Clinical Questions and Answers on Gastrointestinal Endoscopy during the Novel Coronavirus Disease 2019 pandemic

Abstract

Some situations may require endoscopy during the COVID‐19 (Coronavirus Disease 2019) pandemic. Here, we describe the necessary precautions in the form of clinical questions and answers (Q&A) regarding the safe deployment of gastrointestinal endoscopy in such situations while protecting endoscopy staff and patients from infection. Non‐urgent endoscopy should be postponed. The risk of infection in patients should be evaluated in advance by questionnaire and body temperature. The health of staff must be checked every day. Decisions to employ endoscopy should be based on the institutional conditions and aims of endoscopy. All endoscopic staff need to wear appropriate personal protective equipment (PPE). The endoscope and other devices should be cleaned and disinfected after procedures in accordance with the relevant guidelines. Optimal management of the endoscopy unit is required. Endoscopy for infected patients or those with suspected infection demands exceptional caution. When a patient who undergoes endoscopy is later found to have COVID‐19, the members of staff involved are considered exposed to the virus and must not work for at least 14 days if their PPE is considered insufficient. When PPE resources are limited, some equipment may be used continuously throughout a shift as long as it is not contaminated. Details of the aforementioned protective measures are described.

Gastrointestinal endoscopic practice during COVID-19 pandemic: a multi-institutional survey

“…However, the frequency of pancreatobiliary endoscopy (endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography (EUS), and endoscopic ultrasound fine needle aspiration biopsy (EUS-FNAB)) did not change much before and during the pandemic (Figure. (Table. 2). During the pandemic, endoscopy societies recommended the postponing or cancellation of all but emergency and urgent endoscopic interventions [7,8]. In our survey, 11 facilities (11/18: 61%) followed the recommendations by the JGES; consequently, about 35%-50% of esophagogastroduodenoscopies and colonoscopies were canceled.…”

“…We took care not to perform local anesthesia using a lidocaine spray. The reasons for COVID-19 screening before endoscopy were as follows: 1) fever >37.5℃ (17 The recommendations of the JGES for the gastrointestinal endoscopic practice during the pandemic were divided into 7 categories [7]. Their description and implementation rate in each institution are as follows: 1) gastrointestinal bleeding or suspected gastrointestinal bleeding (18/18: 100%); 2) cholangitis or obstructive jaundice that requires treatment using an endoscope (15/18: 83%); 3) symptomatic biliary-pancreatic disease that requires treatment using an endoscope other than 2) (13/18: 73%); 4) gastrointestinal stricture that may affect oral intake (13/18: 73%); 5) gastrointestinal cancers that require treatment using an endoscope (15/18: 83%); 6) other urgent endoscopy procedures that have been decided by the head of the facility (17/18: 94%); 7) screening or surveillance of asymptomatic individuals (7/18: 39%) (Table.…”

“…In addition, the number of SARS-CoV-2 positive patients in our survey was very small compared to that in the United States and Europe. During the pandemic, the JGES recommended restricting training activities in patients who had or were suspected of having COVID-19 [7]. However, there was no restriction for low risk patients if the standard precautions were not problematic.…”

International observational survey of the effectiveness of personal protective equipment during endoscopic procedures performed in patients with COVID-19

“…The virus responsible for this disease, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is highly infectious and causes nosocomial infection in healthcare professionals [1]. Especially, endoscopic procedures have a potentially high risk for healthcare professionals due to transmission via aerosol from COVID-19 patients [2][3][4][5][6][7]. In addition, SARS-CoV-2 has also been detected in stool specimens, suggesting a possible risk of fecal-oral transmission [8], similar to SARS [9,10].…”

Endoscopic mask innovation and protective measures changes during the coronavirus disease‐2019 pandemic: Experience from a Chinese hepato‐biliary‐pancreatic unit

“…This article introduces the COVID‐19 prevention measures used in our medical center (Department of Hepatobiliary Surgery, Tianjin First Central Hospital). Building on the prevention and treatment experience of other countries or centers, 7–10 we offer several reasonable suggestions for conducting endoscopies during the pandemic, applying endoscope protection articles, and endoscope reprocessing.…”