COVID‐19 and gastrointestinal endoscopies: Current insights and emergent strategies

Abstract

A new coronavirus emerged in December 2019 in Wuhan city of China, named as the severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), and the disease was called coronavirus disease‐2019 (COVID‐19). The infection due to this virus spread exponentially throughout China and then spread across >205 nations, including the United States (US). Gastrointestinal (GI) endoscopies are routinely performed in the US and globally. Previous reports of isolated infection outbreaks were reported with endoscopes acting as potential vectors. While multidrug‐resistant organisms have been reported to be spread by endoscopes, few cases of viruses such as hepatitis B and C are noted in the literature. COVID‐19 is predominately spread by droplet transmission, although recent evidence has showed that shedding in feces and feco‐oral transmission could also be possible. It is unclear if COVID‐19 could be transmitted by endoscopes, but it could theoretically happen due to contact with mucous membranes and body fluids. GI endoscopies involve close contact with oral and colonic contents exposing endoscopy staff to respiratory and oropharyngeal secretions. This can increase the risk of contamination and contribute to virus transmission. Given these risks, all major GI societies have called for rescheduling elective non‐urgent procedures and perform only emergent or urgent procedures based on the clinical need. Furthermore, pre‐screening of all individuals prior to endoscopy is recommended. This article focuses on the risk of COVID‐19 transmission by GI shedding, the potential role of endoscopes as a vector of this novel virus, including transmission during endoscopies, and prevention strategies including deferral of elective non‐urgent endoscopy procedures.

Impact of coronavirus pandemic crisis in endoscopic clinical practice: Results from a national survey in Brazil

“…However, there was no clear evidence of transmission directly related to endoscopic procedures in COVID-19-positive patients. Furthermore, it is important to emphasize that no nosocomial outbreaks due to endoscopic procedures were reported and no cases of endoscope-related COVID-19 infection have been reported so far, indicating that current endoscope disinfection techniques are adequate [20].…”

Risk of COVID-19 Transmission During Gastrointestinal Endoscopy

“…Second, a variety of endoscopic procedures including gastroscopy, colonoscopy and endoscopic retrograde cholangio-pancreatography are performed every day, wherein the endoscopists access the GI lumen from a close distance and therefore get exposed to a large number of respiratory, oropharyngeal and gastrointestinal flora. 21,22 Also, many of these procedures are of significantly longer duration, and this further increases the risk of infection to the endoscopist. Johnston et al reported a significant unrecognized exposure to the endoscopist's face of potentially infectious biologic samples during endoscopy.…”

Simple barrier device to minimize facial exposure of endoscopists during COVID‐19 pandemic

“…Endoscopists face the tremendous risk of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) transmission during endoscopy 1,2 because it may generate respiratory fluid 3 (droplets; 10 1 –10 2 μm, aerosol; <<10 1 μm) 4 . To minimize its transmission risk to the endoscopist, protecting their face from exposure of body fluid is important.…”