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Coughlan MF, Sawhney MS, Pleskow DK, Khan U, Silva-Santisteban A, Ahmed A, Zhang X, Glyavina M, Chen L, Upputuri PK, Zakharov YN, Zhang L, Qiu L, Perelman LT. Biopsy channel of the endoscope as a potential source of infectious droplets during GI endoscopy. Gastrointest Endosc 2022; 96:764-770. [PMID: 35724696 PMCID: PMC10699089 DOI: 10.1016/j.gie.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/11/2022] [Accepted: 06/08/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS During endoscopy, droplets with the potential to transmit infectious diseases are known to emanate from a patient's mouth and anus, but they may also be expelled from the biopsy channel of the endoscope. The main goal of our study was to quantify droplets emerging from the biopsy channel during clinical endoscopy. METHODS A novel light-scattering device was used to measure droplets emanating from the biopsy channel. An endoscopy model was created, and in vitro measurements were carried out during air insufflation, air and water suctioning, and the performance of biopsy sampling. Similar measurements were then made on patients undergoing endoscopy, with all measurements taking place over 2 days to minimize variation. RESULTS During in vitro testing, no droplets were observed at the biopsy channel during air insufflation or air and water suctioning. In 3 of 5 cases, droplets were observed during biopsy sampling, mostly when the forceps were being removed from the endoscope. In the 22 patients undergoing routine endoscopy, no droplets were observed during air insufflation and water suctioning. Droplets were detected in 1 of 11 patients during air suctioning. In 9 of 18 patients undergoing biopsy sampling and 5 of 6 patients undergoing snare polypectomies, droplets were observed at the biopsy channel, mostly when instruments were being removed from the endoscope. CONCLUSIONS We found that the biopsy channel may be a source of infectious droplets, especially during the removal of instruments from the biopsy channel. When compared with droplets reported from the mouth and anus, these droplets were larger in size and therefore potentially more infectious.
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Affiliation(s)
- Mark F. Coughlan
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Mandeep S. Sawhney
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Douglas K. Pleskow
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Umar Khan
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Andy Silva-Santisteban
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Awais Ahmed
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Xuejun Zhang
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Maria Glyavina
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Liming Chen
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Paul K. Upputuri
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Yuri N. Zakharov
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Lei Zhang
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Le Qiu
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Lev T. Perelman
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
- Biological and Biomedical Sciences Program, Harvard University
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Cherne MD, Gentry AB, Nemudraia A, Nemudryi A, Hedges JF, Walk H, Blackwell K, Snyder DT, Jerome M, Madden W, Hashimi M, Sebrell TA, King DB, Plowright RK, Jutila MA, Wiedenheft B, Bimczok D. Severe Acute Respiratory Syndrome Coronavirus 2 Is Detected in the Gastrointestinal Tract of Asymptomatic Endoscopy Patients but Is Unlikely to Pose a Significant Risk to Healthcare Personnel. Gastro Hep Adv 2022; 1:844-852. [PMID: 35765598 PMCID: PMC9225937 DOI: 10.1016/j.gastha.2022.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022]
Abstract
Background and Aims Recent evidence suggests that the gut is an additional target for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, whether SARS-CoV-2 spreads via gastrointestinal secretions remains unclear. To determine the prevalence of gastrointestinal SARS-CoV-2 infection in asymptomatic subjects, we analyzed gastrointestinal biopsy and liquid samples from endoscopy patients for the presence of SARS-CoV-2. Methods We enrolled 100 endoscopic patients without known SARS-CoV-2 infection (cohort A) and 12 patients with a previous COVID-19 diagnosis (cohort B) in a cohort study performed at a regional hospital. Gastrointestinal biopsies and fluids were screened for SARS-CoV-2 by polymerase chain reaction (PCR), immunohistochemistry, and virus isolation assay, and the stability of SARS-CoV-2 in gastrointestinal liquids in vitro was analyzed. Results SARS-CoV-2 ribonucleic acid was detected by PCR in the colonic tissue of 1/100 patients in cohort A. In cohort B, 3 colonic liquid samples tested positive for SARS-CoV-2 by PCR and viral nucleocapsid protein was detected in the epithelium of the respective biopsy samples. However, no infectious virions were recovered from any samples. In vitro exposure of SARS-CoV-2 to colonic liquid led to a 4-log-fold reduction of infectious SARS-CoV-2 within 1 hour (P ≤ .05). Conclusion Overall, the persistent detection of SARS-CoV-2 in endoscopy samples after resolution of COVID-19 points to the gut as a long-term reservoir for SARS-CoV-2. Since no infectious virions were recovered and SARS-CoV-2 was rapidly inactivated in the presence of colon liquids, it is unlikely that performing endoscopic procedures is associated with a significant infection risk due to undiagnosed asymptomatic or persistent gastrointestinal SARS-CoV-2 infections.
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Affiliation(s)
- Michelle D Cherne
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - Andrew B Gentry
- Department of Gastroenterology, Bozeman Health Deaconess Hospital, Bozeman, Montana
| | - Anna Nemudraia
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - Artem Nemudryi
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - Jodi F Hedges
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - Heather Walk
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - Karlin Blackwell
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - Deann T Snyder
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - Maria Jerome
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - Wyatt Madden
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
- Rollins School of Public Heath, Emory University, Atlanta, Georgia
| | - Marziah Hashimi
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - T Andrew Sebrell
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - David B King
- Department of Clinical Research, Bozeman Health Deaconess Hospital, Bozeman, Montana
| | - Raina K Plowright
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - Mark A Jutila
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - Blake Wiedenheft
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
| | - Diane Bimczok
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana
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Asokkumar R, Seow I, Chin Hong L, Chang J, Tan D, Salazar E. Rostered routine testing for severe acute respiratory coronavirus virus 2 infection among healthcare workers: Do we detect more? J Gastroenterol Hepatol 2022; 37:404-405. [PMID: 34694645 PMCID: PMC8656364 DOI: 10.1111/jgh.15720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022]
Affiliation(s)
- R Asokkumar
- Department of Gastroenterology and HepatologySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
| | - I Seow
- Department of Colorectal SurgerySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
| | - L Chin Hong
- Department of Upper Gastrointestinal and Bariatric SurgerySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
| | - J Chang
- Department of Gastroenterology and HepatologySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
| | - D Tan
- Department of Gastroenterology and HepatologySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
| | - E Salazar
- Department of Gastroenterology and HepatologySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
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