Peroral Endoscopy During Thecovid-19 Pandemic: Efficacy Of The Acrylic Box (Endo-Splash Protective (Esp) Box) For Preventing Droplet Transmission

Background and Aim: Appropriate personal protective equipment should be worn in all clinical settings during the COVID-19 pandemic because anyone could be carrying SARS-CoV-2. Peroral endoscopy is the procedure potentially generating large volumes of aerosols through stimulation of patient coughing. The present study investigated the efficacy of a specially designed acrylic box (Endo-Splash Protective [ESP] box) for preventing droplet transmission as part of droplet precautions for endoscopists and assistants during routine endoscopy for potential asymptomatic carriers or emergent endoscopy for confirmed or suspected COVID-19 patients.Methods and Results: ESP box was fabricated for use in peroral endoscopy performed with the patient in either a left lateral or prone position. Circular ports were created, one for scope insertion and one for each of the assistant's hands. Simulated droplets were released inside ESP box, and the number of droplets was counted every 100/3 ms for 5 s pre-release and post-release at the positions of the endoscopist and assistant. The experiment was repeated eight times at the endoscopist and assistant positions, and the median numbers of droplets were calculated and compared. No significant differences were observed between the median number of droplets counted for 5 s prerelease and postrelease at either the endoscopist (P= 0.239) or assistant (P= 0.576) positions. We could block the droplets by using ESP box.Conclusions: The present findings suggest that use of ESP box during peroral endoscopy may reduce endoscopist and assistant droplet exposure, potentially reducing the risk of droplet transmission to healthcare professionals performing peroral endoscopy during the COVID-19 pandemic.