Post written by Takashi Muramoto, MD, PhD, from the Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

We introduce a continuous saliva suction tube that can be used during endoscopy (Salsuction; Fujifilm Medical Co, Ltd, Tokyo, Japan). Not only is this device disposable and easy to set up with a mouthpiece, it also has 3 other advantageous features. First, it can be directly connected to the tube of the aspirator. Second, the soft tip of the suction tube has multiple slits on its side, making it difficult for the tip to stick to the oral mucosa and cause damage. Third, the tube is made from stainless steel, making it malleable to maintain a particular shape. This device is inexpensive (costing about 3.00 USD), easy to set up, easy to change the suction position in the oral cavity from outside the body, and can be used in all cases, regardless of the endoscopic manipulations. Since time-consuming treatments, such as ESD, endoscopic hemostasis for the upper gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP), often increase saliva production, this device can be constantly used to prevent aspiration. Furthermore, because the risk of aspiration, regardless of the examination time, is high, this device can be used for procedures in elderly patients and for lugol voiding during examinations. In addition, in view of the current COVID-19 pandemic, saliva can be a source of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection for endoscopists and assistants, and this device might be useful for preventing salivary transmission of the virus.

Since the number of endoscopic treatments for elderly patients is expected to continue to increase in the future, a new strategy is needed to prevent aspiration pneumonia associated with liquid reflux and saliva retention in the oral cavity. This device has the potential to prevent aspiration pneumonia during upper gastrointestinal endoscopic procedures, including ERCP.

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