Published online Oct 16, 2020. doi: 10.4253/wjge.v12.i10.404
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.
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.