Letter to the Editor
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2020; 12(10): 404-407
Published online Oct 16, 2020. doi: 10.4253/wjge.v12.i10.404
Endotracheal intubation in patients with COVID-19 using an ultrathin flexible gastrointestinal endoscope
Shigenori Masaki, Chizuko Yamada, Takashi Kawamoto
Shigenori Masaki, Department of Surgery and Gastroenterology, Miyanomori Memorial Hospital, Sapporo 064-0953, Hokkaido, Japan
Chizuko Yamada, Department of Safety Management, Miyanomori Memorial Hospital, Sapporo 064-0953, Hokkaido, Japan
Takashi Kawamoto, Department of Neurosurgery, Miyanomori Memorial Hospital, Sapporo 064-0953, Hokkaido, Japan
Author contributions: Masaki S, Yamada C, and Kawamoto T designed, conducted the study, and revised the manuscript critically; Masaki S and Yamada C collected and interpreted data; Masaki S drafted the manuscript; all authors approved the final version of the manuscript.
Conflict-of-interest statement: All authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shigenori Masaki, MD, Chief Doctor, Department of Surgery and Gastroenterology, Miyanomori Memorial Hospital, 3-7-5-25 Miyanomori, Chuo-ku, Sapporo 064-0953, Hokkaido, Japan. ayukkyjp@yahoo.co.jp
Received: May 27, 2020
Peer-review started: May 27, 2020
First decision: September 11, 2020
Revised: September 19, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: October 16, 2020

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 occasionally becomes severe and requires endotracheal intubation. Endotracheal intubation is usually performed using a laryngoscope; however, the operator needs to be in close proximity to the patient’s face during the procedure, which increases the risk of droplet exposure. Therefore, we simulated fiberoptic endotracheal intubation on a mannequin representing the patient, using an ultrathin flexible gastrointestinal endoscope as an alternative to the bronchoscope, in order to maintain distance from the patient during the procedure. We performed this procedure 10 times and measured the time required; the median procedure time was 6.4 s (interquartile range, 5.7-8.1 s). The advantage of this method is the short procedure time and distance maintained from the patients. The flexible tip-steerable control and length of the gastrointestinal endoscope contributed to shortening the procedure time and maintaining distance from the patients. In addition, this method can handle difficult airways without risk of misplacement of the endotracheal tube. However, it is necessary to consider the risk of aerosol generation associated with this procedure. In the pandemic setting of coronavirus disease 2019, this approach may be useful when a gastrointestinal endoscopist is in charge of endotracheal intubation of patients with coronavirus disease 2019.

Keywords: Endotracheal intubation, SARS-CoV-2, COVID-19, Laryngoscopes, Bronchoscopes, Gastrointestinal endoscopes

Core Tip: Proximity of the operators to the patient is inevitable with conventional endotracheal intubation procedures. In this endotracheal intubation method, the gastrointestinal endoscope is used as an alternative to the bronchoscope. Thus, endotracheal intubation can be performed while keeping a relatively safe distance from the patient, as the gastrointestinal endoscope has a long effective length. Furthermore, the flexible tip-steerable control of the gastrointestinal endoscope enables quick and reliable endotracheal intubation.