Health-care professionals attending certain smoke-producing endoscopic gastrointestinal procedures could be exposed to harmful toxin levels during each procedure and, in turn, may face significant health risks over the course of their careers.
“Surgeons in the operating room have regulations and guidelines to mitigate smoke exposure, but that does not exist for gastrointestinal endoscopy,” stressed Trent Walradt, MD, a research fellow at Brigham and Women’s Hospital. “When you’re using cautery, it generates a smoke plume. We wanted to know whether the smoke that's produced during some of our endoscopic procedures is dangerous.”
In a recent study, presented at Digestive Disease Week 2024 (Abstract Mo1121), researchers evaluated the air quality of an endoscopy laboratory prior to and during 27 procedures, including 4 different types of gastrointestinal endoscopic procedures that produce smoke: argon plasma coagulation, gastric endoscopic submucosal dissection, colonic endoscopic submucosal dissection, and ampullary sphincterotomy.
The researchers discovered that the peak level of volatile organic compounds reached twice the maximum level determined to be safe by the Environmental Protection Agency. Elevated levels of ultrafine particles and fine inhalable particles measuring smaller than 2.5 micrometers were detected during all the procedures, with the highest average levels occurring during argon plasma coagulation, which utilizes argon gas and an electrical current to cauterize and remove tissue. The intensity and length of exposure during a single procedure was found to be equivalent to smoking a cigarette.
“Over the course of a career, endoscopic smoke may pose significant health risks to personnel in the endoscopy suite. If [endoscopists are] doing four or five procedures [per] day, that’s five cigarettes [each] day. Over the course of 1 week, it’s like … smoking a pack of cigarettes. That's not acceptable,” emphasized senior study author Chris Thompson, MD, Director of Endoscopy at Brigham and Women’s Hospital. “We're in the early phases of this, but I think our findings are very important and … a little concerning and surprising,” he continued.
Further studies may be needed to better understand the risks of exposure to endoscopic smoke, however, the researchers indicated that possible solutions to minimize the risks may include using insufflators that deliver gas to open space within the body during surgery, or the use of other devices to remove smoke during procedures, wearing masks, or making changes to how procedures are performed in order to produce less smoke.
“As we develop new tools and techniques, more procedures are generating this smoke. As we're pushing those limits and doing more to help patients, we need to be aware of the side effects and protect ourselves too,” concluded Dr. Walradt.
