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Chen YJ, Hou MC, Yang TC, Lee PC, Huang YH, Lee FY. Triage policy to postpone endoscopy for patients with low-risk varices is safe during the lockdown period of COVID-19 pandemic. BMC Gastroenterol 2023; 23:236. [PMID: 37438707 DOI: 10.1186/s12876-023-02866-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND & AIMS During the COVID-19 pandemic, most of the endoscopic services were electively postponed or suspended. We aimed to assess the safety of a triage policy in patients receiving esophageal variceal ligation during the COVID-19 pandemic. METHODS Triage policy of endoscopic variceal ligation (EVL) was implemented in our hospital during the lockdown period from 15th May 2021 to 26th July 2021. One experienced gastroenterologist reviewed the prior-scheduled list of patients for the EVL prophylaxisprogram. We compared the clinical characteristics and outcomes with those receiving endoscopy due to esophageal varices from 17th May 2020 to 28th July 2020. RESULTS Of the 124 patients receiving EVL, a higher percentage of esophageal variceal bleeding (EVB) was noted (9/32, 28.1% vs. 8/92, 8.7%, p = 0.006) during the lockdown period, with a higher percentage of EVB in the referrals (7/9, 77.8% vs. 2/14, 14.2%, p = 0.007). Among patients who received prophylactic EVL, 6 of 78 (7.7%) experienced EVB during the normal period, which is no different to 2 of 23 (8.7%) during the lockdown period. Twenty-three patients whose endoscopies were postponed by triage policy due to low-risk or eradicated varices did not experience EVB during the lockdown period. Child-Turcotte-Pugh (CTP) class C was predictive of EVB (relative risk 8.400, P = 0.033), entering the program of prophylactic EVL was the protective factor of EVB (relative risk 0.016, P = 0.002). CONCLUSION Entrance into the prophylaxis program does not only decreases risk of EVB but also fosters comprehensive triage to postpone endoscopy during the lockdown period.
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Affiliation(s)
- Yu-Jen Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 112, Taipei City, Taiwan
- National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 112, Taipei City, Taiwan.
- National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan, ROC.
| | - Tsung-Chieh Yang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 112, Taipei City, Taiwan
- National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 112, Taipei City, Taiwan
- National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 112, Taipei City, Taiwan
- National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 112, Taipei City, Taiwan
- National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan, ROC
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Faria ATRD, Omairi TW, Krubniki BR, Silva BL, Micelli-Neto O, Taglieri E, Ardengh JC. THE IMPACT OF THE COVID-19 PANDEMIC ON ENDOSCOPIC ULTRASOUND PROCEDURES IN A HIGH-VOLUME ENDOSCOPY UNIT IN BRAZIL. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:364-372. [PMID: 37792767 DOI: 10.1590/s0004-2803.230302023-75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/27/2023] [Indexed: 10/06/2023]
Abstract
•In pancreatic neoplasms the EUS plays a key role in the management. •During the pandemic period, lockdown measures prevented patients with comorbidities from performing EUS. •The D-EUS decreased during COVID-19, while I-EUS increased and EUS-TA was the most commonly I-EUS procedure performed, with no increase in adverse events. •Despite the moderate impact of the pandemic period in endoscopic services around the world, EUS-TA of solid and cystic tumors of the pancreas was the main indication. Background - Reports of the impact of the 2020 COVID-19 pandemic period/2020 on endoscopic ultrasound (EUS) are scarce. Objective - We analyzed the impact of the pandemic period/2020 on the demographics, indications, and number of diagnostic EUS (D-EUS) and interventional EUS (I-EUS) procedures performed in a high-volume endoscopy unit compared with the previous non-pandemic period/2019. Methods - We retrospectively reviewed the medical records of all patients undergoing D-EUS or I-EUS from March 1, 2019, to February 29, 2020 (non-pandemic period/2019) and from March 1, 2020, to February 28, 2021 (pandemic period/2020). Data compared between the study periods included sex, age, comorbidities, EUS findings and diagnosis, need for interventional procedures during EUS, and adverse events (AEs). Results were significant at P<0.05. Results - EUS procedures decreased from 475 in the non-pandemic period/2019 to 289 in the pandemic period/2020, accounting for a 39% reduction. In non-pandemic period/2019, 388 (81.7%) D-EUS and 88 (18.5%) I-EUS were performed, against 206 (71.3%) D-EUS and 83 (28.7%) I-EUS in pandemic period/2020 (P=0.001). Only 5/289 (1.7%) patients had COVID-19. Fewer patients with comorbidities underwent EUS during pandemic period/2020 due to lockdown measures (P<0.001). D-EUS decreased, whereas I-EUS increased (P<0.001). EUS-guided tissue acquisition (EUS-TA) was the most common I-EUS, performed in 83/289 (28.7%) patients in pandemic period/2020, against 88/475 (18.5%) in non-pandemic period/2019 (P=0.001). AEs did not differ significantly between the study periods. Conclusion - Pandemic Period/2020 had a moderate impact on reducing EUS procedures due to the risks involved. Although I-EUS increased, EUS-related AEs did not. Solid and cystic pancreatic tumors remained a major indication for EUS-TA even during the pandemic period/2020.
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Affiliation(s)
| | | | | | | | - Otávio Micelli-Neto
- Hospital Moriah, Unidade de Endoscopia, São Paulo, SP, Brasil
- Hospital A.C.Camargo Cancer Center, Unidade de Endoscopia, São Paulo, SP, Brasil
| | - Eloy Taglieri
- Hospital A.C.Camargo Cancer Center, Unidade de Endoscopia, São Paulo, SP, Brasil
| | - José Celso Ardengh
- Hospital Moriah, Unidade de Endoscopia, São Paulo, SP, Brasil
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Departamento de Cirurgia e Anatomia, Divisão de Cirurgia Gastrointestinal, Ribeirão Preto, SP, Brasil
- Universidade Federal de São Paulo, Departamento de Diagnóstico por Imagem, São Paulo, SP, Brasil
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Sultan S. Gastrointestinal Endoscopy in Patients with Coronavirus Disease 2019: Indications, Findings, and Safety. Gastroenterol Clin North Am 2023; 52:157-172. [PMID: 36813423 PMCID: PMC9678816 DOI: 10.1016/j.gtc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed the practice of gastroenterology and how we perform endoscopy. As with any new or emerging pathogen, early in the pandemic, there was limited evidence and understanding of disease transmission, limited testing capability, and resource constraints, especially availability of personal protective equipment (PPE). As the COVID-19 pandemic progressed, enhanced protocols with particular emphasis on assessing the risk status of patients and proper use of PPE have been incorporated into routine patient care. The COVID-19 pandemic has taught us important lessons for the future of gastroenterology and endoscopy.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 420 Delaware Street Southeast, MMC 36, Minneapolis, MN 55455, USA.
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Khashab MA, Muthusamy VR, Akshintala VS, Kothari S, Sethi A, Rastogi A, Palmisano DJ, Zhang LY, Hess MRR, Rashba K, Gupta N, Wani S, Komanduri S. Best live endoscopy practices: an ASGE white paper. Gastrointest Endosc 2023; 97:383-393.e3. [PMID: 36639318 DOI: 10.1016/j.gie.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/27/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Mouen A Khashab
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland.
| | - V Raman Muthusamy
- Division of Digestive Diseases, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Venkata S Akshintala
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Shivangi Kothari
- Division of Gastroenterology/Hepatology, University of Rochester Medical Center & Strong Memorial Hospital, Rochester, New York
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York
| | - Amit Rastogi
- Department of Gastroenterology, University of Kansas Medical Center, Kansas City VA, Kansas City, Kansas
| | | | - Linda Yun Zhang
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Mary-Rose R Hess
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Kira Rashba
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Neil Gupta
- Department of Gastroenterology, Loyola Medicine, Maywood, Illinois
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Srinadh Komanduri
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Chaikajornwat J, Pittayanon R, Ananchuensook P, Kongwibulwut M, Rerknimitr R. The comparison of aerosol exposures to endoscopy personnel performing diagnostic upper gastrointestinal endoscopy in patients with and without head box: A randomized control trial. J Gastroenterol Hepatol 2023; 38:233-240. [PMID: 36464891 DOI: 10.1111/jgh.16082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/11/2022] [Accepted: 11/29/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Esophagogastroduodenoscopy (EGD) has been identified as an aerosol-generating procedure (AGP) during the COVID-19 pandemic. The risk of AGP and benefits of utilizing protective measures have never been fully studied. METHODS A randomized control, open-label study in patients scheduled for diagnostic EGD between September and December 2021 was conducted. Patients were randomly assigned to either head box group or without head box group (control group). Particles were measured with six-size particle counters at the nurse anesthetist and endoscopist position. Primary composite outcomes were the mean difference of aerosol particle levels during and before EGD at the nurse anesthetist face position and at the endoscopist face position. Secondary outcomes were factors increasing aerosol particle levels and safety of the head box. RESULTS From 196 enrolled patients, 190 were analyzed. Baseline characteristics were not different between the two groups. The mean distance between endoscopist face and patient mouth was 67.2 ± 4.9 cm. The mean differences of 0.3-, 0.5-, and 1.0-μm particles during the procedure and at baseline before the procedure at nurse anesthetist position and the mean differences of 0.3-μm particles at the endoscopist position was found to have decreased in the head box group and increased in the control group (P < 0.001, 0.001, 0.014, and P < 0.001, respectively). Cough, burping, and body movement increased aerosol particles. No additional adverse events were observed in the head box group. CONCLUSIONS EGD with the head box is safe and can reduce significant aerosolization to endoscopy personnel including nurse anesthetists and endoscopists.
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Affiliation(s)
- Jukkaphop Chaikajornwat
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross, Bangkok, Thailand
| | - Rapat Pittayanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross, Bangkok, Thailand
| | - Prooksa Ananchuensook
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross, Bangkok, Thailand
| | - Manasnun Kongwibulwut
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross, Bangkok, Thailand
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Trinh LL, Vinh MKB, Choudhary A, Levitt BS, Kutty GR, Shieh EC, Nguyen KK, Trinh HN, Nguyen HA, Purohit TG. Endoscopic evaluation during the COVID-19 pandemic: Observational study of the experience in community practices. Medicine (Baltimore) 2022; 101:e30577. [PMID: 36123845 PMCID: PMC9477704 DOI: 10.1097/md.0000000000030577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Endoscopic screening is used widely to minimize the rates of colorectal cancer cases and deaths. During highly virulent infectious disease pandemics such as the coronavirus disease 2019 (COVID-19) pandemic, it is essential to weigh the risks and benefits of receiving endoscopy, especially in regions with moderately high viral infection rates. An observational study was conducted to assess the number of patients seen for endoscopic procedure at 2 of our surgery centers. Reasons for their procedure were collected in addition to information regarding any positive COVID-19 cases. This study considers the rate of severe acute respiratory syndrome coronavirus 2 infection along with the number of colorectal cancer cases encountered at a community endoscopy center to suggest that the benefits of undergoing endoscopic evaluation may outweigh the risks of attending an endoscopy procedure during the COVID-19 pandemic. One of the main reasons patients underwent endoscopic procedure was for colon cancer screenings (41.9%), and 5 of 1020 patients seen during the observation period were diagnosed with cancer. Of these 1020 patients, 8 were found to have positive tests for COVID-19 within 2 to 4 weeks after their procedure.
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Affiliation(s)
- Lindsey L. Trinh
- Silicon Valley Research Institute, San Jose, CA
- San Jose Gastroenterology, San Jose, CA
| | - Minh-Khang B. Vinh
- Silicon Valley Research Institute, San Jose, CA
- San Jose Gastroenterology, San Jose, CA
| | | | | | | | | | | | | | | | - Treta G. Purohit
- San Jose Gastroenterology, San Jose, CA
- *Correspondence: Treta Purohit, San Jose Gastroenterology, San Jose, CA, USA (e-mail: )
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Abougergi MS. The role of COVID-19 symptom and exposure screening and SARS-CoV-2 nucleic acid amplification testing in risk stratification before endoscopy. Gastrointest Endosc 2022; 96:433-435. [PMID: 35850863 PMCID: PMC9287593 DOI: 10.1016/j.gie.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA; Catalyst Medical Consulting, Simpsonville, South Carolina, USA
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Clinical and Endoscopic Consequences of Delay in Stent Exchange Procedures With ERCP During the Covid-19 Pandemic. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:714-719. [PMID: 36044333 DOI: 10.1097/sle.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/28/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION During the COVID-19 pandemic, elective endoscopic retrograde cholangiopancreatography (ERCP) procedures have been postponed as recommended by international guidelines. In this study, the results of biliary and pancreatic ERCP procedures that had to be postponed during the pandemic process were investigated. MATERIALS AND METHODS Forty-seven patients whose stent exchange procedures with ERCP were postponed between March 2020 and June 2020 due to the COVID-19 pandemic were included in the study. Patients were evaluated in 2 groups as delayed biliary procedures (n: 32) and delayed pancreatic procedures (n: 15). Clinical problems (biliary or pancreatic pain, itching, cholangitis, etc.) and technical problems encountered during the procedure (stent migration, abundant stone sludge in the bile ducts, etc.) were compared with 46 patients who could be treated without delay (39 interventions for the biliary system and seven interventions for the pancreas). FINDINGS Considering the procedures for the biliary system, there was no difference in age and sex between the groups. Although clinical problems in biliary procedures were more common in the group with delay than in those without delay, this difference was not significant (34% vs. 20%; P: 0.14). The technical problems encountered during the procedures in the group with delay were significantly higher than those without delay (21% vs. 2.5%; P: 0.019), with stent migration being the most common problem (n: 5). Age and sex did not differ in the patients who had pancreatic interventions with and without delay. The clinical problems that developed in the patients did not differ between the groups with and without delay (26% vs. 28%; P: 0.8). Although technical problems were encountered in 1 out of 15 patients in the group with delay, no technical problem was experienced in the group without delay (P: 0.68). CONCLUSION Postponing elective ERCP procedures for the biliary system not for the pancreatic system during the COVID-19 pandemic brings technical problems.
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Nampoolsuksan C, Chinswangwatanakul V, Methasate A, Swangsri J, Trakarnsanga A, Phalanusitthepha C, Parakonthun T, Taweerutchana V, Srisuworanan N, Suwatthanarak T, Tawantanakorn T, Akaraviputh T. Management of aerosol generation during upper gastrointestinal endoscopy. Clin Endosc 2022; 55:588-593. [PMID: 35999697 PMCID: PMC9539303 DOI: 10.5946/ce.2022.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
In the highly contagious coronavirus disease 2019 pandemic, aerosol-generating procedures (AGPs) are associated with high-risk of transmission. Upper gastrointestinal endoscopy is a procedure with the potential to cause dissemination of bodily fluids. At present, there is no consensus that endoscopy is defined as an AGP. This review discusses the current evidence on this topic with additional management. Prevailing publications on coronavirus related to upper gastrointestinal endoscopy and aerosolization from the PubMed and Scopus databases were searched and reviewed. Comparative quantitative analyses showed a significant elevation of particle numbers, implying that aerosols were generated by upper gastrointestinal endoscopy. The associated source events have also been reported. To reduce the dispersion, certain protective measures have been developed. Endoscopic unit protocols are recommended for the concerned personnel. Therefore, upper gastrointestinal endoscopy should be classified as an AGP. Proper practices should be adopted by healthcare workers and patients.
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Affiliation(s)
- Chawisa Nampoolsuksan
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Asada Methasate
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jirawat Swangsri
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Atthaphorn Trakarnsanga
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Thammawat Parakonthun
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Voraboot Taweerutchana
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nicha Srisuworanan
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tharathorn Suwatthanarak
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Thawatchai Akaraviputh
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Yılmaz H, Kocyigit B. Factors associated with non-attendance at appointments in the gastroenterology endoscopy unit: a retrospective cohort study. PeerJ 2022; 10:e13518. [PMID: 35910767 PMCID: PMC9332409 DOI: 10.7717/peerj.13518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/09/2022] [Indexed: 01/17/2023] Open
Abstract
Background and Aims Gastrointestinal (GI) endoscopy is a limited health resource because of a scarcity of qualified personnel and limited availability of equipment. Non-adherence to endoscopy appointments therefore wastes healthcare resources and may compromise the early detection and treatment of GI diseases. We aimed to identify factors affecting non-attendance at scheduled appointments for GI endoscopy and thus improve GI healthcare outcomes. Methods This was a single-center retrospective cohort study performed at a tertiary hospital gastroenterology endoscopy unit, 12 months before and 12 months after the start of the COVID-19 pandemic. We used multiple logistic regression analysis to identify variables associated with non-attendance at scheduled appointments. Results Overall, 5,938 appointments were analyzed, and the non-attendance rate was 18.3% (1,088). The non-attendance rate fell significantly during the pandemic (22.6% vs. 11.6%, p < 0.001). Multivariable regression analysis identified the absence of deep sedation (OR: 3.253, 95% CI [2.386-4.435]; p < 0.001), a referral from a physician other than a gastroenterologist (OR: 1.891, 95% CI [1.630-2.193]; p < 0.001), a longer lead time (OR: 1.006, 95% CI [1.004-1.008]; p < 0.001), and female gender (OR: 1.187, 95% CI [1.033-1.363]; p = 0.015) as associated with appointment non-attendance. Conclusions Female patients, those undergoing endoscopic procedures without deep sedation, those referred by physicians other than gastroenterologists, and with longer lead time were less likely to adhere to appointments. Precautions should be directed at patients with one or more of these risk factors, and for those scheduled for screening procedures during the COVID-19 pandemic.
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Affiliation(s)
- Hasan Yılmaz
- Department of Gastroenterology, Kocaeli University, İzmit, Kocaceli, Turkey,Department of Internal Medicine, Kocaeli University, İzmit, Kocaceli, Turkey
| | - Burcu Kocyigit
- Department of Internal Medicine, Kocaeli University, İzmit, Kocaceli, Turkey
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Lin S, Lau LH, Chanchlani N, Kennedy NA, Ng SC. Recent advances in clinical practice: management of inflammatory bowel disease during the COVID-19 pandemic. Gut 2022; 71:1426-1439. [PMID: 35477864 PMCID: PMC9185820 DOI: 10.1136/gutjnl-2021-326784] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/14/2022] [Indexed: 01/28/2023]
Abstract
The COVID-19 pandemic has raised considerable concerns that patients with inflammatory bowel disease (IBD), particularly those treated with immunosuppressive therapies, may have an increased risk of SARS-CoV-2 acquisition, develop worse outcomes following COVID-19, and have suboptimal vaccine response compared with the general population. In this review, we summarise data on the risk of COVID-19 and associated outcomes, and latest guidance on SARS-CoV-2 vaccines in patients with IBD. Emerging evidence suggests that commonly used medications for IBD, such as corticosteroids but not biologicals, were associated with adverse outcomes to COVID-19. There has been no increased risk of de novo, or delayed, IBD diagnoses, however, an overall decrease in endoscopy procedures has led to a rise in the number of missed endoscopic-detected cancers during the pandemic. The impact of IBD medication on vaccine response has been a research priority recently. Data suggest that patients with IBD treated with antitumour necrosis factor (TNF) medications had attenuated humoral responses to SARS-CoV-2 vaccines, and more rapid antibody decay, compared with non-anti-TNF-treated patients. Reassuringly, rates of breakthrough infections and hospitalisations in all patients who received vaccines, irrespective of IBD treatment, remained low. International guidelines recommend that all patients with IBD treated with immunosuppressive therapies should receive, at any point during their treatment cycle, three primary doses of SARS-CoV-2 vaccines with a further booster dose as soon as possible. Future research should focus on our understanding of the rate of antibody decay in biological-treated patients, which patients require additional doses of SARS-CoV-2 vaccine, the long-term risks of COVID-19 on IBD disease course and activity, and the potential risk of long COVID-19 in patients with IBD.
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Affiliation(s)
- Simeng Lin
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Louis Hs Lau
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Neil Chanchlani
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Siew C Ng
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Microbiota I-Center (MagIC), Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Cho SJ. A Novel Aerosol-Exposure Protection Mask for Patients During Upper Endoscopy. Clin Endosc 2022; 55:208-209. [PMID: 35391520 PMCID: PMC8995990 DOI: 10.5946/ce.2022.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Soo-Jeong Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Correspondence: Soo-Jeong Cho Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-4073, Fax: +82-2-762-9662, E-mail: ,
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Endoscopy After the COVID-19 Pandemic—What Will Be Different? CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2022; 20:46-59. [PMID: 35095262 PMCID: PMC8789548 DOI: 10.1007/s11938-022-00370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 10/26/2022]
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14
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Correia C, Almeida N, Gomes D, Figueiredo P. Rare cause of obstructive haemobilia with recurrent biliopancreatic complications: a paradigmatic case. BMJ Case Rep 2022; 15:e245303. [PMID: 35217550 PMCID: PMC8883207 DOI: 10.1136/bcr-2021-245303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 12/07/2022] Open
Abstract
Haemobilia is an unusual but significant cause of upper gastrointestinal bleeding. Two-thirds of haemobilia cases are secondary to invasive hepato-biliopancreatic procedures. Biliary angiodysplasia is exceptionally unusual, with only three cases reported. Herein, we report the case of an autonomous 80-year-old woman with a history of cholecystectomy 5 years ago and cardiovascular disease-hypertension, heart failure, acute myocardial infarction, stroke and non-valvular atrial fibrillation, anticoagulated with apixaban 2.5 mg two times per day. Since July 2019, she had four episodes of acute cholangitis of mild-to-moderate severity, having undergone broad spectrum antibiotics treatment and endoscopic retrograde cholangiopancreatography (ERCP), with sphincterotomy and bile sludge extraction. After 3 months, the patient presented with a new episode of acute cholangitis, this time with haemobilia (Quincke's triad). An abdominal CT angiography showed no evidence of active bleeding, with plastic biliary prosthesis left by ERCP. The patient continued presenting new episodes of acute cholangitis with haemobilia, some of them with associated pancreatitis. A cholangioscopy with Spyglass DS II was performed, showing an angiodysplasia occupying half of the luminal circumference of the middle choledoccus, without active haemorrhage. After a multidisciplinary meeting and given the high haemorrhagic/thrombotic risk (CHA2DS2-VASc 8), closure of the left atrial appendage was considered. However, relapse of the condition after beginning the antiaggregation protocol for cardiovascular intervention made it unfeasible. Another cholangioscopy with an ultra-thin endoscope for argon-plasma coagulation was attempted, without success. The abdominal CT angiography was repeated, this time with identification of dilated ramifications of the gastroduodenal and inferior pancreatic arteries. After embolisation of these aberrant vessels with microcoils, the patient went well, with no recurrence of bleeding or biliopancreatic complications. We present a case of obstructive haemobilia with multiple biliopancreatic complications, secondary to an extremely rare cause-choledochal angiodysplasia. Cholangioscopy had a decisive role in the diagnosis and therapeutic guidance. The diagnostic/therapeutic challenge associated with haemobilia stands out, with the need for a personalised and multidisciplinary approach.
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Affiliation(s)
- Catarina Correia
- Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Nuno Almeida
- Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Dário Gomes
- Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Pedro Figueiredo
- Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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15
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Marroquín-Reyes JD, Zepeda-Gómez S, Tepox-Padrón A, Quintanar-Martínez M, Trujillo-Benavides OE, Téllez-Avila FI. National survey regarding the timing of endoscopic procedures during the COVID-19 pandemic. Surg Endosc 2022; 36:361-366. [PMID: 33492499 PMCID: PMC7831145 DOI: 10.1007/s00464-021-08290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, several questions have arisen about which endoscopic procedures (EPs) must be performed and which ones can be postponed. The aim of this study was to conduct a nationwide survey regarding the appropriate timing of EPs during the COVID-19 pandemic. METHODS This prospective study was performed through a nationwide electronic survey. The survey consisted of 15 questions divided into three sections. The first evaluated the agreement for EPs classified as "time sensitive" and "not time sensitive". Two other sections assessed "high-priority" and "low-priority" scenarios. Agreement was considered when > 75% of respondents answered a question in the same direction. RESULTS The response rate was 27.2% (214/784). Among the respondents, agreement for the need to perform EP in < 72 h was only reached for variceal bleeding (93.4%). Dysphagia with alarm symptoms was the scenario in which the highest percentage of physicians (95.9%) agreed that an EP needed to be performed within a month. Less than 30% of endoscopists would perform an EP within the first 72 h for patients with mild cholangitis, non-variceal upper gastrointestinal bleeding without hemodynamic instability, or severe anaemia without overt bleeding. In time-sensitive clinical scenarios suggestive of benign disease, none of the scenarios reached agreement in any sense. Among the time-sensitive clinical scenarios suggestive of malignancy, > 90% of the surveyed respondents considered that EP could not be postponed for > 8 weeks. CONCLUSIONS There was no consensus among endoscopists about the timing of EPs in patients with pathologies considered time sensitive or in those with high-priority pathologies. Agreement was only reached in five (17%) of the evaluated clinical scenarios.
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Affiliation(s)
- José Daniel Marroquín-Reyes
- Department of Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15. Col. Sección XVI. Del. Tlalpan, C.P. 14000, Mexico City, Mexico
| | | | - Alejandra Tepox-Padrón
- Department of Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15. Col. Sección XVI. Del. Tlalpan, C.P. 14000, Mexico City, Mexico
| | - Mariana Quintanar-Martínez
- Department of Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15. Col. Sección XVI. Del. Tlalpan, C.P. 14000, Mexico City, Mexico
| | | | - Félix I Téllez-Avila
- Department of Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15. Col. Sección XVI. Del. Tlalpan, C.P. 14000, Mexico City, Mexico.
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16
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Makiguchi ME, Abe S, Okagawa Y, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Ryuta O, Saito Y. Preclinical Efficacy and Clinical Feasibility of a Novel Aerosol-Exposure Protection Mask for Esophagogastroduodenoscopy. Clin Endosc 2021; 55:226-233. [PMID: 34905818 PMCID: PMC8995999 DOI: 10.5946/ce.2021.178-iden] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/09/2021] [Indexed: 01/25/2023] Open
Abstract
Background/Aims This study aimed to assess the efficacy of a novel aerosol-exposure protection (AP) mask in preventing coronavirus disease in healthcare professionals during upper gastrointestinal endoscopy and to evaluate its clinical feasibility.
Methods In Study 1, three healthy volunteers volitionally coughed with and without the AP mask in a cleanroom. Microparticles were visualized and counted with a specific measurement system and compared with and without the AP mask. In Study 2, 30 patients underwent endoscopic resection with the AP mask covering the face, and the SpO2 was measured throughout the procedure.
Results In Study 1, the median number of microparticles in volunteers 1, 2, and 3 with and without the AP mask was 8.5 and 110.0, 7.0 and 51.5, and 8.0 and 95.0, respectively (p<0.01). Using the AP mask, microparticles were reduced by approximately 92%. The median distances of microparticle scattering without the AP mask were 60, 0, and 68 in volunteers 1, 2, and 3, respectively. In Study 2, the mean SpO2 was 96.3%, and desaturation occurred in three patients. Conclusion The AP mask could provide protection from aerosol exposure and can be safely used for endoscopy in clinical practice.
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Affiliation(s)
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Okagawa
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhisa Suzuki
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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17
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Jayasena H, Abeynayake D, De Silva A, Niriella M, de Silva HJ. The use of personal protective equipment in endoscopy: what should the endoscopist wear during a pandemic? Expert Rev Gastroenterol Hepatol 2021; 15:1349-1359. [PMID: 34821190 DOI: 10.1080/17474124.2021.2011213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endoscopists are at high risk of exposure and nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) when performing endoscopic procedures due to the highly aerosol generating nature of these procedures. At present, there is still no consensus among endoscopists with regards to the type of protective equipment to be worn by healthcare workers, when performing endoscopy during the coronavirus 2019 (COVID-19) pandemic. This review encompasses a summary of currently published guidelines related to the use of personal protective equipment (PPE) when performing endoscopic procedures during the COVID-19 pandemic. With increasing calls to rationalize the use of PPE due to shortages in global supply chains, the review offers a concise summary on the most appropriate and adequate use of PPE when performing endoscopy during the pandemic. It is expected that these adaptations in the use of PPE during the pandemic will help to improve standards of care and safety of healthcare workers.
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Affiliation(s)
- Hiruni Jayasena
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Clinical Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
| | | | - Arjuna De Silva
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Madunil Niriella
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - H Janaka de Silva
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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18
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A Review of the Impact of the COVID-19 Pandemic on Colorectal Cancer Screening: Implications and Solutions. Pathogens 2021; 10:pathogens10111508. [PMID: 34832663 PMCID: PMC8619517 DOI: 10.3390/pathogens10111508] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 pandemic has impacted all aspects of medical care, including cancer screening and preventative measures. Colorectal cancer screening declined significantly at the onset of the pandemic as the result of an intentional effort to conserve resources, prioritize emergencies and reduce risk of transmission. There has already been an increase in diagnosis at more advanced stages and symptomatic emergencies due to suspended screenings. As endoscopy units find their way back to pre-pandemic practices, a backlog of cases remains. The missed CRC diagnoses amongst the missed screenings carry a risk of increased morbidity and mortality which will only increase as time-to-diagnosis grows. This review discusses the impact of COVID-19 on colonoscopy screening rates, trends in stages/symptoms/circumstances at diagnosis, and economic and social impact of delayed diagnosis. Triaging and use of FITs are proposed solutions to the challenge of catching up with the large number of pandemic-driven missed CRC screenings.
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19
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Abdelqader A, Sarkar A, Shahid H, Tyberg A, Sameera S, Gjeorgjievski M, Escobedo K, Simon A, Bareket R, He P, Zhao E, Gaidhane M, Kahaleh M. Impact of the SARS-CoV-2 pandemic on turnover time and revenue in the endoscopy unit: single-center experience. Endosc Int Open 2021; 9:E1680-E1685. [PMID: 34790530 PMCID: PMC8589563 DOI: 10.1055/a-1546-8302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background and study aims The SARS-CoV-2 pandemic heavily impacted the New York metro area causing most institutions to either reduce case volume or fully close remaining open units incorporated specific guidelines for procedures lockdown potentially leading to a greater turn-over time. We analyzed the quantitative and financial impact of this lost time on our tertiary care center's endoscopy unit. Patients and methods This single-center, retrospective study included demographics, procedure details and turn-over times (TOT) from all endoscopic procedures between December 1, 2019 to June 30, 2020. Cases were categorized as pre-COVID-19 group from December 1, 2019 to March 15, 2020 and during COVID-19 (lockdown) group from March 16, 2020 to June 30, 2020. The financial impact was assessed using national averages for reimbursement of outpatient endoscopic procedures provided by Center for Medicare and Medicaid Services. Results A total of 3622 procedures were performed during the study period: 2297 in the pre-COVID-19 period, 1325 in the COVID-19 period, representing a 42.32 % decrease. In the COVID-19 lockdown group, there was a significant increase in TOT in both the general endoscopy cases (18.11 minutes, P = 0.000) and advanced endoscopy cases (17.7 minutes, P = 0.000). The 42.3 % decrease in volume equated to at least $1.6 million USD in lost revenue during the lockdown. Conclusions COVID-19 pandemic led to an increase in TOT with overall reduced procedure volume and a negative effect on revenue. Providing continued endoscopic management during a pandemic avoids delays in reopening the endoscopy unit and hampers the post-pandemic surge of delayed cases and its financial impact.
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Affiliation(s)
- Abdelhai Abdelqader
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Haroon Shahid
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Amy Tyberg
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Sohini Sameera
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Mihajlo Gjeorgjievski
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Karoline Escobedo
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Alexa Simon
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Romy Bareket
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Ping He
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Eric Zhao
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Monica Gaidhane
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
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20
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Rosevics L, Fossati BS, Teixeira S, Bem RSD, Souza RCAD. COVID-19 AND DIGESTIVE ENDOSCOPY: EMERGENCY ENDOSCOPIC PROCEDURES AND RISK FACTORS FOR UPPER GASTROINTESTINAL BLEEDING. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:337-343. [PMID: 34705968 DOI: 10.1590/s0004-2803.202100000-57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/15/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic has changed digestive endoscopy services around the world. OBJECTIVE This study aimed to measure the number of urgent/emergency endoscopic procedures performed in a Brazilian hospital, comparing it to the same period in the previous year, and to identify risk factors in COVID-19 patients undergoing endoscopic procedures for upper gastrointestinal bleeding (UGIB). METHODS This was a retrospective, cross-sectional, observational, single-center study. The study evaluated urgent/emergency endoscopic procedures performed on adult patients from March to August in 2019 and 2020. The COVID-19 patients included were diagnosed using RT-PCR, aged over 18 years with complete medical record information. The variables evaluated were age, sex, comorbidities, length of stay, D-dimer, need for intensive care unit (ICU) and mechanical ventilation. Student's t-test for independent samples or the non-parametric Mann-Whitney test was used to compare quantitative variables. Categorical variables were analyzed using Fisher's exact test. A P-value <0.05 indicated statistical significance. RESULTS A total of 130 urgent/emergency endoscopic procedures were performed in 2020 and 97 in 2019. During the study period, 631 patients were hospitalized due to COVID-19, of whom 16 underwent urgent/emergency endoscopic procedures, 10 (1.6%) due to UGIB. Of the variables analyzed, the need for ICU and/or mechanical ventilation during hospitalization was statistically significant as a risk factor for UGIB. CONCLUSION This study showed increased urgent/emergency endoscopic procedures during the pandemic at the study site. Among the patients hospitalized with the novel coronavirus, there is a higher risk for UGIB in those needing ICU and/or mechanical ventilation.
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Affiliation(s)
- Leticia Rosevics
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brasil
| | | | - Sandra Teixeira
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brasil
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21
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Kerdsirichairat T, Shin EJ. Important Quality Metrics and Standardization in Endoscopy. Gastrointest Endosc Clin N Am 2021; 31:727-742. [PMID: 34538412 DOI: 10.1016/j.giec.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Quality metrics and standardization has become critical as the Affordable Care Act mandates that the Center for Medicare and Medicaid Services change reimbursement from volume to a value-based system. While the most commonly used quality indicators are related to that of colonoscopy, quality metrics for other procedures and endoscopy units have been developed mainly by the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy. Data to show that these quality metrics, especially in the field of advanced endoscopy as well as in the era of COVID-19 pandemic, can improve patient outcomes, are anticipated.
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Affiliation(s)
- Tossapol Kerdsirichairat
- Digestive Disease Center, Bumrungrad International Hospital, Bangkok, Thailand 33 Soi Sukhumvit 3, Wattana, Bangkok 10110 Thailand
| | - Eun Ji Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower, Suite 7125H, Baltimore, MD 21287, USA.
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22
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Zellmer S, Ebigbo A, Kahn M, Muzalyova A, Classen J, Grünherz V, Temizel S, Dhillon C, Messmann H, Römmele C. Evaluation of the ESGE recommendations for COVID-19 pre-endoscopy risk-stratification in a high-volume center in Germany. Endosc Int Open 2021; 9:E1556-E1560. [PMID: 34540550 PMCID: PMC8445688 DOI: 10.1055/a-1526-1169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/25/2021] [Indexed: 12/27/2022] Open
Abstract
Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) has defined COVID-19 infection prevention and control strategies within the endoscopy unit. These include pre-endoscopic questionnaire-based risk-stratification as well as pre-procedure viral testing. Real-life data on the effectiveness of these measures are presented here. Patients and methods Data from the outpatient endoscopic unit of the University Hospital Augsburg between July 1, 2020 and December 31, 2020 including the second pandemic wave were reviewed retrospectively. All patients were assessed with a pre-endoscopic risk-stratification questionnaire as well as viral testing using an antigen point-of-care test (Ag-POCT) in conjunction with a standard polymerase chain reaction (PCR) test. Highly elective procedures were postponed. The theoretically expected number of SARS-CoV-2-positive patients was simulated and compared with the actual number. In addition, endoscopy staff was evaluated with a rapid antibody test to determine the number of infections among the personnel. Results In total, 1029 procedures, 591 questionnaires, 591 Ag-POCTs, and 529 standard PCR tests were performed in 591 patients. 247 procedures in 142 patients were postponed. One Ag-POCT was positive but with a negative PCR test, while one PCR test was positive but with a negative Ag-POCT. This was lower than the theoretically expected number of COVID-19-positive patients (n = 15). One of 43 employees (2.3 %) in the outpatient endoscopy unit was seropositive. Conclusions Pre-endoscopic risk management including questionnaire-based risk stratification and viral testing seems to be an effective tool in combination with personal protective equipment for SARS-CoV-2 infection prevention and control within the endoscopy unit even in a high-prevalence setting.
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Affiliation(s)
- Stephan Zellmer
- Department of Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Maria Kahn
- Department of Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Anna Muzalyova
- Department of Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Johanna Classen
- Department of Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Vivian Grünherz
- Department of Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Selin Temizel
- Department of Hygiene and Environmental Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Christine Dhillon
- Covid-19 Task Force, University Hospital of Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Christoph Römmele
- Department of Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
- Covid-19 Task Force, University Hospital of Augsburg, Augsburg, Germany
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23
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Mergener K. The Future of Endoscopic Operations After the Coronavirus Pandemic. Gastrointest Endosc Clin N Am 2021; 31:773-785. [PMID: 34538415 PMCID: PMC8149204 DOI: 10.1016/j.giec.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The unprecedented COVID-19 pandemic and its rapid global shutdowns have posed tremendous challenges for GI practices, including sudden delays in endoscopic procedures. As full reopening approaches, practices are wrestling with completely retooling their operations to ensure the resumption of high-quality, safe, and effective patient care. The pandemic's long-term effects on practice operations must be assessed: What will postpandemic GI care look like? Will some aspects of our work be changed forever, and if so, what are the practice management implications? This chapter surveys the pandemic's impact on US-based GI practices and discusses key "lessons learned" for future operations.
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Affiliation(s)
- Klaus Mergener
- Division of Gastroenterology, University of Washington, 1917 Warren Avenue North, Seattle, WA 98109, USA.
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24
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Gadour E, Agu O, Musharaf M, Dixon M, Askar A, Hafeez S, Shafiq Y, Arabiyat A, Moradi J. Success Rate of Wire Control-Assisted ERCP Sphincterotomy Versus Non-assisted ERCP Cannulation of Common Bile Duct in a Secondary Care Unit During the First COVID-19 Peak: A Retrospective Observational Study of 281 Patients. Cureus 2021; 13:e17861. [PMID: 34522563 PMCID: PMC8429881 DOI: 10.7759/cureus.17861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background The British Society of Gastroenterology (BSG) recommended that during the COVID-19 pandemic, endoscopy units perform endoscopic retrograde cholangiopancreatography (ERCP) for obstructive biliary pathologies in an emergency. We assessed the local performance of ERCP during the first wave of COVID-19 at our local endoscopy center, in particular the technique to common bile duct (CBD) cannulation. Methodology All ERCP procedures performed from January to June 2020 were retrospectively assessed and compared with procedures performed between January and June 2019 at the Royal Lancaster Infirmary. The indications for ERCP, success rate, and complications were studied separately. Correlation analysis was conducted using Spearman's rank correlation coefficient. The binary logistic regression model was used to compute the factors associated with successful ERCP. Significance was established when the two-sided P-value < 0.05. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 25 for Windows (SPSS Inc., Chicago, IL, USA, 2017). Results A total of 281 ERCP were included in this study, with 169 and 112 performed during the first six months of 2019 and 2020, respectively. A statistically significant (0.0087) higher proportion of cases with liver dysfunction presented for ERCP before the COVID-19 outbreak (152, 89.94%). All patients before COVID-19 underwent wire control-assisted ERCP, while 82 (73.21%) received assisted ERCP during the first wave (P < 0.001). There was no statistically significant difference (P = 0.10) in the number of patients who underwent sphincterotomy before and during the first wave of COVID-19, with 97 (57.39%) and 76 (67.85%), respectively. The success rate of ERCP before COVID-19 was relatively high, accounting for 146 (86.39%) patients in contrast to 87 (77.67%) patients during the first wave (P = 0.074). Sphincterotomy (β = 2.800, P = 0.028) and stent insertion (β = 0.852, P = 0.046) were statistically significant predictors of ERCP outcomes. There was no statistically significant impact of cholangitis on the success of ERCP (β = 1.672, P = 0.109). Conclusion The first wave of COVID-19 had a statistically proven negative impact on the expected standards of ERCP performance. Although the complication rate was significantly higher during the first wave case difficulty, the American Society of Anesthesia (ASA) status was not assessed on an individual basis. Both ASA status and case difficulty are now included in our endoscopy selection process. We recommend adding the complexity of cases and ASA to the local and national recording databases. This is a rare study on UK-based hospitals.
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Affiliation(s)
- Eyad Gadour
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Okwudili Agu
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Mutwakil Musharaf
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Megan Dixon
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Amr Askar
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Siddrah Hafeez
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Yousuf Shafiq
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Abdalla Arabiyat
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Julia Moradi
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
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25
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Papanikolaou IS, Tziatzios G, Chatzidakis A, Facciorusso A, Crinò SF, Gkolfakis P, Deriban G, Tadic M, Hauser G, Vezakis A, Jovanovic I, Muscatiello N, Meneghetti A, Miltiadou K, Stardelova K, Lacković A, Bourou MZ, Djuranovic S, Triantafyllou K. COVID-19 in the endoscopy unit: How likely is transmission of infection? Results from an international, multicenter study. World J Gastrointest Endosc 2021; 13:416-425. [PMID: 34630891 PMCID: PMC8474700 DOI: 10.4253/wjge.v13.i9.416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) significantly affected endoscopy practice, as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units (PEU).
AIM To assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020).
METHODS Patients undergoing endoscopy in nine endoscopy units across six European countries during the period of the first European lockdown for COVID-19 (March-May 2020) were included. Prior to the endoscopy procedure, participants were stratified as low- or high- risk for potential COVID-19 infection according to the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) joint statement, and contacted 7-14 d later to assess COVID-19 infection status. PEU were questioned regarding COVID-19 symptoms and/or infection via questionnaire, while information regarding hospitalizations, intensive care unit-admissions and COVID-19-related deaths were collected. The number of weekly endoscopies at each center during the lockdown period was also recorded.
RESULTS A total of 1267 endoscopies were performed in 1222 individuals across nine European endoscopy departments in six countries. Eighty-seven (7%) were excluded because of initial positive testing. Of the 1135 pre-endoscopy low risk or polymerase chain reaction negative for COVID-19, 254 (22.4%) were tested post endoscopy and 8 were eventually found positive, resulting in an infection rate of 0.7% [(95%CI: 0.2-0.12]. The majority (6 of the 8 patients, 75%) had undergone esophagogastroduodenoscopy. Of the 163 PEU, 5 [3%; (95%CI: 0.4-5.7)] tested positive during the study period. A decrease of 68.7% (95%CI: 64.8-72.7) in the number of weekly endoscopies was recorded in all centers after March 2020. All centers implemented appropriate personal protective measures (PPM) from the initial phases of the lockdown.
CONCLUSION COVID-19 transmission in endoscopy units is highly unlikely in a lockdown setting, provided endoscopies are restricted to emergency cases and PPM are implemented.
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Affiliation(s)
- Ioannis S Papanikolaou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Alexandros Chatzidakis
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels 1070, Belgium
- Department of Medical Oncology, Institut Jules Bordet, Brussels 1000, Belgium
| | - Gjorgi Deriban
- University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia
| | - Mario Tadic
- Department of Gastroenterology, Dubrava University Hospital Zagreb, Zagreb 10040, Croatia
| | - Goran Hauser
- Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Antonios Vezakis
- 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Ivan Jovanovic
- Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy
| | - Anna Meneghetti
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy
| | - Konstantinos Miltiadou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Kalina Stardelova
- University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia
| | - Alojzije Lacković
- Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Maria-Zoi Bourou
- 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Srdjan Djuranovic
- Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
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Jo HH, Kim EY. Protecting Your Endoscopy Unit during the COVID-19 Pandemic. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2021.0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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27
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Chua TY, Kyanam Kabir Baig KR, Leung FW, Ashat M, Jamidar PA, Mulki R, Singh A, Yu JX, Lightdale JR. GIE Editorial Board top 10 topics: advances in GI endoscopy in 2020. Gastrointest Endosc 2021; 94:441-451. [PMID: 34147512 DOI: 10.1016/j.gie.2021.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 02/08/2023]
Abstract
The American Society for Gastrointestinal Endoscopy's Gastrointestinal Endoscopy Editorial Board reviewed a systematic literature search of original endoscopy-related articles published during 2020 in Gastrointestinal Endoscopy and 10 other high-impact medical and gastroenterology journals. Votes from each individual board member were tallied to identify a consensus list of the 10 most significant topic areas in GI endoscopy over the calendar year of study using 4 criteria: significance, novelty, impact on national health, and impact on global health. The 10 areas identified were as follows: artificial intelligence in endoscopy, coronavirus disease 2019 and GI practice, third-space endoscopy, lumen-apposing metal stents, single-use duodenoscopes and other disposable equipment, endosonographic needle technology and techniques, endoscopic closure devices, advances in GI bleeding management, improvements in polypectomy techniques, and bariatric endoscopy. Each board member contributed a summary of important articles relevant to 1 to 2 topic areas, leading to a collective summary that is presented in this document of the "top 10" endoscopic advances of 2020.
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Affiliation(s)
- Tiffany Y Chua
- Division of Digestive Diseases, Harbor-University of California Los Angeles, Torrance, California, USA
| | - Kondal R Kyanam Kabir Baig
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Felix W Leung
- VA Sepulveda Ambulatory Care Center, North Hills, California, USA
| | - Munish Ashat
- Division of Gastroenterology and Hepatology, Indiana School of Medicine, Indianapolis, Indiana, USA
| | - Priya A Jamidar
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ramzi Mulki
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ajaypal Singh
- Division of Digestive Diseases and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Jessica X Yu
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jenifer R Lightdale
- Division of Pediatric Gastroenterology and Nutrition, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Boškoski I, Di Gemma A, Matteo MV, Grilli F, Cattani P, Costamagna G. Endoscopes used in positive and critically ill patients are SARS-CoV-2 negative at virological assessment. Gut 2021; 70:1629-1631. [PMID: 33408123 PMCID: PMC7789205 DOI: 10.1136/gutjnl-2020-323577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022]
Abstract
The risk of SARS-CoV-2 transmission in endoscopy is not only between patients and endoscopy staff but is also through inadequately reprocessed endoscopes. There are no studies that could confirm the efficacy of current ways of endoscope reprocessing on the elimination of SARS-CoV-2. The aim of this pilot study was to evaluate the efficacy of high disinfection of endoscopes with peracetic acid on eliminating SARS-CoV-2, but surprisingly we found that the virus cannot be detected on any part of endoscopes used in critically ill patients due to SARS-CoV-2 and this was the same for all types of endoscopies and procedures. If confirmed in larger studies, these findings will probably open a new scenario in the overall understanding of the real impact of the virus.
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Affiliation(s)
- Ivo Boškoski
- Digestive Endoscopy Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
| | - Anna Di Gemma
- Digestive Endoscopy Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
| | - Maria Valeria Matteo
- Digestive Endoscopy Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
| | - Fabio Grilli
- Digestive Endoscopy Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
| | - Paola Cattani
- Digestive Endoscopy Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
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29
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Yang D, Perbtani YB, Loeb J, Liu N, Draganov PV, Estores DE, Lauzardo M, Maurelli A, Lednicky JA, Morris JG. Detection of SARS-CoV-2 in the gastrointestinal tract among patients with negative nasopharyngeal COVID-19 testing prior to endoscopy. Endosc Int Open 2021; 9:E1276-E1282. [PMID: 34447876 PMCID: PMC8383081 DOI: 10.1055/a-1490-9234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background and study aims The clinical significance of SARS-CoV-2 RNA in the stool remains unclear. We aimed to determine whether SARS-CoV-2 is detected via real-time reverse transcriptase polymerase chain reaction (rRT-PCR) in the gastrointestinal tracts of patients scheduled for endoscopy and if the virus obtained from these clinical specimens could be isolated in culture. Patients and methods All patients underwent symptom screening and had negative nasopharyngeal testing for SARS-CoV-2 within 72 hours of their scheduled procedure. Study samples were collected via nasopharyngeal swab, rectal swab, and fluid from the upper gastrointestinal tract and/or colon based on their endoscopic procedure(s). Samples were tested for SARS-CoV-2 via rRT-PCR. SARS-CoV-2 positive specimens were isolated and cultured in Vero-E6 cells. Results 243 patients (mean age 63.1 years;54.3 % men) were enrolled from July 15, 2020 to September 2, 2020. SARS-CoV-2 testing was performed from 242 (99.6 %) nasopharyngeal, 243 (100 %) rectal, 183 (75.3 %) upper gastrointestinal tract and 73 (30 %) colon samples. SARS-CoV-2 RNA was detected in the nasopharynx and gastrointestinal specimens in one patient (0.4 %). After a 14-day incubation period, there was no evidence of virus growth in cells incubated with any of these specimens. Conclusions SARS-CoV-2 was rarely detected in the gastrointestinal tract of patients with negative nasopharyngeal testing prior to endoscopy. No live virus was detected by culture, further highlighting that presence of viral genome on its own is not sufficient proof of infectivity. PCR-based screening provides limited insight into virus infectivity and its results should be interpreted carefully as to avoid unnecessary delays in clinical care or inadvertent risk exposure.
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Affiliation(s)
- Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
| | - Yaseen B. Perbtani
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
| | - Julia Loeb
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States,Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States
| | - Nanlong Liu
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
| | - Peter V. Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
| | - David E. Estores
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
| | - Michael Lauzardo
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States,Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Anthony Maurelli
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States,Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States
| | - John A. Lednicky
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States,Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States
| | - J. Glenn Morris
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States,Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States
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30
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Oikonomou KG, Papamichalis P, Zafeiridis T, Xanthoudaki M, Papapostolou E, Valsamaki A, Bouliaris K, Papamichalis M, Karvouniaris M, Vlachostergios PJ, Skoura AL, Komnos A. Gastroenterology and liver disease during COVID-19 and in anticipation of post-COVID-19 era: Current practice and future directions. World J Clin Cases 2021; 9:4918-4938. [PMID: 34307544 PMCID: PMC8283616 DOI: 10.12998/wjcc.v9.i19.4918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/10/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a major threat to global public health. The virus causes the clinical syndrome known as coronavirus disease 2019 (COVID-19), in which multiple organs can get affected. Apart from manifestations of the respiratory system, which predominate, its clinical presentation is frequently accompanied by symptoms of the gastro-intestinal (GI) tract and liver abnormalities. The correlation of symptoms and abnormalities with disease severity is discussed, leading to ambiguous results from international literature. Moreover, the disease infects patients with co-existing liver and GI disorders affecting both their health status and the availability of healthcare services provided to them. The risk of transmission of the disease during aerosol-generating procedures has changed the diagnostic approach and follow-up algorithms for liver and GI diseases. For the safety of both doctors and patients, telemedicine and distant evaluation have become everyday practice, whereas several routines and emergency visits at outpatient and emergency departments have been postponed or delayed. Vaccination against SARS-CoV-2 is underway, providing hope to humanity and the expectation that the post-COVID-19 era is near. This review aims to update knowledge about the manifestations of COVID-19 related to liver and GI diseases and the effect of the pandemic on the diagnostic and therapeutic procedures for these diseases with a special focus on how current practices have changed and what changes will possibly remain in the future.
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Affiliation(s)
- Katerina G Oikonomou
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
| | | | | | - Maria Xanthoudaki
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
| | | | - Asimina Valsamaki
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
| | | | - Michail Papamichalis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Thessaly, Greece
| | - Marios Karvouniaris
- Intensive Care Unit, University Hospital of Larissa, Larissa 41110, Thessaly, Greece
| | - Panagiotis J Vlachostergios
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | - Apostolia-Lemonia Skoura
- Intensive Care Unit, University Hospital of Larissa, Larissa 41110, Thessaly, Greece
- Transfusion Medicine Department, University Hospital of Larissa, Larissa 41110, Thessaly, Greece
| | - Apostolos Komnos
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
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31
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Correia C, Almeida N, Figueiredo P. The Role of Preprocedure Screening of SARS-CoV-2 Infection: A Tertiary Care Medical Center Analysis. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 95814:1-7. [PMID: 34373842 PMCID: PMC8339018 DOI: 10.1159/000516912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to understand the prevalence of asymptomatic COVID-19 infection among patients undergoing endoscopic procedures at a tertiary care hospital. The results allow prediction of the magnitude of cases which this endoscopic service might witness in the next months and planning of future actions accordingly. METHODS This retrospective study was conducted in the gastroenterology department of a large urban tertiary care medical center from October 15, 2020, to November 15, 2020. In this institution, all patients proposed for endoscopic procedures under deep sedation must be submitted to reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) detection. These results were thoroughly reviewed. RESULTS In the 1-month period, a total of 833 different procedures were done in 833 patients admitted to the endoscopy unit. Of these, 167 (20%) were submitted to nasal swab for SARS-CoV-2. Only 1 (0.6%) was positive for this infection, and her procedure was postponed. This RT-PCR-positive patient was not symptomatic for CO-VID-19 infection at the time of preprocedure screening. She had no positive contacts for COVID-19 and had not traveled outside the country. CONCLUSION We found that the proportion of patients proposed for an endoscopic intervention who were asymptomatic carriers of SARS-CoV-2 was low. However, only one fifth of patients were tested and, considering the proportion of 0.6%, it is reasonable to consider that exposure of healthcare workers and other patients can occur. So, all prevention measures must be strictly followed. However, the cost-benefit of an universal testing policy must be proven.
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Affiliation(s)
- Catarina Correia
- Department Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Nuno Almeida
- Department Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Pedro Figueiredo
- Department Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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32
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Zhang S, Wu X, Pan H, Wu D, Xu T, Shen N, Zhang Y, Feng Y, Wang Q, Jiang Q, Guo T, Wu D, Tang S, Yang A. Gastrointestinal endoscopy infection control strategy during COVID-19 pandemic: Experience from a tertiary medical center in China. Dig Endosc 2021; 33:577-586. [PMID: 32594570 PMCID: PMC7361359 DOI: 10.1111/den.13783] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) has spread globally and become a pandemic. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) not only infects the gastrointestinal (GI) tract and causes GI symptoms, but also increases nosocomial transmission risk during endoscopic procedures for aerosol generation. We hereby share our infection control strategies aiming to minimize COVID-19 transmission in the endoscopy center. METHODS We established our infection control strategies based on the guidance of Chinese Society of Digestive Endoscopy and inputs from hospital infection control experts: admission control through the procedure and patient triage, environmental control to reduce possible virus exposure, proper usage of personal protective equipment (PPE), and scope disinfection and room decontamination. All endoscopic procedures accomplished during COVID-19 outbreak and progress of stepwise resumption of elective endoscopy procedures were retrospectively reviewed. RESULTS Only urgent or semi-urgent procedures were performed during COVID-19 outbreak. After no local new-onset COVID-19 case in Beijing for four weeks, we reopened the endoscopy center for elective procedures and monitored the outbreak continuously while maintaining a sustainable endoscopy service. CONCLUSIONS It is imperative that all endoscopy centers should establish standard infection control strategies in order to fight COVID-19 pandemic based on national guidance and academic society guidelines and tailor them to individual resources. These measures and setup can also be reserved for future pandemics.
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Affiliation(s)
- Shengyu Zhang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Xi Wu
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Hui Pan
- Medical Affairs DepartmentPeking Union Medical College HospitalBeijingChina
| | - Dong Wu
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Tao Xu
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Ning Shen
- Medical Affairs DepartmentPeking Union Medical College HospitalBeijingChina
| | - Yizhen Zhang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Yunlu Feng
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Qiang Wang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Qingwei Jiang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Tao Guo
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Dongsheng Wu
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Shou‐jiang Tang
- Division of Digestive DiseasesDepartment of MedicineUniversity of Mississippi Medical CenterJacksonUSA
| | - Aiming Yang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
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33
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Lee E, Cho SJ. How to Cope with COVID-19 in the Endoscopy Room. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021. [DOI: 10.4166/kjg.2021.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Eunwoo Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Jeong Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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34
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Kapuria D, Bollipo S, Rabiee A, Ben‐Yakov G, Kumar G, Siau K, Lee H, Congly S, Turnes J, Dhanasekaran R, Lui RN. Roadmap to resuming care for liver diseases after coronavirus disease-2019. J Gastroenterol Hepatol 2021; 36:885-892. [PMID: 32656794 PMCID: PMC7404933 DOI: 10.1111/jgh.15178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/27/2020] [Accepted: 07/04/2020] [Indexed: 12/13/2022]
Abstract
The global pandemic of coronavirus disease-2019 (COVID-19) has led to significant disruptions in healthcare delivery. Patients with chronic liver diseases require a high level of care and are therefore particularly vulnerable to disruptions in medical services during COVID-19. Recent data have also identified chronic liver disease as an independent risk factor for COVID-19 related hospital mortality. In response to the pandemic, national and international societies have recommended interim changes to the management of patients with liver diseases. These modifications included the implementation of telehealth, postponement or cancelation of elective procedures, and other non-urgent patient care-related activities. There is concern that reduced access to diagnosis and treatment can also lead to increased morbidity in patients with liver diseases and we may witness a delayed surge of hospitalizations related to decompensated liver disease after the COVID-19 pandemic has receded. Therefore, it is paramount that liver practices craft a comprehensive plan for safe resumption of clinical operations while minimizing the risk of exposure to patients and health-care professionals. Here, we provide a broad roadmap for how to safely resume care for patients with chronic liver disease according to various phases of the pandemic with particular emphasis on outpatient care, liver transplantation, liver cancer care, and endoscopy.
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Affiliation(s)
- Devika Kapuria
- Division of Gastroenterology and HepatologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Steven Bollipo
- Department of GastroenterologyJohn Hunter HospitalNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Atoosa Rabiee
- Gastroenterology and Hepatology SectionVeterans Affairs HospitalWashingtonDistrict of ColumbiaUSA
| | - Gil Ben‐Yakov
- Center for Liver DiseaseSheba Medical CenterTel HaShomerIsrael
| | - Goutham Kumar
- Department of Liver Diseases and TransplantationManipal HospitalsBangaloreIndia
| | - Keith Siau
- Liver UnitQueen Elizabeth Hospital BirminghamBirminghamUK
| | - Hye‐Won Lee
- Division of GastroenterologyDepartment of Internal MedicineYonsei University College of MedicineSeoulSouth Korea
| | - Stephen Congly
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Juan Turnes
- Gastroenterology and HepatologyPontevedra University Hospital ComplexPontevedraSpain
- Galicia Sur Health Research InstituteVigoSpain
| | | | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong KongChina
- Institute of Digestive DiseaseThe Chinese University of Hong KongHong KongChina
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35
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Hernández Camba A, Marcelino Reyes R, Hernández-Guerra M, Blasco Amato ÓA, Bennemann P, De La Riva N, Diaz Machin S, Medina JA. Pre-procedural antibody testing for SARS-CoV-2 in the routine endoscopic practice. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:116-118. [PMID: 33261503 DOI: 10.17235/reed.2020.7434/2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
METHODS a retrospective multicenter cohort study was performed of all endoscopic procedures performed between April 27 and June 15, 2020. A screening questionnaire (SQ) was performed with patients three days prior to the procedure and 14 days after. Furthermore, a serologic SARS-CoV-2 test was performed 48 hours before. RESULTS two hundred and eleven consecutive patients with endoscopic procedures were included. No patients had a positive SQ, either on entry to the study or 14 days later. Only four patients (1.9 % [95 % CI: 0.07-4.8 %]) were positive for antibodies. CONCLUSION the pre-endoscopy seroprevalence of SARS-CoV-2 is low in this cohort. Pre-procedural SARS-CoV-2 antibody testing does not add any benefit over clinical SQ to identify active COVID-19 patients.
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Pratique de l'endoscopie digestive à l'ère de la pandémie COVID-19. LA TUNISIE MÉDICALE 2021. [PMCID: PMC8724690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Le personnel de la santé qui travaille en unité d'endoscopie digestive est exposé au risque de transmission du SARS-CoV-2 via les
aérosols et le contact avec les surfaces contaminées.
Objectifs: Etablir des recommandations pour la pratique de l'endoscopie digestive durant les différentes phases de l'épidémie COVID-19, applicables
pour notre pays dans un contexte de ressources limitées, d'équipements couteux et d'absence de dépistage de masse.
Méthodes: Une revue de la littérature médicale a été réalisée via la base de données Medline®, moyennant diverses combinaisons des mots clés
suivants : SARS-CoV-2, coronavirus, COVID-19, pandemics, endoscopy, digestive system, Real-time polymerase chain reaction, infection control,
personal protective equipment. Les articles les plus pertinents ont été retenus. Dans un second temps le club d'endoscopie digestive a émis des
recommandations en tenant compte des conditions locales.
Résultats: Afin de réduire le risque de transmission du virus, une stratification du risque d'infection des patients et du degré d'urgence des examens
endoscopiques était recommandée avant la procédure. Durant la phase 4 de l'épidémie, tous les patients doivent être considérés à haut risque
d'infection, seules les endoscopies urgentes ou hautement prioritaires sont réalisées et les équipements de protection renforcés doivent être portés
en salles d'endoscopie et de désinfection. Durant les autres phases, certaines mesures doivent être respectées en fonction de la période épidémique
et du risque infectieux du patient.
Conclusion: L'application des recommandations proposées permettront au personnel des unités d'endoscopie digestive de travailler en sécurité et
de prévenir la transmission du virus aux patients durant l'épidémie COVID-19.
Mots clés: Coronavirus, COVID-19, endoscopie, système digestif, équipement de protection individuelle.
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Zhang S, Wu X, Feng Y, Wang Q, Jiang Q, Guo T, Wu D, Xu T, Li R, Yang A. GI endoscopy infection control strategy after COVID-19 peak: changing strategy for a changing epidemic. Gastrointest Endosc 2021; 93:530-532.e1. [PMID: 32882202 PMCID: PMC7458042 DOI: 10.1016/j.gie.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Shengyu Zhang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xi Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yunlu Feng
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Qiang Wang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Qingwei Jiang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Tao Guo
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Dongsheng Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Tao Xu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Ran Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Aiming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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Ebigbo A, Römmele C, Bartenschlager C, Temizel S, Kling E, Brunner J, Messmann H. Cost-effectiveness analysis of SARS-CoV-2 infection prevention strategies including pre-endoscopic virus testing and use of high risk personal protective equipment. Endoscopy 2021; 53:156-161. [PMID: 33080647 PMCID: PMC7869042 DOI: 10.1055/a-1294-0427] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Infection prevention strategies to protect healthcare workers in endoscopy units during the post-peak phase of the COVID-19 pandemic are currently under intense discussion. In this paper, the cost-effectiveness of routine pre-endoscopy testing and high risk personal protective equipment (PPE) is addressed. METHOD A model based on theoretical assumptions of 10 000 asymptomatic patients presenting to a high volume center was created. Incremental cost-effectiveness ratios (ICERs) and absolute costs per endoscopy were calculated using a Monte Carlo simulation. RESULTS ICER values for universal testing decreased with increasing prevalence rates. For higher prevalence rates (≥ 1 %), ICER values were lowest for routine pre-endoscopy testing coupled with use of high risk PPE, while cost per endoscopy was lowest for routine use of high risk PPE without universal testing. CONCLUSION In general, routine pre-endoscopy testing combined with high risk PPE becomes more cost-effective with rising prevalence rates of COVID-19.
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Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Christoph Römmele
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Christina Bartenschlager
- Chair of Health Care Operations/Health Information Management (UNIKA-T), Faculty of Business and Economics, University of Augsburg, Augsburg, Germany
| | - Selin Temizel
- Department of Hygiene and Environmental Medicine, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Elisabeth Kling
- Department of Laboratory Medicine and Microbiology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Jens Brunner
- Chair of Health Care Operations/Health Information Management (UNIKA-T), Faculty of Business and Economics, University of Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
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Aguila EJT, Cua IHY. Adapting digital technology to the gastroenterology and endoscopy practice in the pandemic era. ADVANCES IN DIGESTIVE MEDICINE 2021. [DOI: 10.1002/aid2.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Enrik John T. Aguila
- Institute of Digestive and Liver Diseases St. Luke's Medical Center Global City Taguig Philippines
| | - Ian Homer Y. Cua
- Institute of Digestive and Liver Diseases St. Luke's Medical Center Global City Taguig Philippines
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Chiriac S, Stanciu C, Cojocariu C, Sfarti C, Singeap AM, Girleanu I, Cuciureanu T, Huiban L, David D, Zenovia S, Nastasa R, Balan GG, Trifan A. The Impact of the COVID-19 Pandemic on Gastrointestinal Endoscopy Activity in a Tertiary Care Center from Northeastern Romania. Healthcare (Basel) 2021; 9:healthcare9010100. [PMID: 33477942 PMCID: PMC7833369 DOI: 10.3390/healthcare9010100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The outbreak of the coronavirus disease 2019 (COVID-19) has led to significant changes in endoscopy units worldwide, with potential impact on patients' welfare as well as on endoscopy training. We aimed to assess the real-life impact of COVID-19 on the endoscopy unit in a tertiary care center from Romania. METHODS A 6.5-month period during the COVID-19 pandemic was compared to a similar period from 2019. RESULTS A 6.2-fold decrease of endoscopic procedures was noted. Colonoscopies were reduced from 916 to 42, p < 0.001; flexible sigmoidoscopies from 189 to 14, p = 0.009; upper gastrointestinal (GI) endoscopies from 2269 to 401, p = 0.006; and ERCP from 234 to 125, p < 0.001. The percentage of emergency procedures increased (38.8% vs. 26.2%, p < 0.001), as well as the rate of endoscopies performed for upper GI bleeding (42.5% vs. 24.4%, respectively, p < 0.001). The detection of cancers was considerably reduced (57 compared to 249, p = 0.001). There were fewer complications and higher success rates (7.6% vs. 19.2%, p < 0.001, and 94.2% vs. 90.7%, respectively). Fellows participation was also reduced from 90% to 40.9% (p < 0.001). CONCLUSIONS The COVID-19 pandemic has significantly altered the workflow of the endoscopy unit, lowering the number of procedures performed and potentially compromising the early detection of cancers.
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Affiliation(s)
- Stefan Chiriac
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.C.); (C.S.); (A.-M.S.); (I.G.); (T.C.); (L.H.); (S.Z.); (R.N.); (G.G.B.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (C.S.); (D.D.)
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (C.S.); (D.D.)
| | - Camelia Cojocariu
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.C.); (C.S.); (A.-M.S.); (I.G.); (T.C.); (L.H.); (S.Z.); (R.N.); (G.G.B.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (C.S.); (D.D.)
- Correspondence: ; Tel.: +40-752-223-968
| | - Catalin Sfarti
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.C.); (C.S.); (A.-M.S.); (I.G.); (T.C.); (L.H.); (S.Z.); (R.N.); (G.G.B.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (C.S.); (D.D.)
| | - Ana-Maria Singeap
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.C.); (C.S.); (A.-M.S.); (I.G.); (T.C.); (L.H.); (S.Z.); (R.N.); (G.G.B.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (C.S.); (D.D.)
| | - Irina Girleanu
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.C.); (C.S.); (A.-M.S.); (I.G.); (T.C.); (L.H.); (S.Z.); (R.N.); (G.G.B.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (C.S.); (D.D.)
| | - Tudor Cuciureanu
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.C.); (C.S.); (A.-M.S.); (I.G.); (T.C.); (L.H.); (S.Z.); (R.N.); (G.G.B.); (A.T.)
| | - Laura Huiban
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.C.); (C.S.); (A.-M.S.); (I.G.); (T.C.); (L.H.); (S.Z.); (R.N.); (G.G.B.); (A.T.)
| | - Diana David
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (C.S.); (D.D.)
| | - Sebastian Zenovia
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.C.); (C.S.); (A.-M.S.); (I.G.); (T.C.); (L.H.); (S.Z.); (R.N.); (G.G.B.); (A.T.)
| | - Robert Nastasa
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.C.); (C.S.); (A.-M.S.); (I.G.); (T.C.); (L.H.); (S.Z.); (R.N.); (G.G.B.); (A.T.)
| | - Gheorghe G. Balan
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.C.); (C.S.); (A.-M.S.); (I.G.); (T.C.); (L.H.); (S.Z.); (R.N.); (G.G.B.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (C.S.); (D.D.)
| | - Anca Trifan
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.C.); (C.S.); (A.-M.S.); (I.G.); (T.C.); (L.H.); (S.Z.); (R.N.); (G.G.B.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (C.S.); (D.D.)
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Abstract
Objective This study aims to explore the necessity and safety of digestive endoscopy during the epidemic of coronavirus disease 2019. Methods A retrospective cohort study method was used to collect patients’ data from the endoscopy center of the Civil Aviation General Hospital of China from February 1 to May 31, 2020, as the observation group. The patients’ data of endoscopic diagnosis and treatment during the same period in 2019 were used as a control group, to compare the differences in the number of diagnosis and treatment and the detection rate of gastrointestinal diseases in the two groups. At the same time, patients and related staff were followed up for the situation of new infection. Results During the epidemic, our endoscopy center conducted a total of 1,808 cases of endoscopic operations and 5,903 cases in the control group. The amount of endoscopic work during the epidemic period was 30.63% in the same period last year. During the epidemic, 26 patients underwent endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) treatment, 26 patients underwent ERCP, and 18 patients underwent gastrointestinal stent implantation. In the control group, 273 patients underwent EMR/ESD, 17 underwent ERCP, and 16 underwent gastrointestinal stenting. During COVID-19, compared with the same period last year, the detection rates of peptic ulcer, esophageal cancer, gastric cancer, colon cancer, and rectal cancer were significantly higher (χ2 = 4.482, P = 0.034; χ2 = 5.223, P = 0.006; χ2 = 2.329, P = 0.041; χ2 = 8.755, P = 0.003; and χ2 = 5.136, P = 0.023). Through telephone follow-up, novel coronavirus nucleic acid detection and blood antibody detection, no patients or medical staff were infected with the novel coronavirus. Conclusion During COVID-19, the number of digestive endoscopic operations decreased significantly compared with the same period last year, but the detection rate of various diseases of the digestive tract increased significantly. On the basis of strict prevention and control, orderly recovery of endoscopic work is essential.
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Covid-19 post-lockdown: A transparent box, used as protective equipment in gastroscopy. A test of feasibility and efficacy. Dig Liver Dis 2021; 53:13-16. [PMID: 32948491 PMCID: PMC7456272 DOI: 10.1016/j.dld.2020.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 02/05/2023]
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Safety in Endoscopy for Patients and Healthcare Workers During the COVID-19 Pandemic. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2021; 23:170-178. [PMID: 33103130 PMCID: PMC7568769 DOI: 10.1016/j.tige.2020.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is still wreaking havoc in many parts of the world and poses a great burden to healthcare systems worldwide. Mitigation and suppression strategies have been implemented globally but the disease has proven to be difficult to contain. Initially many elective gastrointestinal endoscopies were cancelled to reduce the risk of infection and conserve personal protective equipment, but many endoscopy units are now faced with the dilemma of resuming endoscopy service during the pandemic as indefinitely postponing diagnostic procedures may lead to a delay in the diagnosis and treatment of malignancies. Further concerns are surfacing as COVID-19 is now known to affect the gastrointestinal tract and may potentially be spread via the fecal-oral route. Until more effective drugs and vaccines are available, it is unlikely that the pandemic will wind down in the near future. Maintaining a balance between protecting healthcare workers and patients from being infected on the one hand and providing timely and effective clinical care on the other will become increasingly important as the pandemic persists. In this narrative review, the risk of COVID-19 infection for healthcare workers and patients undergoing endoscopy, and recommendations on maintaining safe, high-quality endoscopy practice will be discussed.
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To assess the efficacy of safety measures adopted during endoscopy in the Corona Virus Disease-19 era for health care professionals-A single-centre tertiary care hospital experience. Indian J Gastroenterol 2021; 40:410-419. [PMID: 34342866 PMCID: PMC8329413 DOI: 10.1007/s12664-021-01146-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES During Corona Virus Disease-19 (COVID-19) pandemic, it has been estimated that approximately 10% of health care professionals (HCPs) have been diagnosed contacting COVID-19. Aerosol-generating procedures have led to change in safety practices among HCPs. We thus evaluated the efficacy of the endoscopic safety measures among HCPs posted in the endoscopy unit. METHODS In this retrospective analysis, all endoscopic procedures performed over a period of 4 months, from 1 April to 31 July 2020 were included. We noted indications and number of COVID-positive procedures as well as comprehensive screening of HCPs posted in our endoscopy unit. The aim of the study was to evaluate the incidence and outcome of COVID-19 among HCPs. RESULTS Three thousand four hundred and sixty procedures were included in the analysis. Indications were divided as urgent (n = 190, 5.49%), semi-urgent (n = 553, 16%) and non-urgent group (n = 2717, 78.52%). Thirty-four procedures (0.98%) were done on diagnosed COVID-19 patients. The most common indications were gastrointestinal bleed (n = 12/34, 35.30%) followed by biliary sepsis (n = 9/34, 26.5%). Among the HCPs, the incidence of symptomatic COVID-19 was 6.58% (n = 5/76). All HCPs recovered with excellent outcomes. A comprehensive screening showed 7.90% (n = 6/76) HCPs having Immunoglobulin G (IgG) antibody in their sera. CONCLUSION Addition of safety measures in endoscopy leads to low risk of transmission among HCPs.
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Jagtap N, Singh AP, Inavolu P, Tandan M, Lakhtakia S, Reddy DN. Clinical Impact of Universal Screening for COVID-19 before Therapeutic Endoscopy. JOURNAL OF DIGESTIVE ENDOSCOPY 2020. [DOI: 10.1055/s-0040-1722378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
Introduction The Coronavirus pandemic (COVID-19) has led to drastic change in gastrointestinal (GI) endoscopy practice. Endoscopy is an aerosol-generating procedure. COVID-19 testing prior to endoscopy can reduce transmission by delaying non-emergency endoscopies in positive patients. There is scarcity of literature to support such protocols. We aimed to study the clinical impact of universal testing for COVID-19 before therapeutic endoscopy.
Methods This is retrospective analysis of prospectively maintained data. All patients requiring therapeutic endoscopy were enrolled between June 15 to July 15, 2020. Clinical profile, indication, endoscopic intervention, and outcome of patients tested positive for COVID-19 real-time polymerase chain reaction (RT PCR) or CT chest suggestive of CO-RADS 3 or more were included for analysis.
Results Out of 772 patients scheduled for endoscopic interventions, 26 (3.34%) patients had COVID-19 infection with mean age (range) of 48.19 (3–75) years. Eight (30.8%) were females. Of them, seven (26.9%) patients underwent emergency endoscopy, and another seven (26.9%) patients underwent endoscopy after minimum of 2 weeks waiting period. Two deaths were seen in patients who underwent emergency interventions which were unrelated to endoscopy. One patient, who was planned for endoscopic ultrasound (EUS) for choledocholithiasis, developed acute biliary pancreatitis in the waiting period.
Conclusion We suggest use of universal testing for COVID-19 by RT-PCR before endoscopic intervention. Endoscopy can be postponed for 2 weeks with marginal risk of adverse events during the waiting period in nonemergency indications. However, this approach needs to be tailored as per local needs, resources availability, and indication of endoscopy.
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Affiliation(s)
- Nitin Jagtap
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Pradev Inavolu
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manu Tandan
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Mahadev S, Aroniadis OC, Barraza LH, Agarunov E, Smith MS, Goodman AJ, Benias PC, Buscaglia JM, Gross SA, Kasmin F, Cohen J, Carr-Locke DL, Greenwald D, Mendelsohn R, Sethi A, Gonda TA. Gastrointestinal endoscopy during the coronavirus pandemic in the New York area: results from a multi-institutional survey. Endosc Int Open 2020; 8:E1865-E1871. [PMID: 33269322 PMCID: PMC7695511 DOI: 10.1055/a-1264-7599] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The coronavirus disease 2019 (COVID-19), and measures taken to mitigate its impact, have profoundly affected the clinical care of gastroenterology patients and the work of endoscopy units. We aimed to describe the clinical care delivered by gastroenterologists and the type of procedures performed during the early to peak period of the pandemic. Methods Endoscopy leaders in the New York region were invited to participate in an electronic survey describing operations and clinical service. Surveys were distributed on April 7, 2020 and responses were collected over the following week. A follow-up survey was distributed on April 20, 2020. Participants were asked to report procedure volumes and patient characteristics, as well protocols for staffing and testing for COVID-19. Results Eleven large academic endoscopy units in the New York City region responded to the survey, representing every major hospital system. COVID patients occupied an average of 54.5 % (18 - 84 %) of hospital beds at the time of survey completion, with 14.5 % (2 %-23 %) of COVID patients requiring intensive care. Endoscopy procedure volume and the number of physicians performing procedures declined by 90 % (66 %-98 %) and 84.5 % (50 %-97 %) respectively following introduction of restricted practice. During this period the most common procedures were EGDs (7.9/unit/week; 88 % for bleeding; the remainder for foreign body and feeding tube placement); ERCPs (5/unit/week; for cholangitis in 67 % and obstructive jaundice in 20 %); Colonoscopies (4/unit/week for bleeding in 77 % or colitis in 23 %) and least common were EUS (3/unit/week for tumor biopsies). Of the sites, 44 % performed pre-procedure COVID testing and the proportion of COVID-positive patients undergoing procedures was 4.6 % in the first 2 weeks and up to 19.6 % in the subsequent 2 weeks. The majority of COVID-positive patients undergoing procedures underwent EGD (30.6 % COVID +) and ERCP (10.2 % COVID +). Conclusions COVID-19 has profoundly impacted the operation of endoscopy units in the New York region. Our data show the impact of a restricted emergency practice on endoscopy volumes and the proportion of expected COVID positive cases during the peak time of the pandemic.
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Affiliation(s)
- Srihari Mahadev
- NYP-Weill Cornell Medicine, New York, New York, United States
| | | | - Luis H. Barraza
- NYP-Columbia University Irving Medical Center, New York, United States
| | - Emil Agarunov
- NYP-Columbia University Irving Medical Center, New York, United States
| | | | | | | | | | - Seth A. Gross
- NYU Langone Health, New York, New York, United States
| | | | | | | | | | - Robin Mendelsohn
- Memorial Sloan Kettering Hospital, New York, New York, United States
| | - Amrita Sethi
- NYP-Columbia University Irving Medical Center, New York, United States
| | - Tamas A. Gonda
- NYP-Columbia University Irving Medical Center, New York, United States
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Nunoo-Mensah JW, Giordano P, Chung-Faye G. COVID-19: An Opportunity to Reimagine Colorectal Cancer Diagnostic Testing-A New Paradigm Shift. Clin Colorectal Cancer 2020; 19:227-230. [PMID: 32921580 PMCID: PMC7395219 DOI: 10.1016/j.clcc.2020.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Joseph W Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, London, UK; Cleveland Clinic London, London, UK.
| | - Pasquale Giordano
- Department of Colorectal Surgery, Whipps Cross University Hospital, London, UK
| | - Guy Chung-Faye
- Department of Gastroenterology, King's College Hospital Foundation NHS Trust, London, UK
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Sultan S, Siddique SM, Altayar O, Caliendo AM, Davitkov P, Feuerstein JD, Francis D, Inadomi JM, Lim JK, Falck-Ytter Y, Mustafa RA. AGA Institute Rapid Review and Recommendations on the Role of Pre-Procedure SARS-CoV-2 Testing and Endoscopy. Gastroenterology 2020; 159:1935-1948.e5. [PMID: 32735862 PMCID: PMC7386603 DOI: 10.1053/j.gastro.2020.07.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Shazia M Siddique
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Osama Altayar
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Angela M Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Perica Davitkov
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joseph D Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Dawn Francis
- Mayo Clinic College of Medicine, Division of Gastroenterology and Hepatology, Jacksonville, Florida
| | - John M Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joseph K Lim
- Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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49
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Bhandari P, Subramaniam S, Bourke MJ, Alkandari A, Chiu PWY, Brown JF, Keswani RN, Bisschops R, Hassan C, Raju GS, Muthusamy VR, Sethi A, May GR, Albéniz E, Bruno M, Kaminski MF, Alkhatry M, Almadi M, Ibrahim M, Emura F, Moura E, Navarrete C, Wulfson A, Khor C, Ponnudurai R, Inoue H, Saito Y, Yahagi N, Kashin S, Nikonov E, Yu H, Maydeo AP, Reddy DN, Wallace MB, Pochapin MB, Rösch T, Sharma P, Repici A. Recovery of endoscopy services in the era of COVID-19: recommendations from an international Delphi consensus. Gut 2020; 69:1915-1924. [PMID: 32816921 DOI: 10.1136/gutjnl-2020-322329] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.
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Affiliation(s)
- Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK .,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, Hampshire, UK
| | - Sharmila Subramaniam
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Asma Alkandari
- Department of Gastroenterology, Al Jahra Hospital, Kuwait City, Al Jahra, Kuwait
| | - Philip Wai Yan Chiu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - James F Brown
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, Hampshire, UK
| | - Rajesh N Keswani
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Raf Bisschops
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Vlaams Brabant, Belgium
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology and Nutrition, Universidad of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - V Raman Muthusamy
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Gary R May
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo Albéniz
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marco Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Michal Filip Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Centre for Postgraduate Medical Education, Warsaw, Poland.,Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Instytute of Oncology, Warsaw, Poland
| | - Maryam Alkhatry
- Department of Gastroenterology, Obaidulla Hospital, Ras Al Khaimah, United Arab Emirates
| | - Majid Almadi
- Department of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, Riyadh, Saudi Arabia
| | - Mostafa Ibrahim
- Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Giza, Egypt
| | - Fabian Emura
- Gastroenterology Division, Universidad de La Sabana, Chia, Colombia.,Department of Advanced GI Endoscopy, EmuraCenter LatinoAmerica, Bogota, Colombia
| | - Eduardo Moura
- Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | | | - Adolfo Wulfson
- Department of Gastroenterology, Hospital de Emergencias Dr Clemente Alvarez, Rosario, Rosario, Argentina
| | - Christopher Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Ryan Ponnudurai
- Department of Gastroenterology, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Naohisa Yahagi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.,Cancer Center, Keio University, Tokyo, Japan
| | - Sergey Kashin
- Department of Endoscopy, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation
| | - Evgeniy Nikonov
- Department of Gastroenterology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Amit P Maydeo
- Department of Surgery, Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
| | - D Nageshwar Reddy
- Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
| | - Michael B Wallace
- Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Prateek Sharma
- Endoscopy Unit, Veteran Affairs Medical Center and University of Kansas, Kansas City, Kansas, USA
| | - Alessandro Repici
- Gastroenterology and Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy
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50
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Vanella G, Capurso G, Boškoski I, Bossi E, Signorelli C, Ciceri F, Arcidiacono PG, Costamagna G. How to get away with COVID-19: endoscopy during post-peak pandemic. A perspective review. Therap Adv Gastroenterol 2020; 13:1756284820965070. [PMID: 33093872 PMCID: PMC7548539 DOI: 10.1177/1756284820965070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/25/2020] [Indexed: 02/04/2023] Open
Abstract
The SARS-CoV-2 pandemic has changed the way we work, and health care services have to adapt. The use of personal protective equipment (PPE) and the delay of non-urgent procedures were the immediate measures adopted by Gastrointestinal (GI) Endoscopy Units at the time of crisis. As the peak has now passed in most countries, GI facilities are facing the next challenge of this pandemic: service providers must adapt their routine work to a 'new normal'. Routine casework must resume, and waiting lists must be addressed: all in the awareness of the ongoing potential risks of COVID-19, and the threat of a second wave. In this review, we discuss strategies to manage the workload by improving procedure appropriateness and prioritization, whilst maintaining a 'COVID-free' environment. This includes monitoring of an adequate stock of PPE and the implications for the staff's workload, and the GI trainees' need of training.
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Affiliation(s)
- Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography
Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele
University, Milan, Italy
| | - Gabriele Capurso
- Pancreatobiliary Endoscopy and Endosonography
Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele
University, Milan, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico
Universitario Agostino Gemelli IRCCS, Rome, Italy,Centre for Endoscopic Research Therapeutics and
Training (CERTT), Università Cattolica del Sacro Cuore di Roma, Italy
| | - Eleonora Bossi
- School of Medicine, Vita-Salute San Raffaele
University, Milan, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele
University, Milan, Italy
| | - Fabio Ciceri
- Department of Haematology and Stem Cell
Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San
Raffaele University, Milan, Italy
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