Urakawa Shinya, Hirashita Teijiro, Momose Kota, Nishimura Makoto, Nakajima Kiyokazu, Milsom Jeffrey W
Department of Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, United States.
Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University Graduate School of Medicine, Osaka, Japan.
Endosc Int Open. 2021 Mar;9(3):E443-E449. doi: 10.1055/a-1336-2766. Epub 2021 Feb 19.
The risk of aerosolization of body fluids during endoscopic procedures should be evaluated during the COVID-19 era, as this may contribute to serious disease transmission. Here, we aimed to investigate if use of endoscopic tools during flexible endoscopy may permit gas leakage from the scope or tools. Using a fresh 35-cm porcine rectal segment, a colonoscope tip, and manometer were placed intraluminally at opposite ends of the segment. The colonoscope handle, including the biopsy valve, was submerged in a water bath. Sequentially, various endoscopic devices (forceps, clips, snares, endoscopic submucosal dissection (ESD) knives) were inserted into the biopsy valve, simultaneously submerging the device handle in a water bath. The bowel was slowly inflated up to 74.7 mmHg (40 inH O) and presence of gas leakage, leak pressure, and gas leakage volume were measured. Gas leakage was observed from the biopsy valve upon insertion and removal of all endoscopic device tips with jaws, even at 0 mmHg (60/60 trials). The insertion angle of the tool affected extent of gas leakage. In addition, gas leakage was observed from the device handles (8 of 10 devices) with continuous gas leakage at low pressures, especially two snares at 0 mmHg, and an injectable ESD knife at 0.7 ± 0.8 mmHg). Gas leakage from the biopsy valve and device handles commonly occur during endoscopic procedures. We recommend protective measures be considered during use of any tools during endoscopy.
在新冠疫情期间，应评估内镜检查过程中体液雾化的风险，因为这可能导致严重的疾病传播。在此，我们旨在研究在软性内镜检查过程中使用内镜工具是否会导致内镜或工具漏气。使用一段35厘米长的新鲜猪直肠段，将结肠镜尖端和压力计分别置于该段两端的管腔内。将包括活检阀在内的结肠镜手柄浸入水浴中。随后，将各种内镜设备（活检钳、夹子、圈套器、内镜黏膜下剥离术（ESD）刀）插入活检阀，同时将设备手柄浸入水浴中。缓慢向肠内充气至74.7 mmHg（40英寸水柱），测量是否存在漏气、漏气压和漏气量。在插入和取出所有带有钳口的内镜设备尖端时，即使在压力为0 mmHg时（60次试验中的60次），均观察到活检阀漏气。工具的插入角度影响漏气程度。此外，在设备手柄处也观察到漏气（10个设备中有8个），在低压下持续漏气，特别是两个圈套器在0 mmHg时，以及一把可注射的ESD刀在0.7±0.8 mmHg时。在内镜检查过程中，活检阀和设备手柄通常会发生漏气。我们建议在内镜检查使用任何工具时都应考虑采取保护措施。
