Chapter of Gastroenterologists professional guidance on risk mitigation for gastrointestinal endoscopy during COVID-19 pandemic in Singapore

Abstract

In this paper, we aimed to provide professional guidance to practising gastrointestinal (GI) endoscopists for the safe conduct of GI endoscopy procedures during the current coronavirus disease 2019 (COVID-19) pandemic and future outbreaks of similar severe respiratory tract infections in Singapore. It draws on the lessons learnt during the severe acute respiratory syndrome (SARS) epidemic and available published data concerning the COVID-19 pandemic. It addresses measures before, during and after endoscopy that must be considered for both non-infected and infected patients, and provides recommendations for practical implementation.

Impact of enhanced personal protective equipment on colonoscopy performance during the COVID-19 pandemic

“…During the COVID-19 pandemic, depending on the acuity of country-specific healthcare needs and resources, both in terms of manpower and PPE availability, there will be a need to maintain a fine balance between focusing solely on emergency therapeutic endoscopy procedures and performing limited elective procedures that cannot be unduly postponed [4][5][6]. Regions overwhelmed by the pandemic are in a crisis mode, with resources diverted to meet the needs of those afflicted by COVID-19, and all elective procedures would be cancelled and the available limited resources would be only used for emergency therapeutic procedures.…”

“…During the COVID-19 pandemic, use of enhanced personal protective equipment (EPPE) has been recommended by various professional organizations to reduce the risk of endoscopist exposure and infection during gastrointestinal endoscopy [1][2][3][4][5][6]. Singapore was one of the first countries after China to be affected by COVID-19 and was also severely affected by the 2003 outbreak of severe acute respiratory syndrome (SARS).…”

“…Singapore was one of the first countries after China to be affected by COVID-19 and was also severely affected by the 2003 outbreak of severe acute respiratory syndrome (SARS). In Singapore, the recommended EPPE for both upper and lower gastrointestinal endoscopy during the COVID-19 pandemic consists of N95 filtering face piece (FFP) respirator, face shields, and hairnets, in addition to the standard personal protective equipment (SPPE) of water-resistant gown and gloves [6]. Use of such EPPE for staff protection during the COVID-19 pan-demic was implemented beginning on February 7, 2020.…”

Emergency Endoscopy During the SARS-CoV-2 Pandemic in the North of Italy: Experience from St. Orsola University Hospital—Bologna

“…To preserve service continuity, concomitant exposure of staff with specialist skills was avoided [10]. Eventually, a strategy that entirely separated patients infected with SARS-CoV-2 from those who were not infected was clearly identified [11][12][13][14][15][16][17][18][19][20][21][22][23][24]. In our hospital, urgent endoscopies were carried out routinely from 08:00 to 20:00 in the endoscopy suite, whereas overnight they are performed in the ED.…”

COVID-19 Exposure Risk of Healthcare Personnel in Digestive Endoscopy: A Prospective Study

“…Many studies have been published on COVID-19 in GI endoscopy: infection control measures, observational studies and description of activities during SARS-COV-2 outbreak have been described [1][2][3][4][5][6][7]. Although the studies considered the protection of healthcare workers (HW), only few papers described the percentage of positive cases in HW [1,6,7] and no studies considered the asymptomatic cases in the personnel. However, this point has become crucial because asymptomatic, but positive HW can cause inhospital spreading of the infection and should be considered to calculate the percentage of contaminated workers, especially at the beginning of the so-called phase 2 (gradually re-opening of elective procedures).…”