What constitutes urgent endoscopy? A social media snapshot of gastroenterologists’ views during the COVID-19 pandemic

Abstract

Background and study aims There is a consensus among gastroenterology organizations that elective endoscopic procedures should be deferred during the COVID-19 pandemic. While the decision to perform urgent procedures and to defer entirely elective procedures is mostly evident, there is a wide “middle ground” of time-sensitive but not technically urgent or emergent endoscopic interventions. We aimed to survey gastroenterologists worldwide using Twitter to help elucidate these definitions using commonly encountered clinical scenarios during the COVID-19 pandemic. Methods A 16-question survey was designed by the authors to include common clinical scenarios that do not have clear guidelines regarding the timing or urgency of endoscopic evaluation. This survey was posted on Twitter. The survey remained open to polling for 48 hours. During this time, multiple gastroenterologists and fellows with prominent social media presence were tagged to disseminate the survey. Results The initial tweet had 38,795 impressions with a total of 2855 engagements. There was significant variation in responses from gastroenterologists regarding timing of endoscopy in these semi-urgent scenarios. There were only three of 16 scenarios for which more than 70 % of gastroenterologists agreed on procedure-timing. For example, significant variation was noted in regard to timing of upper endoscopy in patients with melena, with 44.5 % of respondents believing that everyone with melena should undergo endoscopic evaluation at this time. Similarly, about 35 % of respondents thought that endoscopic retrograde cholangiopancreatography should only be performed in patients with choledocholithiasis with abdominal pain or jaundice. Conclusion Our analysis shows that there is currently lack of consensus among gastroenterologists in regards to timing of semi-urgent or non-life-threatening procedures during the COVID-19 pandemic. These results support the need for the ongoing development of societal guidance for these “semi-urgent” scenarios to help gastroenterologists in making difficult triage decisions.

COVID-19 polymerase chain reaction testing before endoscopy: an economic analysis

“…The classification of procedures was adapted from a survey of gastroenterologists who had to cancel procedures during the COVID-19 pandemic (Supplementary Table 1, available online at www.giejournal.org). 2 During the week of March 23 to 29, 2020, our institution started a policy to cancel all semiurgent and elective procedures. On March 24, PCR testing for SARS-CoV-2 became available in-house, and testing was performed systematically.…”

“…A recent survey showed no consensus among gastroenterologists regarding the best timing to perform semiurgent procedures for non-life-threatening conditions amid the COVID-19 pandemic. 2 Deferring semiurgent procedures may lead to delays in the diagnosis of critical conditions (eg, localized pancreatic cancer), closing a narrow window of opportunity for endoscopic treatment (eg, ablation of Barrett's esophagus with dysplasia and resection of advanced colon adenomas), and has already led to substantial economic losses.…”

Physicians’ Perspectives on COVID-19: An International Survey

“…In some units, due to the large number of COVID-19 patients hospitalized, and in others aiming at limiting the infection spread, measures like treating only urgent cases were taken. Protocols are changing repeatedly, and no consensus exists on the definition of urgent or life-threatening conditions or procedures [6]. Therefore, COVID-19-free patients' access to medical assistance was limited, making it no longer possible to maintain the same standard of care [7,8].…”

Effect of COVID-19 pandemic on workflows and infection prevention strategies of endoscopy units in Hungary - a cross-sectional survey

“…An online survey carried out on social media platform (Twitter) well demonstrated this, where the answers of gastroenterologists about the timing of procedures showed an agreement of greater than 70% in only three of 16 scenarios. 12 Majority of respondents preferred the deferring of colonoscopy in cases of fecal occult blood test (FOBT) positivity and in cases of unresected colonic polyps. This complies with the guideline of British Society of Gastroenterology and American Gastroenterological Association.…”