COVID-19 and endoscopy: implications for healthcare and digestive cancer screening

Abstract

The world and medical community are sailing in uncharted waters, experiencing a viral pandemic the likes of which we have not experienced in more than 100 years. No medical specialty is immune from its effects, including gastrointestinal endoscopy. The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is affecting and changing the daily practice of gastrointestinal endoscopy (both diagnostic and therapeutic) and will do so for the foreseeable future. Thus, as gastroenterologists and endoscopists, we must adapt and carefully navigate this pandemic while continuing to provide high quality gastrointestinal endoscopy care and, at the same time, protect both our patients and our endoscopy unit personnel. In the past several weeks, international gastroenterology and gastrointestinal endoscopy societies have published a flurry of online guidelines and position statements and hosted online webinars focusing on endoscopy in the era of COVID-19 1,2 . These publications and internet-based 'virtual' conferences have provided detailed guidance on triage and risk stratification for COVID-19 for patients undergoing endoscopy, on infection prevention and control and on proper use of personal protective equipment. Importantly, these same publications have advised gastrointestinal endoscopy units to prioritize necessary endoscopic procedures and to strongly consider postponing elective, non-urgent procedures.The need to protect patients, especially those patients at high risk of COVID-19 morbidity (for example, history of cardio-pulmonary disease, malignancy or immune suppression), and endoscopy unit personnel has forced gastrointestinal endoscopy units to postpone many procedures. Carefully weighing, case-by-case, the benefit of endoscopy with the risk of SARS-CoV-2 infection could have a substantial downstream effect on digestive cancers diagnosed and treated by gastrointestinal endoscopy, for example, colorectal cancer (CRC) and gastric cancer.With the outbreak of COVID-19, many countries with population-based CRC screening programmes have suspended inviting individuals for faecal occult blood testing (FOBT; for example, guaiac-based or immunochemical-based tests) and/or endoscopy-based screening 3 . Depending on how long social and physical distancing and other viral spread mitigation rules continue to be in place, the lack of primary screening for CRC might affect millions of individuals worldwide, both at average and high risk. In terms of CRC prevention and detection, the short-term effect of such a delay is unclear. However, CRC screening programmes will eventually be resumed, albeit slowly, and, once resumed, might create a backlog of screen-positive patients requiring endoscopy. These patients have a 20-30% risk of advanced adenomas or neoplasia at endoscopy, so colonoscopy within 1 month is generally recommended 4 . In addition, in individuals testing positive using faecal immunochemical tests, the risk of CRC or advanced stage disease when colonoscopy is delayed by >6 months...

ESGE and ESGENA Position Statement on gastrointestinal endoscopy and COVID-19: An update on guidance during the post-lockdown phase and selected results from a membership survey

“…We must remember that gastrointestinal endoscopy is not simply a technical discipline, it is also cognitive. Thus, trainees can also further develop their cognitive endoscopic skills by use of online learning and viewing of endoscopy videos and technical training videos [7]. In addition, according to the ESGE survey, research activities have been delayed or completely suspended, apart from specific COVID-19 endoscopy-related projects.…”

Coronavirus Disease (COVID-19) Caused by (SARS-CoV-2) Infections: A Real Challenge for Human Gut Microbiota

“…The COVID-19 pandemic has resulted in an increased need for medical staff for the management of the affected patients ( Danese et al., 2020 ; Gralnek et al., 2020 ). This has adversely affected the diagnosis of IBD patients, due to reduced availability of staff to perform endoscopic testing.…”

Impact of the COVID-19 pandemic on general surgery residency program in Peru: A cross-sectional study

“…Surgical specialties were probably the most affected during the pandemic [ 12 ]. Some procedures usually performed by residents have been postponed or canceled, including elective surgeries, interventional procedures and endoscopies [ 7 , [13] , [14] , [15] ]. Similarly, many surgery residents have been relocated to non-surgical units, shifting to clinical care of COVID-19 patients [ [5] , [6] , [7] ].…”