Study Warns Against Dangerous Smoke Levels Produced During Endoscopic Gastrointestinal Procedures

Healthcare professionals involved in certain smoke-generating endoscopic gastrointestinal procedures, such as those using electrical current to excise polyps, may be exposed to toxin levels comparable to smoking a cigarette during each procedure, posing "significant health risks" throughout their careers, finds a new study.

In the study conducted by researchers at Brigham and Women’s Hospital (Boston, MA, USA), air quality monitoring equipment was set up in an endoscopy lab to assess the air during 27 procedures. They focused on four different types of gastrointestinal endoscopic procedures known to produce smoke, including interventions to halt bleeding, minimize the opening to the small intestine following gastric bypass surgery, or remove cancerous and pre-cancerous polyps adjacent to muscle. The procedures examined were argon plasma coagulation, gastric endoscopic submucosal dissection, colonic endoscopic submucosal dissection, and ampullary sphincterotomy. It was found that the peak levels of volatile organic compounds during these procedures reached twice the maximum safe level as determined by the Environmental Protection Agency.

During all procedures, researchers detected elevated levels of ultrafine particles and fine inhalable particles smaller than 2.5 micrometers, with the highest average levels observed during argon plasma coagulation—a procedure that employs argon gas and electrical current to cauterize and remove tissue. The intensity and duration of exposure to these particles during a single procedure were found to be equivalent to the exposure experienced when smoking a cigarette. Further research is necessary to fully understand the risks, but potential mitigations could include the use of insufflators, devices that introduce gas to create space within the body during surgery, or other systems to evacuate smoke. Additionally, employing masks or altering procedural techniques to reduce smoke production are suggested strategies to lessen exposure.

“Over the course of a career, endoscopic smoke may pose significant health risks to personnel in the endoscopy suite,” said Chris Thompson, MD, director of endoscopy at Brigham and Women’s Hospital and principal investigator on the study. “If you're doing four or five procedures a day, that’s five cigarettes a day. Over the course of a week, it’s like you're smoking a pack of cigarettes. That's not acceptable. We're in the early phases of this, but I think our findings are very important, and quite frankly, a little concerning and surprising.”

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