. Therefore, we aimed to investigate VOCs produced during endoscopic submucosal dissection (ESD).
Thirty-one patients scheduled for ESD were enrolled in this study. Sorbent tubes were installed to collect gas at two sites: one in a suction bottle and the other at the level of the endoscopists' upper chest. Gas collections were performed for up to 30 min during submucosal dissection. Quantitative analysis of the VOCs in gas samples was performed using gas chromatography and mass spectrometry. Concentrations of fifteen VOCs were measured. The total concentration of volatile organic compounds (TVOC) was also calculated.
Among the five carcinogens-benzene, ethylbenzene, formaldehyde, tetrachloroethylene, and trichloroethylene (TCE)-measured, excess life-time risks of cancer for benzene and TCE were interpreted as unacceptable based on the New Jersey Department of Environmental Protection Division of Air Quality and the Environmental Protection Agency guidelines (5 × 10 and 7 × 10, respectively). Among the non-carcinogenic VOCs, the mean concentration of toluene was much higher than the reference value (260 μg/m) in the Japanese guidelines for indoor air quality (IAQ) (1323.7 ± 2884.0 μg/m from the air at the upper chest level of endoscopists and 540.9 ± 1345.4 μg/m from the suction bottle). Mean TVOCs were at least 10 times higher than the reference value (400 μg/m) issued by the Japanese guidelines for IAQ.
Various carcinogenic and non-carcinogenic VOCs were detected at levels higher than the reference "safe" values during the submucosal dissection step of ESD. Implementation of counter measures is essential to protect medical personnel who are involved in ESD surgeries.
尽管已经证明手术过程中会产生各种挥发性有机化合物（VOCs），但目前还没有专门针对内镜检查的研究。因此，我们旨在研究内镜黏膜下剥离术（ESD）过程中产生的 VOCs。
本研究纳入了 31 名计划接受 ESD 的患者。在两个部位安装吸附管收集气体：一个在吸引瓶中，另一个在内镜医生的胸部水平。在黏膜下剥离过程中，进行长达 30 分钟的气体采集。使用气相色谱和质谱法对气体样本中的 VOCs 进行定量分析。测量了 15 种 VOC 的浓度。还计算了挥发性有机化合物的总浓度（TVOC）。
在所测量的 5 种致癌物（苯、乙苯、甲醛、四氯乙烯和三氯乙烯（TCE））中，苯和 TCE 的致癌终生风险超过了新泽西州环境保护署空气质量管理司和美国环境保护署指南（分别为 5×10 和 7×10）规定的不可接受水平。在非致癌 VOC 中，甲苯的平均浓度远高于日本室内空气质量（IAQ）指南中的参考值（内镜医生胸部水平的空气中为 1323.7±2884.0μg/m，吸引瓶中为 540.9±1345.4μg/m）。平均 TVOC 至少是日本 IAQ 指南规定的参考值（400μg/m）的 10 倍。
在 ESD 的黏膜下剥离步骤中，检测到各种致癌和非致癌 VOC 的浓度高于参考的“安全”值。必须采取对策来保护参与 ESD 手术的医务人员。
