Italy recorded its first case of confirmed acute respiratory case due to Coronavirus on February 18, 2020, soon after the initial reports in China. Since that time, Italy and nations throughout the world have adopted very stringent and severe measures to protect populations from spread of infection.Despite these measures, the number of infected people is growing exponentially with a significant number of patients developing acute respiratory insufficiency. Endoscopy departments face significant risk for diffusion of respiratory diseases that can be spread via an airborne route, including aspiration of oral and fecal material via endoscopes. The purpose of this article is to discuss the measures, with specific focus on personal protection equipment and dressing code modalities, which have been implemented in our hospital to prevent further dissemination of COVID-19 infection.

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U p to 20% of health care personnel (HCP) were found to be infected with coronavirus disease (COVID-19) 1 in the outbreak in northern Italy. 2 Recommendations on patient and HCP protection have been made, such as postponing procedures, triage, use of personal protective equipment (PPE), and creation of differentiated in-hospital pathways. 3,4 However, several barriers against the adoption of these strategies exist, including cultural factors and shortages of medical resources; therefore, there are few reports of real-world experiences and outcomes with their adoption. 5 The aim of this survey was to investigate the burden of COVID-19 on endoscopic activity in a high-risk area of COVID-19 outbreak, approaches to evaluating patients, adoption and compliance of HCP with protective measures, and initial possible viral transmission outcomes from endoscopy units within a large, community-based setting (both between patients and HCP and between HCP). MethodsThe study was conducted as a survey between March 16 and March 21, 2020. Directors of emergency departments in highrisk areas of northern Italy (Supplementary Figure 1) were invited by e-mail to complete a questionnaire (Figure 1 and Supplementary Table 1). Participation was voluntary. Additional methodology is provided in the Supplementary Material. Results Characteristics of the Endoscopy UnitsA total of 42 endoscopy units were invited, of which 41 participated (97.6%). Most respondents (n ¼ 37, 90.2%) were from high-volume endoscopy units, for a total of 968 endoscopy personnel, including 323 endoscopists, 496 nurses, and 149 health care assistants. Changes in Endoscopy Activity Related to Coronavirus Disease 2019All endoscopy units had patients diagnosed with COVID-19 in their hospital. All but 1 center (40/41, 97.6%) reduced Infection Prevention and Control Measures for Coronavirus Disease 2019Regarding the preventive measures taken after the first Italian case (February 18, 2020), 5 (12.2%) endoscopy units did not take any measures, 29 (70.7%) endoscopy units adopted a triage for risk stratification of COVID-19 infection, 7 (17.1%) endoscopy units decreased endoscopic See editorial on page 36.

Background and aimsArtificial intelligence has been shown to increase adenoma detection rate (ADR) as the main surrogate outcome parameter of colonoscopy quality. To which extent this effect may be related to physician experience is not known. We performed a randomised trial with colonoscopists in their qualification period (AID-2) and compared these data with a previously published randomised trial in expert endoscopists (AID-1).MethodsIn this prospective, randomised controlled non-inferiority trial (AID-2), 10 non-expert endoscopists (<2000 colonoscopies) performed screening/surveillance/diagnostic colonoscopies in consecutive 40–80 year-old subjects using high-definition colonoscopy with or without a real-time deep-learning computer-aided detection (CADe) (GI Genius, Medtronic). The primary outcome was ADR in both groups with histology of resected lesions as reference. In a post-hoc analysis, data from this randomised controlled trial (RCT) were compared with data from the previous AID-1 RCT involving six experienced endoscopists in an otherwise similar setting.ResultsIn 660 patients (62.3±10 years; men/women: 330/330) with equal distribution of study parameters, overall ADR was higher in the CADe than in the control group (53.3% vs 44.5%; relative risk (RR): 1.22; 95% CI: 1.04 to 1.40; p<0.01 for non-inferiority and p=0.02 for superiority). Similar increases were seen in adenoma numbers per colonoscopy and in small and distal lesions. No differences were observed with regards to detection of non-neoplastic lesions. When pooling these data with those from the AID-1 study, use of CADe (RR 1.29; 95% CI: 1.16 to 1.42) and colonoscopy indication, but not the level of examiner experience (RR 1.02; 95% CI: 0.89 to 1.16) were associated with ADR differences in a multivariate analysis.ConclusionsIn less experienced examiners, CADe assistance during colonoscopy increased ADR and a number of related polyp parameters as compared with the control group. Experience appears to play a minor role as determining factor for ADR.Trial registration numberNCT:04260321.

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