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

Abstract

Background: The impact of gastrointestinal endoscopy on COVID-19 infection remains poorly investigated. We herein performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 in patients undergoing gastrointestinal endoscopy. Method: Ovid Medline, Ovid EMBASE, Ovid the Cochrane Library, and other electronic databases were searched until 30 November 2020 to identify publications with confirmed COVID-19 infection in patients undergoing gastrointestinal endoscopy. The primary outcomes were SARS-CoV-2 transmission, personal protective equipment use, rates of case fatality, complications, and procedural success. Results: A total of 18 articles involving 329 patients were included in this systematic review and meta-analysis. The overall basic reproduction rate is 0.37, while the subgroup results from Asia, Europe, and North America are 0.13, 0.44, and 0.33, respectively. The differences in personal protective equipment use between the positive transmission and non-transmission group are mainly in isolation gowns, N95 or equivalent masks, and goggles or face-shields. The rate of case fatality, complication, and procedural success are 0.17 (95% confidence interval = 0.02–0.38), 0.00 (95% confidence interval = 0.00–0.02), and 0.89 (95% confidence interval = 0.50–1.00), respectively. The fatality rate in Europe was the highest (0.23, 95% confidence interval = 0.04–0.50), which is significantly different from other continents ( p = 0.034). Conclusion: The risk of SARS-CoV-2 transmission within gastrointestinal endoscopy units is considerably low if proper use of personal protective equipment is applied. Similarly, a low fatality and complication rate, as well as a high procedural success rate, indicated that a full recovery of endoscopic units should be considered.

Analysis of the effects of the first and second/third waves of the COVID-19 pandemic on an Interdisciplinary Endoscopy Unit in a German ‘hotspot’ area: a single-center experience

“…Accordingly, a multicenter study confirmed our local findings showing a minimal infection rate in a lockdown situation with provision of personal protective measures. 24 , 25 During the pandemic, we were able to comply with ESGE recommendations 26 to establish a negative pressure room with laminar air flow for endoscopy. However, during the entire pandemic, it was actually used only twice, as we had an internal agreement permitting us to perform endoscopies in positive patients at the ICU, if possible only with an emergency indication.…”

Impact of the coronavirus disease pandemic on peroral endoscopic myotomy and high‐resolution manometry activity in Japan

“…Nevertheless, according to a recent systematic review and meta‐analysis regarding the clinical outcomes of COVID‐19‐positive patients undergoing gastrointestinal endoscopy, the risk of SARS‐CoV‐2 transmission within gastrointestinal endoscopic units is considerably lower if proper PPE is utilized. Additionally, low fatality and complication rates, and a high procedural success rate for diverse gastrointestinal endoscopic procedures, have been demonstrated in COVID‐19‐positive Western cohorts 3 …”

“…The causative agent—severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)—is a virus mainly transmitted via droplets and contact; however, data are emerging that support airborne transmission during aerosol‐generating procedures, including endoscopy. Since almost 50% of COVID‐19 patients exhibit detectable viral RNA in fecal samples, 1,2 there are still considerable concerns regarding viral transmission within endoscopic units, forcing endoscopists to implement strict precautions, such as a high threshold for endoscopy 3 . Indeed, the pandemic has had a significant global impact on endoscopic services, which is linked to the substantial reduction in capacity 4 .…”

“…Additionally, low fatality and complication rates, and a high procedural success rate for diverse gastrointestinal endoscopic procedures, have been demonstrated in COVID-19-positive Western cohorts. 3 Given the downward trend in new COVID-19 cases in Japan, along with sufficient medical supplies and the preservation of PPE, we are considering the full recovery of endoscopic units-without compromising the safety and effectiveness of POEM-under secure assessment using HRM to satisfy the unmet needs of patients with EMDs, even in their elective settings. Considering that POEM should be performed under general anesthesia, careful evaluation of SARS-CoV-2 infection-as well as underlying comorbidities with risk factors for becoming more severe disease-remains a prerequisite when using multiple diagnostic tests to determine SARS-CoV-2 infection status, at least until specific antiviral agents have been developed and sufficiently supplied.…”

Special Issue “The Next Generation of Upper Gastrointestinal Endoscopy”

“…It is also worth noting that this mouthpiece is designed to reduce the gag reflex. The COVID-19 pandemic has had a major impact on upper gastrointestinal endoscopy practices worldwide [ 3 , 4 ]. In upper gastrointestinal endoscopy, aerosol-generating procedures are performed at close range, raising concerns about the inadvertent exposure of healthcare workers and the possibility of infection [ 5 , 6 ].…”