Impact of the COVID-19 pandemic on an interdisciplinary endoscopy unit in a German “hotspot” area: a single center experience

Abstract

Background and study aims Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of coronavirus disease 2019 (COVID-19), has posed a pandemic threat to global health and has challenged health care system in all affected countries. Patients and methods This is a combined study including a descriptive part about the changes in the daily work routine of an Interdisciplinary Endoscopic Unit (IEU) and a prospective analysis of patients tested positive for SARS-CoV-2 who required endoscopic interventions. Conclusively, we present the finding of a point-prevalence analysis in the staff of the IEU. Results We present effects of the COVID-19-related restructuring of processes in our interdisciplinary endoscopy unit (IEU) with respect to cancelation of examinations, relocation of staff to other departments, impact of SARS-CoV-2 on medical staff of the IEU, and supply of protective clothing. Additionally, we analyzed the cohort of COVID-19 patients: Sixteen endoscopic interventions were done in ten patients. In all patients with confirmed infection with SARS-CoV-2, emergency endoscopies were required for relevant bleeding situations. Re-endoscopies were required only in critically ill COVID-19 patients. Conclusions The restructuring of processes in the IEU was feasible in short time, effective, and can also be applied broadly at least in developed countries [Garbe et al. in Gastroenterology 159:778–780, 2020; Repici A, Pace F, Gabbiadini R, Colombo M, Hassan C, Dinelli M, Group IG-CW, Maselli R, Spadaccini M, Mutignani M, Gabbrielli A, Signorelli C, Spada C, Leoni P, Fabbri C, Segato S, Gaffuri N, Mangiavillano B, Radaelli F, Salerno R, Bargiggia S, Maroni L, Benedetti A, Occhipinti P, De Grazia F, Ferraris L, Cengia G, Greco S, Alvisi C, Scarcelli A, De Luca L, Cereatti F, Testoni PA, Mingotto R, Aragona G, Manes G, Beretta P, Amvrosiadis G, Cennamo V, Lella F, Missale G, Lagoussis P, Triossi O, Giovanardi M, De Roberto G, Cantu P, Buscarini E, Anderloni A, Carrara S, Fugazza A, Galtieri PA, Pellegatta G, Antonelli G, Rosch T, Sharma P (2020) Endoscopy units and the COVID-19 Outbreak: a Multi-Center Experience from Italy. Gastroenterology;]. The endoscopy-related rate of SARS-CoV-2 infection of staff is low, but supply of protective equipment is crucial for this. Endoscopic procedures in COVID-19 patients were not directly related to SARS-CoV-2 infection, but to other underlying diseases or typical complications of long-term ICU treatment.

Systematic review and meta-analysis of clinical outcomes of COVID-19 patients undergoing gastrointestinal endoscopy

“…Fifteen studies with a total of 122 COVID-positive patients reported the potential COVID-19 transmission rate, as shown in Table 2 . 11 , 19 , 20 , 22 – 24 , 26 – 34 Three studies 11 , 19 , 32 reported potential transmission of SARS-CoV-2 within GI endoscopy units, for a total of 46 HCWs or patients. The total basic reproduction rate (R0) equals 0.37, while the subgroup results from Asia, Europe, and America are 0.13, 0.44, and 0.33, respectively.…”

“…The effect of PPE use on the transmission of SARS-CoV-2 within GI endoscopy units is evaluated by comparing the differences of PPE use between the studies that reported no transmission and the studies that reported positive transmissions. Eight studies 20 , 27 , 29 – 34 were finally included for the analysis of PPE use in GI endoscopy units. Seven studies 20 , 27 , 29 – 31 , 33 , 34 claimed that no transmission of SARS-CoV-2 was found in their GI endoscopy unit, whereas one study 32 demonstrated successful screening of 3 COVID-positive transmitted cases.…”

“…Eight studies 20 , 27 , 29 – 34 were finally included for the analysis of PPE use in GI endoscopy units. Seven studies 20 , 27 , 29 – 31 , 33 , 34 claimed that no transmission of SARS-CoV-2 was found in their GI endoscopy unit, whereas one study 32 demonstrated successful screening of 3 COVID-positive transmitted cases. As is shown in Figure 2(b) , the frequencies of PPE use in two group sets (no transmission group and positive transmissions group) were displayed.…”

“…Five studies 21 , 24 – 27 with a total of 183 COVID-positive subjects reported the case fatality rate in confirmed COVID-19 patients undergoing GI endoscopy ( Figure 3(a) ). Random-effects meta-analysis demonstrates that the total case fatality rate is 0.17 (95% CI = 0.02–0.38).…”

“…Four studies 13 , 24 – 27 with a total of 68 COVID-positive patients pointed out the complication rate in confirmed COVID-19 patients who have undergone GI endoscopy ( Figure 3(b) ). The pooled complication rate is 0.00 (95% CI = 0.00–0.02), and there is no statistically significant difference between the European group and the North American Group ( p -value = 0.90) using a fixed analysis.…”