A Proof of Concept Study: Esophagogastroduodenoscopy Is an Aerosol-Generating Procedure and Continuous Oral Suction During the Procedure Reduces the Amount of Aerosol Generated

Shannon Melissa Chan, Tsz Wah Ma, Marc Ka-Chun Chong, Daniel Leonard Chan, Enders Kwok Wai Ng, Philip Wai Yan Chiu, Shannon Melissa Chan, Tsz Wah Ma, Marc Ka-Chun Chong, Daniel Leonard Chan, Enders Kwok Wai Ng, Philip Wai Yan Chiu

No abstract available

Keywords: COVID-19; Esophagogastroduodenoscopy; Health Care Workers; SARS-CoV-2.

Figures

Supplementary Figure 1

(A) Line graphs of particle counts sizes 0.3, 0.5, 0.7, 1, 5, and 10 μm of an unsedated diagnostic procedure without the use of dental sucker. (B) Line graphs of particle counts sizes 0.3, 0.5, 0.7, 1, 5, and 10 μm of an unsedated diagnostic procedure with the use of dental sucker. (C) The change in LN_dCF during the procedure compared with baseline with or without sucker. The use of dental sucker reduced the association between timing of procedure (before vs during) and dCF_0.3 (estimate = −0.24 [SE = 0.04]; 95% confidence interval [CI], −0.32 to −0.16; P < .001), dCF_0.5 (estimate = −0.36 [SE = 0.07]; 95% CI, −.50 to −.22; P < .001), dCF_0.7 (estimate = −.36 [SE = .10]; 95% CI, −0.56 to −0.16; P < .001), dCF_1 (estimate = −0.32 [SE = 0.13]; 95% CI, −0.57 to −0.07; P = .02), dCF_5 (estimate = −1.14 [SE = .40]; 95% CI, −1.92 to −0.36; P < .01), and dCF_10 (estimate = −0.71 [SE = 0.35]; 95% CI, −1.40 to −.02; P = .046). In other words, the use of dental sucker significantly reduced the amount of particles of all sizes expelled during the procedure compared with baseline. Simple slope tests revealed that when compared with baseline, particles of all sizes during EGD were significantly increased in procedures performed without dental sucker (dCF_0.3 estimate = 0.18, t = 6.30; P < .01; dCF_0.5 estimate = .30, t = 5.54; P < .01; dCF_0.7 estimate = .28, t = 3.89; P < .01; dCF_1 estimate = .22, t = 2.43; P = .02; dCF_5 estimate = 2.49, t = 8.54; P < .01; dCF_10 estimate = 1.53, t = 6.03; P < .01). The number of dCF_0.3, dCF_0.5, dCF_0.7, and dCF_1 during EGD were nonsignificantly decreased among participants when dental sucker was used (dCF_0.3 estimate = −0.06, t = −1.22; P = .23; dCF_0.5 estimate = −0.07, t = −2.35; P = .02; dCF_0.7 estimate = −0.08, t = −1.06; P = .29; dCF_1 estimate = −0.09, t = −0.84; P =.40). For particles dCF_5 and dCF_10, the magnitude of the increase was significantly smaller with the use of dental sucker (dCF_5 estimate = 1.35, t = 3.69; P < .01; dCF_10 estimate = .82, t = 2.78; P < .01 ). Confounders were controlled at the multilevel modeling.

Supplementary Figure 2

The line graph showing the change in dCF during a per-oral endoscopic myotomy procedure performed under general anesthesia with CO2 insufflation. There was a surge seen in all particle sizes during the initial intubation of the endoscope and diagnostic EGD. There was also a significant increase in all particles generated once the energy cutting devices were used. These findings suggest that general anesthesia might not have a protective effect on the amount of aerosol generated and the use of energy cutting devices generates a significant amount of aerosols.