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).

1658 Duodenal Stricture Secondary to Chronic Pancreatitis; A Case Report

The complications of chronic pancreatitis are well established; however, the incidence of duodenal strictures in the context of previous necrotising pancreas is uncommon. I herein report the case of a 30-year Caucasian woman who presents with reduced oral intake, vomiting and profound cachexia. Medical history of note includes necrotising pancreatitis and umbilical hernia repair. Computed tomography scan revealed multiple cystic collections in the anterior pararenal space. Oesophagogastroduodenoscopy (OGD) revealed a duodenal stricture, which was histologically benign. Endoscopic insertion of a percutaneous jejunostomy (PEJ) unfortunately failed. Upon counselling with the patient, the decision was made to perform a laparotomy with loop gastrojejunostomy and jejunostomy tube insertion. The patient was subsequently able to be fed, initially with the aid of dieticians, and trained for independent care at home. This case highlights the uncommon complication of duodenal stricture in the context of chronic pancreatitis, and the importance of timely diagnosis and management.

Preoperative stenting in insulinoma located nearby pancreatic duct: a case report and literature review

Insulinoma is a rare functional neuroendocrine tumor of pancreas. The only recommended treatment is surgical removal. We present a case of a 46-year-old female patient who underwent the enucleation of insulinoma localized nearby pancreatic main duct after preoperative endoscopic insertion of pancreatic stent. The tumor was safely identified during the surgery and was enucleated without injury of pancreatic duct or postoperative complications.

Endoscopic Insertion of Nasojejunal Feeding Tube at Bedside for Critically Ill Patients: Relationship between Tube Position and Intragastric Countercurrent of Contrast Medium

Background and Oblectives: We evaluated the success rate of endoscopically positioned nasojejunal feeding tubes and the intragastric countercurrent of contrast medium thereafter. Method: This retrospective observational study investigated patients who were admitted to a single intensive care unit and required endoscopic placement of a post-pyloric feeding tube between January 2010 and June 2016. The feeding tube was grasped with forceps via a transoral endoscope and inserted into the duodenum or jejunum. Thereafter, we assessed the position of the tube and the intragastric countercurrent using abdominal radiography with contrast medium. Results: The tube tip was inserted at the jejunum and the duodenal fourth portion in 55.8 and 33.6% of patients, respectively. The tip of the inserted tube had moved into the jejunum of 71.7% of patients by the following day. The countercurrent rate was significantly lower among patients with a tube inserted into the duodenal fourth portion or more distal than among those with tubes inserted more proximally (8.4 vs. 45.4%, p = 0.0022). Conclusions: The endoscopic insertion and positioning of a nasojejunal feeding tube seemed effective because the rate of tube insertion into the duodenal fourth portion or more distal was about 90%. The findings of intragastric countercurrents indicated that feeding tubes should be inserted into the duodenal fourth portion or beyond to prevent vomiting and the aspiration of enteral nutrients.

Foreign Body Moves Retrograde through Ileocecal Valve during Colonoscopy

Ingestion of foreign bodies and particularly of button or/and cylindrical batteries is frequent in children and adults with underlying psychiatric diseases. We present a case of a 30-year-old woman with unstable borderline disorder, where overall 4 button and 2 cylindrical batteries were endoscopically removed from her digestive system. During the last session of colonoscopy a peculiar incident was observed, as a cylindrical battery of 15 mm diameter and 43 mm length moved retrograde through ileocecal valve into the small bowel. The foreign body removal from terminal ileum was effective and safe using an endoscopic loop. This report suggests that endoscopic insertion in terminal ileum should be attempted in every colonoscopy session conducted under the indication of foreign body removal, as the possibility of retrograde movement of even large foreign bodies in the colon and through ileocecal valve is given.

Tracheal T-tube: a novel endoscopic insertion technique

Background:Laryngotracheal stenosis is a complex condition of airway compromise involving either the larynx or trachea, or both.Objectives:This paper describes a new method of endoscopically inserting a silicone tracheal T-tube as treatment for laryngotracheal stenosis. The advantages of this method over previously described methods are discussed.

Characteristics of a Pneumatic Bellows Actuator for Colonoscopy

Since colonoscopic insertion requires a high level of skill on the part of the examining physician, the patient may experience pain if the physician is not so highly skilled. In this study, our objective is to realize an easy-to-execute endoscopic insertion that does not rely on the physician’s skill. We develop a pneumatic actuator that gives the endoscope self-propulsion capability. The actuator is configured with three bellows made of polyethylene film. By applying pneumatic pressure to the bellows in a specific sequence to extend and contract them, the end of the actuator moves elliptically. Thus, the endoscope can be given propulsion performance by attaching several actuators and driving them in different phases. In this paper, the basic characteristics of the actuator are determined geometrically from the characteristics of the bellows, and then those characteristics are compared to the results of experiments. In addition, experiments are conducted in which a rod, used as a dummy endoscope, is transported through a pipe and inserted in an intestinal tract model. The experiments confirm and validate the proposed concept.