• Endoscopic submucosal dissection
• Gastrectomy
• Gastric cancer
• Real-World data
• Regional disparity

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/pathology
• Male
• Japan/epidemiology
• Female
• Aged
• Gastrectomy/statistics & numerical data
• Retrospective Studies
• Middle Aged
• Databases, Factual
• Laparoscopy/statistics & numerical data
• Laparoscopy/methods
• Adult
• Aged, 80 and over
• COVID-19/epidemiology
• Incidence
• Gastroscopy/statistics & numerical data
• Young Adult

• 24A005 National Center for Global Health and Medicine

• COVID-19 pandemic
• cancer stage
• colorectal cancer

• Humans
• COVID-19/epidemiology
• Japan/epidemiology
• Colorectal Neoplasms/epidemiology
• Colorectal Neoplasms/pathology
• Female
• Male
• Aged
• Retrospective Studies
• Middle Aged
• Neoplasm Staging
• Adult
• Aged, 80 and over
• Databases, Factual
• Hospitals/statistics & numerical data
• Pandemics

• COVID-19
• Diagnosis
• Head and neck cancer
• Treatment

• COVID‐19
• colonoscopy
• colorectal cancers
• endoscopy
• gastric cancers

• COVID‐19
• emergencies
• endoscopy
• gastrointestinal hemorrhage
• retrospective studies

• colorectal neoplasms
• covid-19
• emergencies
• general surgery
• intestinal perforation
• intestinal obstruction
• neoplasias colorretais
• emergências
• cirurgia geral
• perfuração intestinal
• obstrução intestinal

• Humans
• Colorectal Neoplasms/diagnosis
• COVID-19/complications
• Pandemics
• Intestinal Perforation
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Retrospective Studies

• COVID-19 pandemic
• gastric cancer
• mortality

• JP21K17227 Japan Society for the Promotion of Science

• adenosine triphosphate hygiene monitoring test
• endoscopic submucosal dissection
• esophagogastroduodenoscopy
• infection
• particle counter

• COVID-19
• Dilation
• Eosinophilic esophagitis
• Fibrosis
• Outcomes
• Stricture

• Adult
• Humans
• Eosinophilic Esophagitis/pathology
• Retrospective Studies
• Constriction, Pathologic
• Pandemics
• Esophageal Stenosis/pathology
• COVID-19
• Endoscopy
• Endoscopy, Gastrointestinal

• T35 DK007386 NIDDK NIH HHS
• national institutes of health

• COVID-19
• Cancer diagnosis
• Health services
• The National Database of Japan

The coronavirus pandemic significantly impacted endoscopic practice. During lower gastrointestinal endoscopy, infectious substances disseminate; therefore, we developed an infection control device (STEP‐L) for lower gastrointestinal endoscopy and examined its usefulness.

STEP‐L wraps around the patient's buttocks and covers the endoscope. Using lower endoscopy training models, three endoscopists performed 18 colonoscopies with STEP‐L (group S) and without (group C). Endoscopic insertion time and pigmented areas of ​​gloves and diapers after the examination were compared between both groups.

Insertion of the endoscope up to the cecum was possible in all 18 examinations. The insertion time to the cecum was 52.4 ± 19.0 s in group S and 53.9 ± 13.3 s in group C. The pigmented areas of the ​​gloves measured 39,108.0 ± 16,155.3 pixels in group C, but were significantly reduced to 2610.5 ± 4333.8 pixels in group S (p < 0.05). The pigmented areas of the diapers measured 2280.9 ± 3285.2 pixels in group C, but were significantly reduced to 138.0 ± 82.9 pixels in group S (p < 0.05).

Using STEP‐L does not change the insertion time, and is technically feasible. STEP‐L significantly reduces the adhesion of virtual pollutants to the surroundings, suggesting that this device is useful for infection control during lower gastrointestinal endoscopy.

• aerosol infection
• colonoscopy
• contact infection
• coronavirus
• droplet infection

• covid-19
• epidemiology
• gastrointestinal symptoms
• pathophysiology

• COVID-19/epidemiology
• Gastrointestinal Diseases/epidemiology
• Global Health
• Humans
• Maryland
• SARS-CoV-2

• COVID-19
• assessment of adherence
• endoscopy

• COVID-19
• hospital-based cancer registries
• neoplasms
• real-world data
• treatment

A 70-year-old man was diagnosed with coronavirus disease 2019 (COVID-19). The patient had suspected upper gastrointestinal bleeding during the course of the COVID-19 infection. Urgent esophagogastroduodenoscopy (EGD) was performed. However, because of mobility restrictions imposed as a COVID-19 countermeasure, EGD was done in a small hospital room. Hemostatic treatment was successful, but no sufficient close examination could be done. The patient, who was diagnosed as having alpha-fetoprotein-producing gastric cancer, died about three months later.

• fluoroscopy-guided endoscopic procedures
• radiation exposure
• radiation exposure protection

• COVID-19
• Coronavirus
• Gastric cancer

• COVID-19/epidemiology
• Humans
• Japan/epidemiology
• Pandemics
• Retrospective Studies
• SARS-CoV-2
• Stomach Neoplasms/therapy

Under the current pandemic situation of the coronavirus disease 2019 (COVID‐19), we have newly developed a commercially available device named Endomask to prevent the diffusion of droplets from subjects undergoing esophagogastroduodenoscopy (EGD). Herein, we evaluate the efficacy and safety of the device, and also evaluate the stress of the device on the operators and the subjects of EGD.

The efficacy of the device was evaluated using an experimental model that simulated the environment of EGD. The safety of the device was evaluated clinically by means of measuring the oxygen saturation and the expiratory carbonic dioxide partial pressure of subjects with our device during EGD. The stress of the device on the operability of the endoscopists and the respiration of the subjects were evaluated using questionnaires.

In the experiments with Endomask, the percentage of the area with simulated droplets was significantly reduced compared to that without our device (median, 0.24% vs. 6.96%, p = 0.009). The saturation of oxygen and the expiratory carbonic dioxide partial pressure of subjects with the device did not show significant change at any recording times. Neither the operators nor the subjects felt serious stress from examination with the device.

Endomask could remarkably and safely prevent the diffusion of droplets without serious stress. Endomask is expected to contribute to a reduction of the infectious risk of SARS‐CoV‐2 in endoscopy units during COVID‐19 pandemic.

Although the novel coronavirus disease 2019 did not lead to a serious medical collapse in Japan, its impact on treatment of oesophageal cancer has rarely been investigated. This study aimed to investigate the influence of the pandemic on consultation status and initial treatment in patients with primary oesophageal cancer.

A retrospective study was conducted among 546 patients with oesophageal cancer who visited our hospital from April 2018 to March 2021. Pre-pandemic and pandemic data were compared with the clinical features, oncological factors and initial treatment as outcome measures.

Diagnoses of oesophageal cancer decreased during the early phase of the pandemic from April to June (P = 0.048); however, there was no significant difference between the pre-pandemic and pandemic periods throughout the year. The proportion of patients diagnosed with distant metastases significantly increased during the pandemic (P = 0.026), while the proportion of those who underwent initial radical treatment decreased (P = 0.044). The rate of definitive chemoradiotherapy decreased by 58.6% relative to pre-pandemic levels (P = 0.001).

Patients may have refrained from consultation during the early phase of the coronavirus disease 2019 pandemic. The resultant delay in diagnosis may have led to an increase in the number of patients who were not indicated for radical treatment, as well as a decrease in the number of those who underwent definitive chemoradiotherapy. Our findings highlight the need to maintain the health care system and raise awareness on the importance of consultation.

• COVID-19
• Japan
• chemoradiotherapy
• oesophageal neoplasms
• referral and consultation

• COVID-19/epidemiology
• Esophageal Neoplasms/epidemiology
• Esophageal Neoplasms/therapy
• Humans
• Pandemics
• Rare Diseases
• Retrospective Studies
• SARS-CoV-2
• Tokyo/epidemiology

This study aimed to assess the efficacy of a novel aerosol-exposure protection (AP) mask in preventing coronavirus disease in healthcare professionals during upper gastrointestinal endoscopy and to evaluate its clinical feasibility.

In Study 1, three healthy volunteers volitionally coughed with and without the AP mask in a cleanroom. Microparticles were visualized and counted with a specific measurement system and compared with and without the AP mask. In Study 2, 30 patients underwent endoscopic resection with the AP mask covering the face, and the SpO2 was measured throughout the procedure.

In Study 1, the median number of microparticles in volunteers 1, 2, and 3 with and without the AP mask was 8.5 and 110.0, 7.0 and 51.5, and 8.0 and 95.0, respectively (p<0.01). Using the AP mask, microparticles were reduced by approximately 92%. The median distances of microparticle scattering without the AP mask were 60, 0, and 68 in volunteers 1, 2, and 3, respectively. In Study 2, the mean SpO2 was 96.3%, and desaturation occurred in three patients.

The AP mask could provide protection from aerosol exposure and can be safely used for endoscopy in clinical practice.

• COVID-19
• Gastrointestinal endoscopy
• Personal protective equipment

Endoscopy confers high risk for acquiring coronavirus disease 2019. Although guidelines recommend that medical staff use personal protective equipment, no infection control equipment have been established for patients. This study aimed to clarify the usefulness of two face masks we had designed for transnasal and transoral endoscopy.

The efficacy of the masks was evaluated by simulating coughing in a mannequin with fluorescent dyes and mapping the droplet trajectory and number. The number of aerosols generated during endoscopy was clinically evaluated in the endoscopy room. Overall, 4356 screening endoscopies were performed with the patients wearing our masks at Medcity21, a health checkup facility, between June and December 2020; the effects of the masks on the patient’s condition were evaluated retrospectively. An 11-item paper-based survey was performed by the endoscopy staff 6 months after the adoption of the mask-based infection control method.

Use of both masks reduced the number of droplets released during the simulation. Clinically, the use of both masks did not affect the patients’ conditions during endoscopy and prevented an increase in the aerosols in the endoscopy room. This mask-based infection control method was favorably received, and all staff indicated that understanding the efficacy of our mask-based infection control reduced their anxiety regarding infection. Until December 2020, none of our staff had contracted SARS-CoV-2.

Our mask-based infection control method is easy to adopt, inexpensive, and effective; understanding its effectiveness may help ease the fear of infection among endoscopy staff.

• COVID-19
• endoscopy
• infection control
• personal protective equipment

• Asia
• COVID-19
• Endoscopy
• Personal protective equipment
• Severe acute respiratory syndrome coronavirus 2

• COVID-19
• Endoscopy
• Endoscopy, Gastrointestinal
• Humans
• Pandemics
• SARS-CoV-2
• Surveys and Questionnaires

• COVID-19
• education
• endoscopy

Esophagogastroduodenoscopy (EGD) has a high risk of virus transmission during the current coronavirus disease 2019 era, and preventive measures are under investigation. We investigated the effectiveness of a newly developed patient-covering negative-pressure box system (Endo barrier^®) (EB) for EGD. Eighty consecutive unsedated patients who underwent screening EGD with EB use were prospectively enrolled. To examine the aerosol ratio before, during, and after EGD, 0.3- and 0.5-μm aerosols were measured every 60 s using an optical counter. Moreover, the degree of contamination of the examiners’ goggles and vinyl gowns was assessed before and after EGD using a rapid adenosine triphosphate (ATP) test for simulated droplets. Data were available in 73 patients and showed that 0.3- and 0.5-μm particles did not increase in 95.8% (70/73) and 94.5% (69/73) of patients during EGD under EB. There were no significant differences in the total 0.3- or 0.5-μm particle counts before versus after EGD. The difference in the ATP levels before and after EGD was −0.6 ± 16.6 relative light units (RLU) on goggles and 1.59 ± 19.9 RLU on gowns (both within the cutoff value). EB use during EGD may provide a certain preventive effect against aerosols and droplets, decreasing examiners’ exposure to viruses.

• COVID-19
• aerosol
• esophagogastroduodenoscopy
• virus transmission

• Cross Infection/prevention & control
• Endoscopy
• Humans
• Incidence
• Infection Control

The spread of coronavirus disease 2019 (COVID-19) has affected socioeconomic and healthcare systems in many countries. Accordingly, many individuals may have canceled their annual health-check programs, including esophagogastroduodenoscopy, which would have resulted in lower numbers of newly diagnosed patients with gastric cancer in comparison to other times.

Questionnaires were distributed to 62 hospitals every week from May 2020 to August 2020 (total 744) through mailing lists of the Stomach Cancer Study Group of the Japan Clinical Oncology Group. The number of patients with gastric cancer and hospital systems during the COVID-19 pandemic were surveyed.

In total, 74% (551 out of 744) of the questionnaires were answered and analyzed. In early May, approximately 50% of hospitals had to restrict surgical slots due to the COVID-19 pandemic. However, they gradually loosened the restrictions thereafter. The number of gastrectomies was < 80% that of the same period in the previous year, and hospitals in Tokyo were seriously affected by a 50% decrease in the number of gastrectomies.

The number of gastrectomies was lower than that in the previous year. Further multi-center follow-up studies are required to evaluate the long-term effects of COVID-19 on the clinical outcomes of patients with gastric cancer.

The online version contains supplementary material available at 10.1007/s00595-021-02329-y.

• COVID-19
• Coronavirus
• Gastrectomy
• Socioeconomic factors
• Stomach neoplasms

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spreading at an alarming rate, and it has created an unprecedented health emergency threatening tens of millions of people worldwide. Previous studies have indicated that SARS-CoV-2 ribonucleic acid could be detected in the feces of patients even after smear-negative respiratory samples. However, demonstration of confirmed fecal-oral transmission has been difficult. Clinical studies have shown an incidence rate of gastrointestinal (GI) symptoms ranging from 2% to 79.1% in patients with COVID-19. They may precede or accompany respiratory symptoms. The most common GI symptoms included nausea, diarrhea, and abdominal pain. In addition, some patients also had liver injury, pancreatic damage, and even acute mesenteric ischemia/thrombosis. Although the incidence rates reported in different centers were quite different, the digestive system was the clinical component of the COVID-19 section. Studies have shown that angiotensin-converting enzyme 2, the receptor of SARS-CoV-2, was not only expressed in the lungs, but also in the upper esophagus, small intestine, liver, and colon. The possible mechanism of GI symptoms in COVID-19 patients may include direct viral invasion into target cells, dysregulation of angiotensin-converting enzyme 2, immune-mediated tissue injury, and gut dysbiosis caused by microbiota. Additionally, numerous experiences, guidelines, recommendations, and position statements were published or released by different organizations and societies worldwide to optimize the management practice of outpatients, inpatients, and endoscopy in the era of COVID-19. In this review, based on our previous work and relevant literature, we mainly discuss potential fecal-oral transmission, GI manifestations, abdominal imaging findings, relevant pathophysiological mechanisms, and infection control and prevention measures in the time of COVID-19.

• COVID-19
• SARS-CoV-2
• Gastrointestinal manifestations
• Abdominal imaging
• Mechanisms
• Prevention

The surge of coronavirus disease 2019 (COVID-19) patients has markedly influenced the treatment policies of tertiary hospitals because of the need to protect medical staff and contain viral transmission, but the impact COVID-19 had on emergency gastrointestinal endoscopies has not been determined.

To compare endoscopic activities and analyze the clinical outcomes of emergency endoscopies performed before and during the COVID-19 outbreak in Daegu, the worst-hit region in South Korea.

This retrospective cohort study was conducted on patients aged ≥ 18 years that underwent endoscopy from February 18 to March 28, 2020, at a tertiary hospital in Daegu. Demographics, laboratory findings, types and causes of emergency endoscopies, and endoscopic reports were reviewed and compared with those obtained for the same period in 2018 and 2019.

From February 18 to March 28, a total of 366 emergent endoscopic procedures were performed: Upper endoscopy (170, 50.6%), endoscopic retrograde cholangiopancreatography (113, 33.6%), and colonoscopy with sigmoidoscopy (53, 15.8%). The numbers of procedures performed in 2018 and 2019 dropped by 48.8% and 54.8%, respectively, compared with those in 2020. During the COVID-19 outbreak, the main indications for endoscopy were melena (36.7%), hematemesis (30.6%), and hematochezia (10.2%). Of the endoscopic abnormalities detected, gastrointestinal bleeding was the most common: 39 cases in 2018, 51 in 2019, and 35 in 2020.

The impact of COVID-19 is substantial and caused dramatic reductions in endoscopic procedures and changes in patient behaviors. Long-term follow-up studies are required to determine the effects of COVID-19 induced changes in the endoscopy field.

• COVID-19
• Coronavirus
• Endoscopy
• Emergency endoscopy

Esophagogastroduodenoscopy (EGD) under topical pharyngeal anesthesia has the advantage of avoiding the unwanted cardiopulmonary adverse events experienced following intravenous sedation. Lidocaine spray is a common anesthetic option and is safe for unsedated EGD. Although several studies have compared different topical anesthetic agents, their formulations, and delivery techniques, questions still remain concerning the optimal mode of administration. We have designed a lidocaine formulation in the form of an ice popsicle and compared its effectiveness and tolerability with lidocaine spray in patients undergoing unsedated EGD.

This was a single-center prospective randomized controlled trial. Unsedated EGD patients were randomly allocated the lidocaine spray [Group (Gp) A] or lidocaine ice popsicle (Gp B) formulation.

In total, 204 unsedated EGD patients were evaluated. Compared to the spray, the lidocaine ice popsicle group showed better scores for effects in terms of endoscopist satisfaction (Gp A, 7.28±1.44; Gp B, 7.8±0.89; p=0.0022), gag reflex (Gp A, 1.3±0.66; Gp B, 1.02±0.61; p=0.0016), patient satisfaction (Gp A, 7.74±0.82; Gp B, 8.08±0.82; p=0.0039), discomfort (Gp A, 6.54±1.34; Gp B, 5.95±1.21; p=0.0012), and pain (Gp A, 5.38±1.85; Gp B, 4.51±2.01; p=0.0015).

Both the lidocaine spray and ice popsicle formulations are safe, effective options for diagnostic EGD with the ice popsicle exhibiting better performance. We propose the lidocaine ice popsicle formulation for topical pharyngeal anesthesia in patients undergoing unsedated diagnostic EGD and suggest it may be a suitable option during the COVID-19 pandemic.

Thai Clinical Trials Registry (TCTR) number TCTR20190502001.

• esophagogastroduodenoscopy
• lidocaine ice popsicle
• lidocaine spray
• topical pharyngeal anesthesia
• upper gastrointestinal endoscopy

• COVID-19
• endoscopy
• infection control strategy
• personal protective equipment
• triage

• SARS-CoV-2
• coronavirus
• endoscopy
• pandemia
• personal protective equipment

• COVID-19
• SARS-CoV-2
• coronavirus
• infection control
• respiratory management