The ongoing Covid-19 pandemic has not only altered daily lives of people, it has also affected the way medicine is practiced. Endoscopists, like many other frontline specialists, are at risk of exposure to the severe acute respiratory syndrome–related coronavirus 2 (SARS-CoV-2). Upper GI endoscopy increases the risk of infection when the patient coughs during the procedure. Likewise, colonoscopy too is hazardous as the virus has been detected in stools. Hence, guidelines recommend wearing appropriate personal protective equipment (PPE) during endoscopy to prevent the infection. 

This study was conducted to evaluate the impact of personal protective equipment (PPE) including face shields on the quality of gastrointestinal (GI) endoscopy during the pandemic. Medical records of patients undergoing colonoscopy and gastric endoscopic submucosal dissection (ESD) between June 2020 and March 2021 at a tertiary hospital in South Korea were examined in this retrospective study. Four experienced endoscopists with more than 5 years of experience and three second- or third-year trainees performed the colonoscopies. Two experienced endoscopists carried out the gastric ESD. For the first five months of the study, the endoscopists did not wear a face shield, while in the second five months, they wore a face shield while doing the endoscopy. The quality indicators were the overall adenoma detection rates (ADRs), polyp detection rate (PDR), sessile serrated lesion detection rate (SSLDR), advanced neoplasia detection rate (ANDR), complete resection rate (CRR), number of adenomas or polyps during each colonoscopy and gastric ESD procedure time.

The study group comprised of 1359 patients who had undergone colonoscopy, either screening or surveillance (679 in the face shield group and 680 in the non-face shield group) and 144 patients (72 in the face shield group and 72 in the non-face shield group) who had undergone gastric ESD for a gastric neoplasm.

The polyp detection rate (PDR) was equivalent between the two groups; 49.04 vs. 52.50 respectively. Similarly, no significant differences were noted with respect to ADRs (38.59% versus 38.97%), sessile serrated polyp detection rate (SSPDR; 1.91 versus 1.32%) and ANDR (3.98 versus 3.97%). 

Among patients who underwent gastric ESD, the CRR was similar between the two groups; 94.4 versus 93.05%, respectively. Likewise, the procedure time of gastric ESD also did not differ significantly between the two groups; 19.22 minutes versus 19.03 minutes, respectively.

When the experience of the endoscopists, with and without face shields, was assessed, no significant differences in the two groups were noted for trainee as well as experienced endoscopists in the cecal intubation time, withdrawal time and the number of adenomas detected during each colonoscopy.

The single-center study therefore concluded that wearing a face shield while performing endoscopies did not affect the quality indicators of GI endoscopy. Also, use of face shields did not alter the ability of the endoscopists, both trainee and experienced, in carrying out the procedure.

Lee JY, et al. BMC Gastroenterol. 2022 Jan 29;22(1):38.  doi: 10.1186/s12876-022-02114-2.