key: cord-0865261-009gvt4t authors: Hikichi, Takuto; Jun, Nakamura; Hamada, Koichi; Nemoto, Daiki title: A Novel Endoscopic Mouthpiece for COVID-19 Prevention date: 2021-10-15 journal: Clin Endosc DOI: 10.5946/ce.2021.172 sha: 8d6e09b6d2c14e36f89c1c5a2ac738889f218846 doc_id: 865261 cord_uid: 009gvt4t nan During the present coronavirus disease 2019 (COVID-19) pandemic, gastrointestinal endoscopy is regarded as a risky procedure because virus transmission can occur via an airborne route. To reduce the spread of aerosolized droplets, several devices have been developed. [1] [2] [3] [4] [5] [6] [7] This novel mouthpiece consists of a conventional mouthpiece made of polypropylene and a hat-shaped aerosol droplet guard, which are connected together. (Fig. 1A and B) . The aerosol droplet guard, which is made of a thermoplastic elastomer, has a width of 90 mm and a height of 50 mm, and can prevent aerosolized droplets from being ejected from the mouth (Fig. 1C) . The center of the aerosol droplet guard has four slits that are 6 mm long and are oriented to allow the scope to pass through them. (Fig. 1D ), while also acting as valves to prevent aerosolized droplet diffusion. The effectiveness of the new mouthpiece in preventing aerosolized droplet diffusion was compared to that of a conventional mouthpiece. As an experimental model, simulated saliva was sprayed from the mouth of a mannequin using a cough machine. The simulated saliva was prepared by adding 76 g of glycerin to 1 L of water. 8 With the endoscope inserted into the mouthpiece, saliva was sprayed in the following conditions: duration, 0.2 sec; velocity, 10.7 m/sec; volume, 75.4 mL; and pressure, 0.08 MPa. 8 Three technical repeats were completed, and the diffusion of the aerosolized droplets was photographed by a camera in a darkened room with a Polarion light. Although there was significant aerosolized droplet diffusion when using the conventional mouthpiece ( Fig. 2A) , it was only minimally detectable with the new mouthpiece (Fig. 2B ). The aerosol droplet guard not only prevents diffusion in the area from where the scope is inserted, but also blocks diffusion from the gap between the mouthpiece and the mouth, which is a distinct feature not found in conventional mouthpieces. As the new mouthpiece has not yet been applied clinically, its effect on respiratory and circulatory dynamics during endos-copy is still unknown. However, when used in a virtual clinical setting, there was no apparent breathing discomfort ( Fig. 3A and B ). In conclusion, this new mouthpiece can protect clinicians from infection when carrying out endoscopic procedures, especially in the wake of the COVID-19 pandemic. The authors have no potential conflicts of interest. None. Use of a glove-covered mouthpiece during upper endoscopy to prevent COVID-19 transmission Double-surgical-mask-with-slit" method: reducing exposure to aerosol generation at upper gastrointestinal endoscopy during the COVID-19 pandemic Novel device for preventing diffusion of aerosol droplets from subjects undergoing esophagogastroduodenoscopy during COVID-19 pandemic Coronavirus disease outbreak: a simple infection prevention measure using a surgical mask during endoscopy Commercially available endoscopy facemasks to prevent aerosolizing spread of droplets during COVID-19 outbreak Endoscopic shield: barrier enclosure during the endoscopy to prevent aerosol droplets during the COVID-19 pandemic Shielding for patients using a single-use vinyl-box under continuous aerosol suction to minimize SARS-CoV-2 transmission during emergency endoscopy Measurement of cough droplet deposition using the cough machine We wish to express our deepest appreciation to Mr