Mitigation of COVID-19 transmission in endoscopic and surgical aerosol-generating procedures: a narrative review of early-pandemic literature

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China, in December 2019. Coronavirus disease 2019 is a rapidly evolving and highly contagious disease that has caused numerous unprecedented challenges worldwide, particularly with respect to healthcare systems and the medical community.1 Accordingly, groups at highest risk of infection include healthcare workers (HCWs); the World Health Organization reported that 22 073 HCWs worldwide had become infected with COVID-19 by 8 April 2020.1 Although this number may have been influenced by underreporting, it emphasised the need to protect frontline workers in the COVID-19 pandemic.

Although SARS-CoV-2 RNA can be found in various bodily fluids,2 the most probable modes of transmission involve respiratory droplets, fomites, and the faecal-oral route.3 Considering that the size of SARS-CoV-2 viral particles ranges from 0.07 to 0.09 μm,4 the potential for viral transmission via aerosols cannot be excluded.5 Despite the recognition of specific perioperative and endoscopic procedures as aerosol-generating procedures (AGPs), there is lack of high-quality evidence regarding the potential for viral transmission to HCWs and effective methods to reduce this risk. Furthermore, a Delphi consensus panel confirmed ambiguity in terms of which procedures constitute AGPs.6 Therefore, this review was conducted to summarise evidence up to July 2020 regarding the transmission of COVID-19 to HCWs via AGPs during surgery and endoscopy, along with recommended measures to minimise associated risks.