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Intraluminal gas escape from biopsy valves and endoscopic devices during endoscopy: caution advised during the COVID-19 era.

ABSTRACT: Background and study aims ?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. Material and methods ?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 ₂ O) and presence of gas leakage, leak pressure, and gas leakage volume were measured. Results ?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). Conclusions ?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.

SUBMITTER: Urakawa S

PROVIDER: S-EPMC7895664 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Intraluminal gas escape from biopsy valves and endoscopic devices during endoscopy: caution advised during the COVID-19 era.

Urakawa Shinya S Hirashita Teijiro T Momose Kota K Nishimura Makoto M Nakajima Kiyokazu K Milsom Jeffrey W JW

Endoscopy international open 20210219 3

<b>Background and study aims</b> 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. <b>Material and methods</b> Using a fresh 35-cm porcine rectal segment, a colonoscope tip, and manometer were placed intraluminally at opposite ends of the segmen ...[more]

PMID: 33655048

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Project description:BackgroundThe etiological diagnosis of biliary stricture remains a clinical challenge. Currently, endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary biopsy is the most commonly used technique. This retrospective study aimed to evaluate the clinical value of percutaneous transhepatic intraluminal forceps biopsy (TIFB) in patients with biliary stricture after ERCP failure.MethodsThe clinical data of 240 consecutive patients with biliary strictures who sought further etiologic diagnosis at our center between April 2014 and January 2020 were collected. After the exclusion of 197 patients who underwent ERCP-guided biopsy, 43 patients who received TIFB after ERCP failure were included in the study. The primary outcomes were technical success, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Secondary outcomes included procedure duration, radiation exposure, liver function [total bilirubin (TB), direct bilirubin (DB), γ-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)] preoperatively and at 2 weeks postoperatively, and complications.ResultsThe technical success rate of TIFB was 100%. The diagnostic sensitivity, specificity, accuracy, PPV, and NPV of TIFB were 82.35%, 100%, 86.05%, 100%, and 60%, respectively. The accuracy of TIFB was significantly higher for cases with suspicious biliary tract invasion on imaging and intrabiliary malignant origin than it did for cases with no suspicious biliary tract invasion on imaging or extrabiliary malignant origin (P=0.007 and P=0.003, respectively). Only intrabiliary malignant origin (P=0.02) was an independent contributing factor for a true positive result in TIFB diagnosis. The mean procedure duration was 19.3 minutes and the mean radiation exposure was 315.6 mGy. All liver function markers were significantly reduced after 2 weeks (all P<0.001). Three (6.97%) complications occurred, including 1 (2.33%) case of cholangitis and 2 (4.65%) cases of hemobilia.ConclusionsPercutaneous TIFB is an effective method with high sensitivity and accuracy for the etiological diagnosis of biliary stricture after ERCP failure.

Dataset Information

Intraluminal gas escape from biopsy valves and endoscopic devices during endoscopy: caution advised during the COVID-19 era.

Publications

Intraluminal gas escape from biopsy valves and endoscopic devices during endoscopy: caution advised during the COVID-19 era.

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