Volume 84 - 2021 - Fasc.3 - Letters
Surgical mask designed for endoscopic procedures to prevent the diffusion of droplets
Coronavirus disease 2019 (COVID-19) caused by
severe acute respiratory syndrome coronavirus 2 (SARSCoV-
2) has become a global pandemic. The human-tohuman
transmission of SARS-CoV-2 occurs primarily
through droplets, aerosols, and direct contact. Endoscopy
is performed at a short physical distance between an
endoscopist and patient, which increases the risk of
SARS-CoV-2 transmission to the endoscopist through
contact with body fluids and exposure to droplets due
to vomiting, retching, and coughing during endoscopic
procedures (1). Gastrointestinal endoscopic procedures
generate aerosols, which mandates the use of appropriate
personal protective equipment (PPE) (1,2). To further
reduce the risk of viral infection during endoscopy,
additional infection protection is needed to assist PPE
from not only the side of endoscopists but also the side
of patients (3).
Various infection prevention devices, such as a reusable
plastic cube barrier, have been reported (3); however, we
focused on a surgical mask as a simple and inexpensive
method (4). Previous studies proposed modified surgical
masks with an endoscopic insertion port, which were
handmade with an incision for endoscope insertion into
commercially available surgical masks (2,4). Although
these “handmade” masks may be easily modified, their
preparation is burdensome and not sterile. We developed
a novel disposal surgical mask with a mask manufacturer
that is specifically designed as a droplet prevention
device for endoscopic procedures that may be massproduced
with uniform quality and easily introduced into
endoscopy units. This novel surgical mask has a 10-mm
slit in the center for the insertion of an endoscope and
two small 6-mm slits for suction on the left and right.
The width of the pleats in the center have been widened
to easily cut the slits, which allows for cost-effective
mass production. Despite its close fit, the narrow slit
allows for the easy passage of an endoscope and smooth
endoscopic manipulation. Furthermore, the leakage of
droplets and aerosols through the slit in the surgical mask
is minimized (Fig. 1A-D).
Motorized Spiral Enteroscopy: to infinity and beyond?
With the advent of device-assisted enteroscopy
(DAE) in the early 2000s, endoscopic access to the
entire small bowel is possible nowadays (1). And yet,
there is still room for improvement. Total enteroscopy
remains a time-consuming procedure, often combining
the antegrade (oral) and retrograde (anal) approach with
only a reasonable chance to obtain complete endoscopy
of the entire small bowel (2). Therefore, the aim is to go
faster, deeper and to perform more advanced therapeutic
interventions within the long and tortuous small bowel.
Moreover, DAE was also shown to be effective to perform
endoscopic retrograde cholangiopancreatography
(ERCP) in patients with surgically altered anatomy and
to complete colonoscopy in patients with previously
incomplete conventional colonoscopy due to long
dolichocolon (3).
The latest DAE development is Motorized Spiral
Enteroscopy (MSE), initially conceptualized as a
manually driven rotational spiral overtube by Paul A.
Akerman, and further developed and commercialized
as a motorized spiral overtube by the Olympus Medical
Systems Corporation (4). Initial feasibility trials have
shown that MSE can compete with already available DAE
techniques (single- and double-balloon enteroscopy)
with regard to diagnostic yield and endotherapy within
the small bowel (5,6). However, being a short type
enteroscope of 168 cm (as compared to the 200 cm long
single- and double-balloon enteroscopes), MSE appears
to be even more effective in obtaining deep and total
enteroscopy with a relatively short procedural duration
(2,6). In addition, the working channel diameter is
increased to 3.2 mm (as compared to 2.8 mm) with an extra
irrigation channel, facilitating therapeutic interventions
within the small bowel. This faster and deeper (but more
aggressive) enteroscopy technique comes with the price
of an increased risk of mucosal injuries (ranging from
superficial bruising to laceration and even perforation)
within the oesophagus and the small bowel, luckily
remaining asymptomatic most of the time without any
clinical consequence (6). So far, this promising new
technique has the potential of becoming a gamechanger
in the still evolving field of deep enteroscopy.
