We read with interest both the survey on impact of the COVID‐19 pandemic on functional investigations in Europe1 and the ESNM recommendations to be applied in the recovery phase of the pandemic.2

Besides complying with the ESNM recommendations, we felt reasonable to devise a modified surgical mask to be worn by the patient during esophageal manometry and pH (impedance) catheters positioning, two potentially aerosol‐generating procedures.

In order to adapt surgical masks for functional esophageal tests, two holes are made using a scalpel (Figure 1A): a smaller one (1‐2 mm) for introduction of topical lignocaine spray3 and passage of the manometry catheter (hole A) on the upper border of the mask, just below the nose wire in the paramedian position (left or right, according to which nostril is chosen), and a slightly bigger one (3 mm) for the passage of the straw or needle adaptor of a syringe for water swallowing (hole B) placed just below the upper horizontal fold of the mask, one third the distance from the median line to the lateral border of the mask. Both holes are made by cutting the tissue along two perpendicular lines in order to preserve it.

Procedure: Before intubating the patient, his/her mask is replaced with the adapted one. Then, lignocaine is sprayed through hole A followed by the catheter which is inserted into the nostril, positioned, and fixed to the nose with sticky tape. Single water swallows, multiple rapid swallowing, and rapid drink challenge are performed 4 with a syringe or a straw dipping in a glass passed through hole B, as shown in Figure 1B. At the end of the test, once the catheter has been removed, the mask is replaced with a standard one. If pH (impedance) needs performing after manometry, the modified mask is not removed and is positioned covering the mouth only. Intubation is performed while the nurse helps giving water through hole B, as shown in Figure 1C. Once the catheter is in place and secured with tape, the mask is removed and the patient is fitted with a standard one.

Since resumption of our activity in the recovery phase of the pandemic, we have performed 37 high‐resolution esophageal manometry procedures using this mask and no alteration in the quality of tracings has been observed.

We believe that this simply modified cheap mask is an add‐on measure to be used by HCPs in the forthcoming months, in order to ensure safe functional esophageal testing.

我们感兴趣地阅读了关于COVID-19大流行对欧洲1功能调查的影响的调查，以及将在大流行恢复阶段应用的ESNM建议。2

除了符合ESNM的建议外，我们还合理地设计了一种在患者食管测压和pH（阻抗）导管定位过程中要由患者佩戴的改良型手术口罩，这是两种可能产生烟雾的程序。

为了使手术口罩适合食管功能检查，使用手术刀开两个孔（图1A）：一个较小的孔（1-2 mm），用于引入局部利多卡因喷雾剂3和测压导管通过（孔A）。面罩的上边界，在鼻中线的中间位置（左或右，根据选择鼻孔的位置）正下方，并稍大一点（3毫米），以通过注射器的吸管或针头适配器用于将水吞咽（孔B）放置在面罩上水平折线的正下方，是从中线到面罩横向边界的距离的三分之一。这两个孔是通过沿两条垂直线切割组织以保留组织而制成的。

程序：在为患者插管之前，用适合的面具替换其面具。然后，通过孔A喷洒利多卡因，然后将导管插入鼻孔，定位并用胶带将其固定在鼻子上。进行一次吞水，多次快速吞咽和快速饮水挑战4如图1B所示，用注射器或吸管将其浸入通过孔B的玻璃杯中。在测试结束时，一旦导管被拆除，则将面罩更换为标准的面罩。如果在测压后需要执行pH（阻抗）操作，则不会移除修饰的面罩，而是将其放置为仅覆盖口腔。如图1C所示，在护士帮助通过孔B输水的同时进行插管。导管就位并用胶带固定后，取下面罩，并为患者安装标准口罩。

自大流行恢复阶段恢复活动以来，我们已使用该口罩执行了37次高分辨率食管测压程序，但未观察到示踪质量的变化。

我们相信，这种经过简单修改的​​廉价口罩是HCP在接下来的几个月中将使用的一种附加措施，以确保安全的功能性食道检查。