Reopening Endoscopy after the COVID-19 Outbreak: Indications from a High Incidence Scenario

Elli, Luca; Tontini, Gian Eugenio; Scaramella, Lucia; Cantù, P.; Topa, Matilde; Dell’Osso, Bernardo; Muscatello, Antonio; Gori, Andrea; Neumann, Helmut; Vecchi, Maurizio; Penagini, Roberto

doi:10.15403/jgld-2687

Cited by 6 publications

(6 citation statements)

References 25 publications

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“…Hospitalizations were longer and characterized by higher mortality compared to the pre-COVID era. Coherently, elective admissions and endoscopic or dedicated interventional radiological procedures decreased, reflecting the cancellation of all deferrable procedures [ 6 , 7 , 8 , 9 ] and the relocation of most gastroenterological resources (beds, facilities, instrumentations, healthcare personnel) to the prevaricating care needs linked to the pandemic. Another aspect highlighted in our study is the importance and efficacy of regular active surveillance of patients and healthcare personnel with nasopharyngeal swabs and the use of second-level single-use PPE.…”

Section: Discussionmentioning

confidence: 99%

An Unprecedented Challenge: The North Italian Gastroenterologist Response to COVID-19

Tontini

Aldinio

Nandi

et al. 2021

JCM

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Background: COVID-19 pandemic has profoundly changed the activities and daily clinical scenarios, subverting organizational requirements of our Gastroenterology Units. AIM: to evaluate the clinical needs and outcomes of the gastroenterological ward metamorphosis during the COVID-19 outbreaks in a high incidence scenario. Methods: we compared the pertinence of gastroenterological hospitalization, modality of access, mortality rate, days of hospitalization, diagnostic and interventional procedures, age, Charlson comorbidity index, and frequency of SARS-CoV-2 infections in patients and healthcare personnel across the first and the second COVID-19 outbreaks in a COVID-free gastroenterological ward in the metropolitan area of Milan, that was hit first and hardest during the first COVID-19 outbreak since March 2020. Results: pertinence of gastroenterological hospitalization decreased both during the first and, to a lesser degree, the second SARS-CoV2 waves as compared to the pre-COVID era (43.6, 85.4, and 96.2%, respectively), as occurred to the admissions from domicile, while age, comorbidities, length of stay and mortality increased. Endoscopic and interventional radiology procedures declined only during the first wave. Hospitalized patients resulted positive to a SARS-CoV-2 nasopharyngeal swab in 10.2% of cases during the first COVID-19 outbreak after a median of 7 days since admission (range 1–15 days) and only 1 out of 318 patients during the second wave (6 days after admission). During the first wave, 19.5% of healthcare workers tested positive for SARS-CoV-2. Conclusions: a sudden metamorphosis of the gastroenterological ward was observed during the first COVID-19 outbreak with a marked reduction in the gastroenterological pertinence at the admission, together with an increase in patients’ age and multidisciplinary complexity, hospital stays, and mortality, and a substantial risk of developing a SARS-CoV-2 test positivity. This lesson paved the way for the efficiency of hospital safety protocols and admission management, which contributed to the improved outcomes recorded during the second COVID-19 wave.

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Section: Discussionmentioning

confidence: 99%

An Unprecedented Challenge: The North Italian Gastroenterologist Response to COVID-19

Tontini

Aldinio

Nandi

et al. 2021

JCM

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“…Consequently, would it be safe for vaccinated personnel to stop wearing full PPE when performing endoscopy procedures [ [8]] in outpatient units?…”

Section: Endoscopy During the Covid-19 Pandemic: Is It Time To Down-grade Personal Protective Equipment For Vaccinated Personnel?mentioning

confidence: 99%

“…Italy began its vaccination program on 27 December 2020 by administering mRNA vaccines to healthcare personnel, who should develop protective antibody titres 4–6 weeks after vaccination. Consequently, would it be safe for vaccinated personnel to stop wearing full PPE when performing endoscopy procedures [8] in outpatient units?…”

mentioning

confidence: 99%

“…As a result, until more data on the effectiveness of vaccines are available, physicians and endoscopists should continue to use full PPE, as previously described [8] , and maintain maximum precautions to guard against infection with virus variants and to prevent spread to patients. Unfortunately, though vaccines offer real hope that we will be able to move on from this pandemic, it is not yet time to relax our guard.…”

mentioning

confidence: 99%

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Endoscopy during the COVID-19 pandemic: Is it time to down-grade personal protective equipment for vaccinated personnel?

Elli

Rimondi

Tontini

et al. 2021

Digestive and Liver Disease

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Our unit, a Tertiary Gastroenterology Referral Center and Inflammatory Bowel Diseases (IBD) Center of Excellence is involved in the medical care of SARS-Cov2 negative patients. Changes in our medical activity were implemented, to comply with the Romanian Health Ministry recommendation, supported by the Romanian Society for Gastroenterology and Hepatology and Romanian Society for Digestive Endoscopy to suspend all elective endoscopic or surgical procedures and also nonurgent admissions during the 2 months lock-down period, from March until May 2020, with the aim to mitigate the risk of spreading COVID-19, until adequate hospital reorganization was in place [2,3]. We had to quickly adapt and find ways to optimize patient care in this new medical setting, to find a balance between social distancing and the need to provide the required medical care.…”

Section: Original Papermentioning

confidence: 99%

Inflammatory Bowel Disease Management in a Romanian Tertiary Gastroenterology Center: Challenges of the COVID-19 Pandemic

Vadan

Iacob

Costache

et al. 2020

JGLD

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Background and Aims: Inflammatory bowel diseases (IBD) patients management has been challenging during the ongoing coronavirus disease 2019 (COVID-19) pandemic, due to lockdowns, limitation of access to medical facilities and new recommendations regarding patient management. The implications of the COVID-19 pandemic on IBD patients’ management were assessed in our Tertiary Gastroenterology Center in Bucharest, Romania. Methods: Medical records of IBD patients admitted between 15th of March and 15th of August 2020 were retrospectively reviewed and compared to a control cohort of consecutive IBD patients admitted to our unit during the corresponding period of 2019. Results: There was a highly significant shift towards one-day hospitalization during the referral period in 2020 for IBD cases (91% in 2020 vs 82.2% in 2019, p=0.0001). There was no statistically significant difference between the distribution of patient’s gender, IBD phenotype or newly diagnosed IBD cases. A significantly lower proportion of admitted patients received 5-aminosalicylic acid (29% vs 41.2%, p=0.0001), whereas a substantially higher number of patients were prescribed biological therapy in 2020 in comparison to the corresponding 2019-time frame (79.5% vs 57.9%, p<0.0001). The distribution of the biological agent used was significantly different in 2019 in comparison to the 2020 period mainly due to the increase in vedolizumab prescription in 2020 (p<0.0001). During the study period in 2020, seven IBD patients (1.7%) were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection, all of them with mild symptoms without impact on the IBD course. Conclusions: The COVID-19 pandemic led to reorganizing medical care, limiting the hospital admissions in favor of severe IBD cases, favoring telemedicine for mild disease and optimization of treatment for moderate to severe IBD with an increased use of biologicals aimed to maximize the risk/benefit ratio. Incidence of SARS-Cov2 infection during the first wave of COVID-19 infection in our study group was 1.7% and did not adversely impact the IBD disease course.

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Reopening Endoscopy after the COVID-19 Outbreak: Indications from a High Incidence Scenario

Abstract: .

Cited by 6 publications

References 25 publications

An Unprecedented Challenge: The North Italian Gastroenterologist Response to COVID-19

An Unprecedented Challenge: The North Italian Gastroenterologist Response to COVID-19

Endoscopy during the COVID-19 pandemic: Is it time to down-grade personal protective equipment for vaccinated personnel?

Inflammatory Bowel Disease Management in a Romanian Tertiary Gastroenterology Center: Challenges of the COVID-19 Pandemic

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