Approach to Endoscopic Procedures: A Routine Protocol from a Quaternary University Referral Center Exclusively for Coronavirus Disease 2019 Patients

Abstract

The present coronavirus disease (COVID-19) pandemic has ushered in an unprecedented era of quality control that has necessitated advanced safety precautions and the need to ensure the adequate protection of healthcare professionals (HCPs). Endoscopy units, endoscopists, and other HCP may be at a significant risk for transmission of the virus. Given the immense burden on the healthcare system and surge in the number of patients with COVID-19, well-designed protocols and recommendations are needed. We aimed to systematically characterize our approach to endoscopic procedures in a quaternary university hospital setting and provide summary protocol recommendations. METHOD: This descriptive study details a COVID-19-specific protocol designed to minimize infection risks to patients and healthcare workers in the endoscopy unit. RESULTS: Our institution, located in Sã o Paulo, Brazil, includes a 900-bed hospital, with a 200-bed-specific intensive care unit exclusively designed for patients with moderate and severe COVID-19. We highlighted recommendations for infection prevention and control during endoscopic procedures, including appropriate triage and screening, outpatient management and procedural recommendations, role and usage of personal protective equipment (PPE), and role and procedural logistics involving COVID-19-positive patients. We also detailed hospital protocols for reprocessing endoscopes and cleaning rooms and also provided recommendations to minimize severe acute respiratory syndrome coronavirus 2 transmission. CONCLUSION: This COVID-19-specific administrative and clinical protocol can be replicated or adapted in multiple institutions and endoscopy units worldwide. Furthermore, the recommendations and summary protocol may improve patient and HCP safety in these trying times.

Gastrointestinal Manifestations and Associated Health Outcomes of COVID-19: A Brazilian Experience From the Largest South American Public Hospital

“…Out the outset of the pandemic, this quaternary university referral center instituted a protocol to exclusively care for COVID-19 patients. This hospital and institution is comprised of the largest public hospital in South America ( 11 ). The hospital is designed to care for patients presenting with moderate and severe disease and receives patient referrals following local government protocol.…”

“…As disease prevalence, presenting symptoms, and outcomes have varied from reports in China to those in the United States and Europe, examination of COVID-19 specific characteristics is highly relevant for the population of Brazil and South America. Therefore, the primary aim of this study was to assess the prevalence of gastrointestinal symptoms associated with SARS-CoV-2 infection and examine gastrointestinal-specific health outcomes in a quaternary referral hospital exclusively treating COVID-19 patients in São Paulo, Brazil ( 11 ).…”

Successful Distancing: Telemedicine in Gastroenterology and Hepatology During the COVID-19 Pandemic

“…Multiple studies reported a significant decrease in endoscopy volume during the pandemic due to widespread stay-at-home orders. Moreover, due to overwhelmed healthcare systems, endoscopy units were utilized as COVID-19 units [ 25 ], with consequent widespread delays and an increasing backlog of elective cases [ 26 ]. These changes forced providers to communicate with patients via telemedicine route.…”

Analysis of Facilitators and Barriers to the Delivery of Routine Care during the COVID-19 Global Pandemic: A Systematic Review

“…In addition to patient and other healthcare stakeholder education surrounding the facilitation of routine vaccinations, the use of telemedicine and remote diagnosis using medical imagery was also identified in the literature [ 15 , 22 , 24 ]. While some obstetrical care was directly related to diagnostic and similar imaging procedures, facilitation of this service line was also enhanced through the increased use of telehealth resources, as well as facility upgrades to enable safe patient throughput, adequate PPE, and additional medical supplies [ 9 , 38 ].…”