New safety measure for the endoscopic procedures during the COVID-19 pandemic: New STEP

Post written by Daisuke Kikuchi, MD, PhD, from the Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.


Endoscopic procedures pose the risk of contact, droplet, and aerosol infections. Infection control is therefore important during these procedures, but it has not always been adequately achieved. With the advent of the COVID-19 pandemic, infection control during endoscopy is once again in the spotlight.

Current infection control practices for endoscopy consist of 3 steps: hand disinfection before the examination, wearing of PPE during the examination, and hand disinfection and cleaning of the surrounding environment after the examination. However, if a patient vomits or coughs during the procedure, contaminants may diffuse throughout the endoscopy room, making it is difficult to completely clean and disinfect all contaminated surfaces. We should therefore devise ways to shield the patient and prevent contaminants from spreading. To this end, in this article, we propose a new infection control step to shield patients.

Cost and simplicity are important considerations in infection control. Our proposed measure uses only plastic bags, condoms, and 18G needles, all of which are inexpensive and readily disposable, and preparation before endoscopy is easy. In addition, we can maintain operability of the endoscope because the plastic bag is fixed to the mouthpiece. We believe that this new infection control step can be easily performed anywhere in the world for conventional endoscopic procedures. One issue to consider is how to manage oxygen desaturation during the endoscopic procedures: if we remove the shield and place the nasal cannula, there is a risk of infection by spreading contaminants at that time. This could be managed by placing a nasal cannula before starting the endoscopic procedure, and then oxygen saturation can be monitored at any time.

Various protocols for infection control during endoscopy have been reported to date. However, if the infection control measures are not implemented appropriately, none of these protocols will be effective. Similarly, with the infection control measure we propose here, it is important to handle the items used appropriately. It is also imperative that endoscopists be prepared to prevent the spread of contaminants to the surroundings as much as possible. We hope that the infection control step described here can contribute to safety measures for endoscopic medical care worldwide.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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