The global impact of COVID-19 on gastrointestinal endoscopy units: An international survey of endoscopists

Abstract

Background & study aims Corona virus disease-19 (COVID-19) pandemic has markedly impacted routine medical services including gastrointestinal (GI) endoscopy. We aim to report the real-life performance in high volume GI endoscopy units during the pandemic. Patients and methods A web-based survey covering all aspects of daily performance in GI endoscopy units was sent to endoscopy units worldwide. Responses were collected and data were analyzed to reveal the effect of COVID-19 pandemic on endoscopy practice. Results Participants from 48 countries (n = 163) responded to the survey with response rate of 67.35%. The majority (85%) decreased procedure volume by over 50%, and four endoscopy units (2.45%) completely stopped. The top three indications for procedures included upper GI bleeding (89.6%), lower GI bleeding (65.6%) and cholangitis (62.6%). The majority (93.9%) triaged patients for COVID-19 prior to procedure. N95 masks were used in (57.1%), isolation gowns in (74.2%) and head covers in (78.5%). Most centers (65%) did not extend use of N95 masks, however 50.9% of centers reused N95 masks. Almost all (91.4%) centers used standard endoscopic decontamination and most (69%) had no negative pressure rooms. Forty-two centers (25.8%) reported positive cases of SARS-CoV-2 infection among patients and 50 (30.7%) centers reported positive cases of SARS-CoV-2 infection among their healthcare workers. Conclusions Most GI endoscopy centers had a significant reduction in their volume and most procedures performed were urgent. Most centers used the recommended personal protective equipment (PPE) by GI societies however there is still a possibility of transmission of SARS-CoV-2 infection in GI endoscopy units.

The Impact of the COVID-19 Pandemic on Gastrointestinal Endoscopy Activity in a Tertiary Care Center from Northeastern Romania

“…Moreover, the guidelines suggest reducing the onsite endoscopy staff and maintaining only the personnel essential for the procedure, creating special circuits for patients, monitoring temperature of patients and staff, and applying questionnaires for symptoms or previous exposure. All of these measures, combined with the patients’ fear of contracting the SARS-CoV2 infection from hospital milieu, have resulted in the dramatic general decrease of GI endoscopies worldwide [ 4 , 5 , 6 , 7 ]. The impact of these measures is currently being evaluated, and the available data indicate a significant decrease in the GI cancer detection rate [ 5 ] and a reduction in trainees’ opportunities of participating in GI endoscopy [ 16 ].…”

Barriers for resuming endoscopy service in the context of COVID-19 pandemic: A multicenter survey from Egypt

“…Similarly, Alboraie et al [ 21 ] reported that most worldwide centers (93.9%) screened patients for possible COVID-19 disease prior to the procedure and 54 centers (33.13%) used PCR testing. However, asymptomatic infected patients are a known source for transmission[ 2 , 22 ], accordingly, this type of screening is not sufficient to guide for COVID-19 risk stratification.…”

“…More than two-thirds of our centers have adopted a selection strategy to select the endoscopist and the assisting team based on the presence of a suspected/confirmed COVID-19 case. Also, Alboraie et al [ 21 ] stated that the majority (78.5%) of the centers considered dedicated teams for the delivery of endoscopic services after the onset of the pandemic.…”

“…Unfortunately, in our study few participating centers (15.9%) are practicing the strategy of following their patients for the development of any suspected symptoms post-procedure. A similar study showed that 18.4% of centers only called patients back two weeks after procedures[ 21 ]. According to multivariate regression analysis that was done in our study, we found that endoscopy staff shortage, availability of separate designated rooms for COVID-19 cases, and the burden of cases in each locality are the most obvious barriers for the resumption of routine endoscopy practice in Egypt.…”

Gas leakage from the biopsy valve: Does it matter in the era of COVID-19?

“…Of note, almost 90 % of infections occurred before the introduction of safety measures, such as use of personal protective equipment (PPE) and case selection/reduction in gastrointestinal endoscopy [10,11]. In contrast, a worldwide survey found that one-third of 163 endoscopy centers reported positive cases of SARS-CoV-2 infection among their healthcare workers despite the large use of PPE [12].…”