American Neurogastroenterology and Motility Society Task Force Recommendations for Resumption of Motility Laboratory Operations During the COVID-19 Pandemic

Abstract

The American Neurogastroenterology and Motility Society Task Force recommends that gastrointestinal motility procedures should be performed in motility laboratories adhering to the strict recommendations and personal protective equipment (PPE) measures to protect patients, ancillary staff, and motility allied health professionals. When available and within constraints of institutional guidelines, it is preferable for patients scheduled for motility procedures to complete a coronavirus disease 2019 (COVID-19) test within 48 hours before their procedure, similar to the recommendations before endoscopy made by gastroenterology societies. COVID-19 test results must be documented before performing procedures. If procedures are to be performed without a COVID-19 test, full PPE use is recommended, along with all social distancing and infection control measures. Because patients with suspected motility disorders may require multiple procedures, sequential scheduling of procedures should be considered to minimize need for repeat COVID-19 testing. The strategies for and timing of procedure(s) should be adapted, taking into consideration local institutional standards, with the provision for screening without testing in low prevalence areas. If tested positive for COVID-19, subsequent negative testing may be required before scheduling a motility procedure (timing is variable). Specific recommendations for each motility procedure including triaging, indications, PPE use, and alternatives to motility procedures are detailed in the document. These recommendations may evolve as understanding of virus transmission and prevalence of COVID-19 infection in the community changes over the upcoming months.

Recomendaciones para la reapertura y reinicio de actividades de las Unidades de Neurogastroenterología ante la pandemia por COVID-19. Posicionamiento de la Sociedad Latinoamericana de Neurogastroenterología

“…En general son exámenes electivos, que en forma excepcional pueden tener algunas indicaciones urgentes ( tabla 1 ). Existen ciertas indicaciones médicas que pudieran tener cierto grado de urgencia, estas han sido recientemente expuestas por la ANMS 4 . La presencia de una probable acalasia con síntomas severos (disfagia importante con imposibilidad de alimentación e hidratación por boca) o la presencia de grandes hernias hiatales con riesgo de aspiración o vólvulo e imposibilidad de mantener la hidratación y la nutrición por vía oral son indicaciones con urgencia relativa o semi-urgentes.…”

“…A continuación, se detallan en general los pasos a seguir considerando que pudieran existir algunas variaciones de acuerdo con la prueba que se realice 4 , 5 .…”

“…Como en otras partes del mundo, la atención médica ha cambiado dramáticamente para aquellas enfermedades no urgentes que involucran la realización de procedimientos diagnósticos y terapéuticos, como los que se realizan en las Unidades de Neurofisiología y/o Motilidad Digestiva. Aunque existen ya posicionamientos respecto a cómo trabajar y/o reiniciar las actividades en estas Unidades, por ejemplo el de la Asociación Americana de Neurogastroenterología y Motilidad (ANMS) 4 o el del Grupo Español de Motilidad Digestiva (GEMD) 5 y debido a que el comportamiento epidemiológico, la disponibilidad de equipos de protección, la capacidad de realizar pruebas diagnósticas serológicas para corroborar inmunidad y el contexto económico-social es diferente en Latinoamérica, un grupo de expertos miembros de la Sociedad Latinoamericana de Neurogastroenterología (SLNG) se reunieron de forma virtual para elaborar un documento consensuado con las recomendaciones para la realización de estudios motores del tubo digestivo.…”

Response to the Letter: How do we reopen our motility laboratory safely and efficiently?

“…We recognize the increased time commitment for implementing a Motility/GI Physiology Laboratory COVID‐19 safety plan. Therefore, with certain procedures such as the wireless motility capsule and hydrogen breath testing, providers may elect to use alternative methodology (patient ingests motility capsule alone in a room) or alternate tests (home breath testing kits) limiting the need for preprocedural COVID‐19 screening 7 …”

How do we reopen our motility laboratory safely and efficiently?

“…As we attempt to safely navigate restarting motility studies in the age of the COVID‐19 pandemic, there are a multitude of factors that need to be considered. The ANMS task force recently published timely and comprehensive recommendations for the resumption of motility laboratory operatives and recommend COVID‐19 testing, where available, 48 hours prior to all motility procedures, and appropriate personal protective equipment (PPE) for all procedures performed 1 . These recommendations are similar to those previously set forward by a joint statement from the AGA and DHPA regarding pre‐procedure testing 2 and a joint statement from the AASLD, ACG, AGA, ASGE regarding resumption of endoscopic procedures 3…”