Background: Although it has been proven that various volatile organic compounds (VOCs) are produced during surgery, there have been no studies focusing specifically on endoscopy. Therefore, we aimed to investigate VOCs produced during endoscopic submucosal dissection (ESD).
Methods: Thirty-one patients scheduled for ESD were enrolled in this study. Sorbent tubes were installed to collect gas at two sites: one in a suction bottle and the other at the level of the endoscopists' upper chest. Gas collections were performed for up to 30 min during submucosal dissection. Quantitative analysis of the VOCs in gas samples was performed using gas chromatography and mass spectrometry. Concentrations of fifteen VOCs were measured. The total concentration of volatile organic compounds (TVOC) was also calculated.
Results: Among the five carcinogens-benzene, ethylbenzene, formaldehyde, tetrachloroethylene, and trichloroethylene (TCE)-measured, excess life-time risks of cancer for benzene and TCE were interpreted as unacceptable based on the New Jersey Department of Environmental Protection Division of Air Quality and the Environmental Protection Agency guidelines (5 × 10-4 and 7 × 10-5, respectively). Among the non-carcinogenic VOCs, the mean concentration of toluene was much higher than the reference value (260 μg/m3) in the Japanese guidelines for indoor air quality (IAQ) (1323.7 ± 2884.0 μg/m3 from the air at the upper chest level of endoscopists and 540.9 ± 1345.4 μg/m3 from the suction bottle). Mean TVOCs were at least 10 times higher than the reference value (400 μg/m3) issued by the Japanese guidelines for IAQ.
Conclusions: Various carcinogenic and non-carcinogenic VOCs were detected at levels higher than the reference "safe" values during the submucosal dissection step of ESD. Implementation of counter measures is essential to protect medical personnel who are involved in ESD surgeries.
Keywords: Endoscopic submucosal dissection; Gas chromatography; Stomach cancer; Volatile organic compounds.