AGA Institute Rapid Review and Recommendations on the Role of Pre-Procedure SARS-CoV-2 Testing and Endoscopy

Sultan, Shahnaz; Siddique, Shazia Mehmood; Altayar, Osama; Caliendo, Angela M.; Davitkov, Perica; Feuerstein, Joseph D.; Francis, Dawn L.; Inadomi, John M.; Lim, Joseph K.; Falck‐Ytter, Yngve; Mustafa, Reem A.

doi:10.1053/j.gastro.2020.07.043

Cited by 48 publications

(46 citation statements)

References 45 publications

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“…Although dramatic reduction in endoscopy volumes was commonly observed at the start of the pandemic ( 1 ), many centers have cautiously resumed performing elective procedures ( 65 ). Society guidelines recommend COVID-19 before testing in respiratory samples 48–72 hours before elective endoscopy where the prevalence of asymptomatic SARS-CoV-2 infection is intermediate (0.5%–2%) ( 66 ). Increased number of positive results in asymptomatic patients from routine pretesting for COVID-19 infection is expected.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Persistent Shedding of Fecal SARS-CoV-2 RNA in Patients With COVID-19 Infection: A Systematic Review and Meta-analysis

Zhang

Cen

et al. 2021

Clin Transl Gastroenterol

117

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INTRODUCTION: The prevalence and shedding of fecal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA indicate coronavirus disease 2019 (COVID-19) infection in the gastrointestinal (GI) tract and likely infectivity. We performed a systemic review and meta-analysis to evaluate the prevalence and the duration of shedding of fecal RNA in patients with COVID-19 infection. METHODS: PubMed, Embase, Web of Science, and Chinese databases Chinese National Knowledge Infrastructure and Wanfang Data up to June 2020 were searched for studies evaluating fecal SARS-CoV-2 RNA, including anal and rectal samples, in patients with confirmed COVID-19 infection. The pooled prevalence of fecal RNA in patients with detectable respiratory RNA was estimated. The days of shedding and days to loss of fecal and respiratory RNA from presentation were compared. RESULTS: Thirty-five studies (N = 1,636) met criteria. The pooled prevalence of fecal RNA in COVID-19 patients was 43% (95% confidence interval [CI] 34%–52%). Higher proportion of patients with GI symptoms (52.4% vs 25.9%, odds ratio = 2.4, 95% CI 1.2–4.7) compared with no GI symptoms, specifically diarrhea (51.6% vs 24.0%, odds ratio = 3.0, 95% CI 1.9–4.8), had detectable fecal RNA. After loss of respiratory RNA, 27% (95% CI 15%–44%) of the patients had persistent shedding of fecal RNA. Days of RNA shedding in the feces were longer than respiratory samples (21.8 vs 14.7 days, mean difference = 7.1 days, 95% CI 1.2–13.0). Furthermore, days to loss of fecal RNA lagged respiratory RNA by a mean of 4.8 days (95% CI 2.2–7.5). DISCUSSION: Fecal SARS-CoV-2 RNA is commonly detected in COVID-19 patients with a 3-fold increased risk with diarrhea. Shedding of fecal RNA lasted more than 3 weeks after presentation and a week after last detectable respiratory RNA.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Persistent Shedding of Fecal SARS-CoV-2 RNA in Patients With COVID-19 Infection: A Systematic Review and Meta-analysis

Zhang

Cen

et al. 2021

Clin Transl Gastroenterol

117

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“…An economic analysis has shown that performing nucleic acid amplification tests (NAAT) for SARS-CoV-2 on all patients is an effective strategy, though this is subject to the availability of local resources 60 . Recently, recommendations from the AGA suggest that a pre-testing strategy will likely work best for regions with intermediate prevalence of asymptomatic carriers (0.5 -2%) 61 . Real world data from the United Kingdom during the recovery phase of the pandemic found that only 0.11% of asymptomatic patients tested positive for SARS-CoV-2 on nasopharyngeal swab testing pre-endoscopy 23 .…”

Section: Polymerase Chain Reaction Testingmentioning

confidence: 99%

“…Some authors have recommended testing for immunoglobulins against SARS-CoV-2 62 as a screening test. However, this strategy may only indicate a past infection and has no role in diagnosing active COVID-19 in asymptomatic individuals prior to endoscopy 61 .…”

Section: Serologymentioning

confidence: 99%

Safety in Endoscopy for Patients and Healthcare Workers During the COVID-19 Pandemic

Lui

2021

Techniques and Innovations in Gastrointestinal Endoscopy

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Follow-up recommendations for patients with IBD based on treat-to-target strategies mainly focus on the initial treatment phase, when therapies are started in patients with active disease to induce remission 4 . However, patient follow-up upon successful initial treatment is less clear.…”

Section: Introductionmentioning

confidence: 99%

Serum biomarkers confirming stable remission in inflammatory bowel disease

Kessel

Lavrič

Weinhage

et al. 2021

Sci Rep

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Crohn's disease (CD) and ulcerative colitis (UC) have a chronic-remittent course. Optimal management of inflammatory bowel diseases (IBD) relies on early intervention, treat-to-target strategies and a tight disease control. However, it is challenging to assess the risk of relapses in individual patients. We investigated blood-based biomarkers for the confirmation of disease remission in patients with IBD. We retrospectively analyzed samples of 40 IBD patients (30 UC, 10 CD) enrolled in a tight-control follow-up study. Half of the patients had a flare during follow up. Serum was analyzed for S100A12 as well as S100A8/A9 and for 50 further biomarkers in a bead-based multiplex assay. The concentrations of 9 cytokines/chemokines and S100A8/A9 significantly differed in IBD patients with unstable remission (before flares) when compared to IBD patients with stable remission. Although the number of patients was small, ROC curve analyses revealed a number of biomarkers (IL-1β, IL-1RA, IL-8, IL13, IL-15, IL-21, IL-25, IFN-β, CXCL9, CXCL10, CXCL11, Galectin-1, G-CSF and S100A8/A9) that were elevated in patients with later occurring relapses. While earlier studies on peripheral biomarkers in IBD are limited to only few analytes, our study using a broad screening approach identified serum biomarkers with the potential to indicate unstable disease control in IBD, which may help to steer individual therapies to maintain remission.

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AGA Institute Rapid Review and Recommendations on the Role of Pre-Procedure SARS-CoV-2 Testing and Endoscopy

Cited by 48 publications

References 45 publications

Prevalence and Persistent Shedding of Fecal SARS-CoV-2 RNA in Patients With COVID-19 Infection: A Systematic Review and Meta-analysis

Prevalence and Persistent Shedding of Fecal SARS-CoV-2 RNA in Patients With COVID-19 Infection: A Systematic Review and Meta-analysis

Safety in Endoscopy for Patients and Healthcare Workers During the COVID-19 Pandemic

Serum biomarkers confirming stable remission in inflammatory bowel disease

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