Like ‘smoking a cigarette’: Endoscopists exposed to harmful pollutants during procedures
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Key takeaways:
- Peak volatile organic compound level reached double the maximum safe level set by the Environmental Protection Agency.
- Particulate matter and ultrafine particles were highest during argon plasma coagulation.
Endoscopists are exposed to dangerous levels of air pollutants when performing smoke-producing gastrointestinal endoscopic procedures — “comparable to smoking a cigarette” during a single procedure, according to researchers.
“Recent developments in endoscopy have resulted in new tools and techniques becoming available across the field,” Christopher C. Thompson, MD, principal study investigator and director of endoscopy at Brigham and Women’s Hospital, said during the Digestive Disease Week media briefing. “We are now performing more procedures that involve cutting or ablating tissue, and this produces smoke. While surgeons in the operating room have regulations and guidelines to mitigate smoke exposure, there are no comparable rules for gastrointestinal endoscopy.”
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He continued: “Since endoscopists are conducting more smoke-generating procedures — many of which did not even exist a few years ago — we wanted to determine whether the smoke that is being produced during some of these procedures is dangerous.”
To characterize the smoke produced during endoscopic procedures at Brigham’s and Women’s Hospital, Thompson and colleagues placed equipment within 1 meter of an endoscopist, including a condensation particle counter to assess ultrafine particles (UFPs), a personal aerosol monitor to measure particle matter and an indoor air-quality monitor to measure volatile organic compounds.
Researchers assessed air quality during 27 procedures — 13 gastric argon plasma coagulations (APC), four gastric endoscopic submucosal dissections (ESD), eight colonic ESDs and two ampullary sphincterotomies — and took measurements before and during the smoke-generating component of the procedures.
According to results, the mean levels of PM smaller than 2.5 m (PM2.5) and UFP significantly rose during all procedures, with the highest levels occurring during gastric APC.
“We found that the level of volatile organic compounds reached as high as twice the maximum safe level established by the Environmental Protection Agency,” Thompson said.
Researchers also reported that both APC and ESD produced “a brief, very high concentration of PM with an initially rapid, but then slow return to baseline.” PM2.5 levels reached a maximum level of 108 g/m3 during the two sphincterotomies.
“We found that the intensity and length of exposure during a single procedure was comparable to smoking a cigarette, which means if we are conducting four or six procedures — sometimes even more in a day — we are smoking several cigarettes throughout the day,” Thompson said.
“Our findings are surprising and rather concerning,” he added. “The results suggest that over the course of a career, endoscopic smoke may pose significant health risks to personnel in endoscopy and in particular, not just the doctors ... but some personnel are in that room every day, whether that is your technician or your nurse, and this really can add up over time.”
More research is needed to better understand this threat, Thompson said, noting potential solutions include implementing devices to remove smoke during procedures, using different types of masks, changing how procedures are performed, and creating rules and regulations for smoke exposure.
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Walradt T, et al. An unrecognized threat: Evaluation of air-pollutant exposure during smoke-generating endoscopy procedures. Presented at: Digestive Disease Week; May 18-21, 2024; Washington. (hybrid).
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