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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.