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Gonçalves M, Guimarães A, Carvalho T, Antunes P, Mendes S, Soares J, Gonçalves R, Arroja B, Rebelo A. Safety of Endoscopy Units during the COVID-19 Pandemic. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:4-10. [PMID: 38020825 PMCID: PMC10661713 DOI: 10.1159/000526125] [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: 01/22/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2023]
Abstract
Introduction The COVID-19 pandemic drastically changed the daily routine of all healthcare systems worldwide, and endoscopy units were no exception. Endoscopic exams were considered to have a high risk of transmission, and therefore, the safety of endoscopy units and the consequent need for pre-endoscopy SARS-CoV-2 screening were questioned early on. The aim of our study was to assess the safety of endoscopy units during the COVID-19 pandemic, as well as the effectiveness/necessity for SARS-CoV-2 screening prior to endoscopies. Material and Methods This is a retrospective and single-center study carried out in a Portuguese tertiary hospital. All patients who underwent endoscopic procedures between September 1, 2020 and February 28, 2021 were included. The pre-endoscopy screening consisted of a specific questionnaire or a RT-PCR test for SARS-CoV-2 (nasal and oropharyngeal swab). Data were obtained through patient's clinical records and the Trace COVID platform. Results A total of 2,166 patients were included. Patients had a mean age of 61.8 years and were predominantly male (56.2%, n = 1,218). Eighty-one (3.7%) patients had previous SARS-CoV-2 infection, with a median difference of 74 days (IQ 40.5:160.5) between infection and endoscopy. Most patients (70.2%, n = 1,521) underwent PCR screening for SARS-CoV-2 up to 72 h before the procedure, with the remaining patients (29.8%, n = 645) answering a questionnaire of symptoms and risk contacts up to 3 days before endoscopy. Of the patients who underwent RT-PCR screening for SARS-CoV-2, 21 (1.4%) tested positive, and all were asymptomatic at the time of the screening. The evaluation for SARS-CoV-2 infection up to 14 days after the endoscopic exams identified 9 positive patients (0.42%) for SARS-CoV-2. The median difference in days between endoscopy and the diagnosis of infection was 10 days. Discussion/Conclusion Pre-endoscopy screening with RT-PCR test for SARS-CoV-2 identified a very small number of patients with COVID-19 infection as well as patients with COVID-19 infection in the following 14 days. Therefore, the risk of infection in endoscopy units is negligible if screening of symptoms and risk contacts is applied and individual protective equipment is used.
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Affiliation(s)
| | | | - Tânia Carvalho
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Pedro Antunes
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Sofia Mendes
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - João Soares
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | | | - Bruno Arroja
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Ana Rebelo
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
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Römmele C, Kahn M, Zellmer S, Muzalyova A, Hammel G, Bartenschlager C, Beyer A, Rosendahl J, Schlittenbauer T, Zenk J, Al-Nawas B, Frankenberger R, Hoffmann J, Arens C, Lammert F, Traidl-Hoffmann C, Messmann H, Ebigbo A. Factors associated with an increased risk of SARS-CoV-2 infection in healthcare workers in aerosol-generating disciplines. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1009-1017. [PMID: 35878605 DOI: 10.1055/a-1845-2979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) are at a high risk of SARS-CoV-2 infection due to exposure to potentially infectious material, especially during aerosol-generating procedures (AGP). We aimed to investigate risk factors for SARS-CoV-2 infection among HCWs in medical disciplines with AGP. METHODS A nationwide questionnaire-based study in private practices and hospital settings was conducted between 12/16/2020 and 01/24/2021. Data on SARS-CoV-2 infections among HCWs and potential risk factors of infection were investigated. RESULTS 2070 healthcare facilities with 25113 employees were included in the study. The overall infection rate among HCWs was 4.7%. Multivariate analysis showed that regions with higher incidence rates had a significantly increased risk of infection. Furthermore, hospital setting and HCWs in gastrointestinal endoscopy (GIE) had more than double the risk of infection (OR 2.63; 95% CI 2.50-2.82, p<0.01 and OR 2.35; 95% CI 2.25-2.50, p<0.01). For medical facilities who treated confirmed SARS-CoV-2 cases, there was a tendency towards higher risk of infection (OR 1.39; 95% CI 1.11-1.63, p=0.068). CONCLUSION Both factors within and outside medical facilities appear to be associated with an increased risk of infection among HCWs. Therefore, GIE and healthcare delivery setting were related to increased infection rates. Regions with higher SARS-CoV-2 incidence rates were also significantly associated with increased risk of infection.
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Affiliation(s)
- Christoph Römmele
- III. Medizinische Klinik - Gastroenterologie und Infektiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Maria Kahn
- Hospital for Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital Augsburg, Augsburg, Germany
| | - Stephan Zellmer
- Hospital for Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital Augsburg, Augsburg, Germany
| | - Anna Muzalyova
- Hospital for Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital Augsburg, Augsburg, Germany
| | - Gertrud Hammel
- Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
| | - Christina Bartenschlager
- Chair of Health Care Operations/Health Information Management, University of Augsburg, Augsburg, Germany
| | - Albert Beyer
- Medical Practice for Gastroenterology and Gastrointestinal Oncology, Altötting, Germany
| | - Jonas Rosendahl
- Clinic for Internal Medicine I, University Hospital Halle, Halle, Germany
| | - Tilo Schlittenbauer
- Department of Oral and Maxillofacial Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Bilal Al-Nawas
- University Hospital Center Mainz Department of Otorhinolaryngology Head and Neck Surgery, Mainz, Germany
| | - Roland Frankenberger
- Department for Operative Dentistry, Endodontics, and Pediatric Dentistry, Philipps-Universitat Marburg, Marburg, Germany
| | - Juergen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
- Hannover Medical School, Hannover, Germany
| | - Claudia Traidl-Hoffmann
- Department of Environmental Medicine, University of Augsburg Faculty of Medicine, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
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Chapra A, Yousaf Z, Thomas MM, Ali A Al-Mohammed A, Abdelaleem A Ahmed H, Hameed M. Utility of RT-PCR versus electronic track and trace system for pre-procedural COVID-19 screening- a retrospective cohort study. Heliyon 2023; 9:e15379. [PMID: 37064466 PMCID: PMC10089668 DOI: 10.1016/j.heliyon.2023.e15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
Background and aims COVID-19 has disrupted the patient workflow in all healthcare settings. Procedures such as bronchoscopy and spirometry require additional pre-procedure screening for SARS-CoV-2. However, there is uncertainty regarding the utility of this universal pre-procedure screening. The State of Qatar has a robust contact tracing system in place in the form of the mobile application 'Ehteraz.' This study assesses the utility of various pre-procedural screening measures in asymptomatic patients and generate recommendations for any potential improvement in the workflow. Methods This is a cross-sectional study of asymptomatic patients who had SARS-CoV-2 RT-PCR screening performed before bronchoscopy or lung function testing scheduled on an elective basis. Descriptive statistics were used to summarize and determine the sample characteristics. The rate of the positive PCR test result was subsequently calculated. Results Two patients (0.34%) tested positive for COVID-19 on their pre-procedural screen. Four patients (0.68%) had an inconclusive result. Conclusion The positivity rate of SARS-CoV-2 RT-PCR is extremely low in asymptomatic individuals screened before bronchoscopy and spirometry. The authors recommend pre-procedural symptom and electronic application-based contact screening instead of universal pre-procedural SARS-CoV-2 RT-PCR for screening asymptomatic individuals.
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Affiliation(s)
- Ammar Chapra
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Merlin Marry Thomas
- Department of Chest, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
| | - Ahmed Ali A Al-Mohammed
- Department of Chest, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
| | | | - Mansoor Hameed
- Department of Chest, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
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Liu T, Peng C, Hsu F, Chang L, Wang H, Chang W. Setting up a three‐stage pre‐endoscopy triage during the coronavirus disease 2019 pandemic: A multicenter observational study. DEN OPEN 2023; 3:e159. [PMID: 35959099 PMCID: PMC9360760 DOI: 10.1002/deo2.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/14/2022] [Accepted: 07/20/2022] [Indexed: 01/08/2023]
Abstract
Objectives Between May and July 2021, the coronavirus disease 2019 (COVID‐19) pandemic led to a sharp surge in community transmission in Taiwan. We present a three‐stage restructuring process of pre‐endoscopy triage at the beginning of the pandemic, which can support urgent endoscopic procedures while protecting endoscopy staff. Methods The pre‐endoscopy triage framework was set up with three checkpoints at the hospital entrance, outpatient department, and endoscopy unit, with a specific target patient population and screening methods. Relevant data included the number of endoscopic procedures performed, outpatient department visits, and performing screening methods such as temperature measurement, travel, occupation, contact, and clustering history checking, polymerase chain reaction assay, and rapid antigen test. Results Forehead temperature measurement and verification of travel, occupation, contact, and clustering history provided rapid, easy, and early mass screening of symptomatic patients at the hospital entrance. During the pandemic, outpatient department visits and endoscopic procedures decreased by 37% and 64%, respectively. The pre‐endoscopy screening methods used displayed regional variations in COVID‐19 prevalence. Among 16 endoscopy units with a community prevalence of ≥ 31.04 cases per 100,000 residents, 12 (75%) used polymerase chain reaction assay and four (25%) used rapid antigen test to identify asymptomatic patients before endoscopy. Of 6540 pre‐endoscopy screening patients, 15 (0.23%) tested positive by laboratory testing. No endoscopy‐related nosocomial COVID‐19 infections were reported during the pandemic. Conclusions We present a three‐stage pre‐endoscopy triage based on the local laboratory capacity, medical resources, and community prevalence. These measures could be useful during the COVID‐19 pandemic.
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Affiliation(s)
- Tao‐Chieh Liu
- Department of Internal MedicineDivision of GastroenterologyTri‐Service General Hospital, National Defense Medical CenterTaipeiTaiwan
| | - Chen‐Ling Peng
- Department of Integrated Diagnostics and Therapeutics National Taiwan University Hospital, National Taiwan University College of MedicineTaipeiTaiwan
| | - Fang‐Yu Hsu
- Department of Hepatology and GastroenterologyChang Gung Memorial Hospital, Linkou Medical CenterTaipeiTaiwan
| | - Li‐Chun Chang
- Department of Internal MedicineDivision of Gastroenterology and HepatologyNational Taiwan University Hospital, National Taiwan University College of MedicineTaipeiTaiwan
| | - Hsiu‐Po Wang
- Department of Internal MedicineDivision of Gastroenterology and HepatologyNational Taiwan University Hospital, National Taiwan University College of MedicineTaipeiTaiwan
| | - Wei‐Kuo Chang
- Department of Internal MedicineDivision of GastroenterologyTri‐Service General Hospital, National Defense Medical CenterTaipeiTaiwan
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Altaf A, Abbas Z, Qadeer MA, Siyal M. Point of Care Testing for SARS-COV-2 Antibodies before doing Endoscopy. Pak J Med Sci 2023; 39:367-370. [PMID: 36950411 PMCID: PMC10025744 DOI: 10.12669/pjms.39.2.5659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/03/2022] [Accepted: 10/06/2022] [Indexed: 01/29/2023] Open
Abstract
Objectives COVID-19 has taken the world by storm, creating much disparity among both healthcare and non-healthcare centres regarding the provision of services. The purpose of our study was to see the prevalence of the SARS-COV-2 exposure in the asymptomatic patients undergoing the endoscopic procedure, already triaged based on history and examination. Methods Total 207 patients were enrolled during a time period of five months during October 2020 to April 2021 at Dr. Ziauddin Hospital Clifton campus, Karachi. In this prospective observational study patients undergoing endoscopic procedures were included after taking informed consent. The patients who already tested positive for COVID-19 by PCR were excluded. Patients were tested for Covid serology by immunochromatographic rapid serology test (ICT). Standard Operating Procedures for dealing with endoscopy patients during the COVID era were followed in all patients irrespective of antibody status. Result Total number of patients included was 207; males were 121 (58.5%). The mean age was 48.5 ± 17.55 (range 13 to 92). Forty eight patients (23.2%) were positive for either antibody suggesting exposure to the COVID-19 virus. Out of these combined IgM and IgG positivity was seen in 24 (11.5%), IgM mono antibody positivity was seen in 7 (3.38%) and 17 (8.21%) of the study population tested positive for IgG only. 15 out of 46 (32.6%) patients with chronic liver disease in the cohort were seropositive for COVID antibodies. Conclusion About one-fourth of the patients undergoing the endoscopic procedure were tested positive for COVID antibodies of which a significant percentage had chronic liver disease. It stresses the need of observing standard precautions to prevent the spread of infection during these procedures, especially in the vulnerable population.
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Affiliation(s)
- Abeer Altaf
- Abeer Altaf, MBBS., Department of Hepatogastroenterology, Dr. Ziauddin Hospital, Clifton, Karachi, Pakistan
| | - Zaigham Abbas
- Zaigham Abbas, MBBS, FCPS, FRCP, FACP, FACG, AGAF, FRCPI., Department of Hepatogastroenterology, Dr. Ziauddin Hospital, Clifton, Karachi, Pakistan
| | - Muhammad Ali Qadeer
- Muhammad Ali Qadeer, MBBS., Department of Hepatogastroenterology, Dr. Ziauddin Hospital, Clifton, Karachi, Pakistan
| | - Mehreen Siyal
- Mehreen Siyal, MBBS., Department of Hepatogastroenterology, Dr. Ziauddin Hospital, Clifton, Karachi, Pakistan
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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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Duan Z, Liu D, Zhou S, Li H, Sun X, Zhao C, Duan Q, Li L, Zhang X, Jin L. Health-code-based triage versus universal COVID-19 PCR testing before endoscopy in a low incidence area: a real-world experience. Gut 2023; 72:223-225. [PMID: 36351787 DOI: 10.1136/gutjnl-2022-328551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Zhihui Duan
- Endoscopy Center, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Dengxiang Liu
- Institute of Cancer Control, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Shengyun Zhou
- Endoscopy Center, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Hui Li
- Hepatobiliary Surgery, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Xiaofang Sun
- Endoscopy Center, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Chunqian Zhao
- Endoscopy Center, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Qiong Duan
- Gastroenterology, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Liwei Li
- Clinical Laboratory, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Xiaochong Zhang
- Key Laboratory of Cancer Prevention and Treatment, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Lingxuan Jin
- Radiology, Xingtai People's Hospital, Xingtai, Hebei, China
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Asymptomatic screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as an infection prevention measure in healthcare facilities: Challenges and considerations. Infect Control Hosp Epidemiol 2023; 44:2-7. [PMID: 36539917 DOI: 10.1017/ice.2022.295] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, "asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope.
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Abstract
PURPOSE OF REVIEW A large and growing number of patients have persistent gastrointestinal symptoms that they attribute to COVID-19. SARS-CoV-2, the virus that causes COVID-19, replicates within the gut and acute COVID-19 is associated with alteration of the gut microbiome. This article reviews recent observational data related to gastrointestinal symptoms in 'long COVID' and discusses pathophysiologic mechanisms that might explain persistent post-COVID gastrointestinal symptoms. RECENT FINDINGS Gastrointestinal symptoms are present in half of the patients with acute COVID-19, persist 6 months after COVID-19 in 10-25% of patients, and are rated as the most bothersome symptom in 11% of all patients. These symptoms include heartburn, constipation, diarrhoea and abdominal pain and decline in prevalence with the passage of time. Long COVID gastrointestinal symptoms are associated with mental health symptoms (anxiety and depression) that predate COVID-19 and also with mental health symptoms that are concurrent, after recovery from COVID-19. The cause of long COVID gastrointestinal symptoms is unknown and hypotheses include the SARS-CoV-2 virus itself, which infects the gastrointestinal tract; COVID-19, which can be accompanied by gut microbiome changes, a profound systemic inflammatory response and critical illness; and/or effects of pandemic stress on gastrointestinal function and symptom perception, which may be unrelated to either SARS-CoV-2 or to COVID-19. SUMMARY New, persistent gastrointestinal symptoms are commonly reported after recovery from COVID-19. The pathophysiology of these symptoms is unknown but likely to be multifactorial.
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Aby ES, Sultan S, Vaughn BP. Endoscopy COVID-19 Testing Requirements Disproportionately Affect Communities That Are Medically Underserved and May Worsen Health Care Disparities. Gastroenterology 2022; 163:795-799. [PMID: 35780868 PMCID: PMC9247216 DOI: 10.1053/j.gastro.2022.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022]
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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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Gawron AJ, Sultan S, Glorioso TJ, Califano S, Kralovic SM, Jones M, Kirsh S, Dominitz JA. Pre-endoscopy coronavirus disease 2019 screening and severe acute respiratory syndrome coronavirus-2 nucleic acid amplification testing in the Veterans Affairs healthcare system: clinical practice patterns, outcomes, and relationship to procedure volume. Gastrointest Endosc 2022; 96:423-432.e7. [PMID: 35461889 PMCID: PMC9023088 DOI: 10.1016/j.gie.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/12/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The coronavirus disease 2019 (COVID-19) pandemic has had profound impacts worldwide, including on the performance of GI endoscopy. We aimed to describe the performance and outcomes of pre-endoscopy COVID-19 symptom and exposure screening and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) nucleic acid amplification testing (NAAT) across the national Veterans Affairs healthcare system and describe the relationship of SARS-CoV-2 NAAT use and resumption of endoscopy services. METHODS COVID-19 screening and NAAT results from March 2020 to April 2021 were analyzed to determine use, performance characteristics of screening, and association between testing and endoscopic volume trends. RESULTS Of 220,891 completed endoscopies identified, 115,890 (52.5%) had documented preprocedure COVID-19 symptom and exposure screenings and 154,127 (69.8%) had preprocedure NAAT results within 7 days before scheduled endoscopy. Of 131,894 total canceled endoscopies, 26,475 (20.1%) had screening data and 28,505 (21.6%) had SARS-CoV-2 NAAT results. Overall, positive NAAT results were reported in 1.8% of all individuals tested and in 1.3% of those who screened negative. Among completed and canceled endoscopies, COVID-19 screening had a 34.6% sensitivity (95% confidence interval [CI], 32.4%-36.8%) and 96.4% specificity (95% CI, 96.2%-96.5%) when compared with NAAT. COVID-19 screening had a positive predictive value of 15.0% (95% CI, 14.0%-16.1%) and a negative predictive value of 98.7% (95% CI, 98.7%-98.8%). There was a very weak correlation between monthly testing and monthly endoscopy volume by site (Spearman rank correlation coefficient = .09). CONCLUSIONS These findings have important implications for decisions about preprocedure testing, especially given breakthrough infections among vaccinated individuals during the SARS-CoV-2 delta and omicron variant surge.
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Affiliation(s)
- Andrew J. Gawron
- National Gastroenterology and Hepatology Program, Office of Specialty Care Services, Department of Veterans Affairs, Washington, DC, USA,VA Salt Lake City Health Care System, Salt Lake City, Utah, USA,Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VAHCS, Minneapolis, Minnesota, USA
| | - Thomas J. Glorioso
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, USA
| | - Sophia Califano
- Preventive Medicine, National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Washington, DC, USA,General Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Stephen M. Kralovic
- National Infectious Diseases Service, Office of Specialty Care Services, Department of Veterans Affairs, Washington, DC, USA,Medical Service, Cincinnati VA Medical Center, Cincinnati, Ohio, USA,Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Makoto Jones
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Susan Kirsh
- Office of Veterans Access to Care, Veterans Health Administration, Washington, DC, USA
| | - Jason A. Dominitz
- National Gastroenterology and Hepatology Program, Office of Specialty Care Services, Department of Veterans Affairs, Washington, DC, USA,VA Puget Sound Health Care System, Seattle, Washington, USA,Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington, USA,Reprint requests: Jason A. Dominitz, MD, MHS, VA Puget Sound Health Care System, Seattle Division (111-S-Gastro), 1660 S Columbian Way, Seattle, WA 98108
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Lee JK, Lam AY, Jensen CD, Marks AR, Badalov J, Layefsky E, Kao K, Ho NJ, Schottinger JE, Ghai NR, Carlson CM, Halm EA, Green B, Li D, Corley DA, Levin TR. Impact of the COVID-19 Pandemic on Fecal Immunochemical Testing, Colonoscopy Services, and Colorectal Neoplasia Detection in a Large United States Community-based Population. Gastroenterology 2022; 163:723-731.e6. [PMID: 35580655 PMCID: PMC9107101 DOI: 10.1053/j.gastro.2022.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/21/2022] [Accepted: 05/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The COVID-19 pandemic has affected clinical services globally, including colorectal cancer (CRC) screening and diagnostic testing. We investigated the pandemic's impact on fecal immunochemical test (FIT) screening, colonoscopy utilization, and colorectal neoplasia detection across 21 medical centers in a large integrated health care organization. METHODS We performed a retrospective cohort study in Kaiser Permanente Northern California patients ages 18 to 89 years in 2019 and 2020 and measured changes in the numbers of mailed, completed, and positive FITs; colonoscopies; and cases of colorectal neoplasia detected by colonoscopy in 2020 vs 2019. RESULTS FIT kit mailings ceased in mid-March through April 2020 but then rebounded and there was an 8.7% increase in kits mailed compared with 2019. With the later mailing of FIT kits, there were 9.0% fewer FITs completed and 10.1% fewer positive tests in 2020 vs 2019. Colonoscopy volumes declined 79.4% in April 2020 compared with April 2019 but recovered to near pre-pandemic volumes in September through December, resulting in a 26.9% decline in total colonoscopies performed in 2020. The number of patients diagnosed by colonoscopy with CRC and advanced adenoma declined by 8.7% and 26.9%, respectively, in 2020 vs 2019. CONCLUSIONS The pandemic led to fewer FIT screenings and colonoscopies in 2020 vs 2019; however, after the lifting of shelter-in-place orders, FIT screenings exceeded, and colonoscopy volumes nearly reached numbers from those same months in 2019. Overall, there was an 8.7% reduction in CRC cases diagnosed by colonoscopy in 2020. These data may help inform the development of strategies for CRC screening and diagnostic testing during future national emergencies.
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Affiliation(s)
- Jeffrey K. Lee
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California,Division of Research, Kaiser Permanente Northern California, Oakland, California,Correspondence Address correspondence to Jeffrey K. Lee, MD, MPH, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, California 94612
| | - Angela Y. Lam
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | | | - Amy R. Marks
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jessica Badalov
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Evan Layefsky
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Kevin Kao
- Department of Gastroenterology, Kaiser Permanente Downey Medical Center, Downey, California,Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Ngoc J. Ho
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | | | - Nirupa R. Ghai
- Department of Quality and Systems of Care, Kaiser Permanente Southern California, Pasadena, California
| | - Cheryl M. Carlson
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Ethan A. Halm
- Department of Population and Data Sciences and the Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Beverly Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Dan Li
- Division of Research, Kaiser Permanente Northern California, Oakland, California,Department of Gastroenterology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Douglas A. Corley
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California,Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Theodore R. Levin
- Division of Research, Kaiser Permanente Northern California, Oakland, California,Department of Gastroenterology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California
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14
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Penney JA, Doron SI. Finding the off-ramp: Rethinking severe acute respiratory coronavirus virus 2 (SARS-CoV-2) preoperative screening. Infect Control Hosp Epidemiol 2022; 43:918-919. [PMID: 34986925 PMCID: PMC8795772 DOI: 10.1017/ice.2022.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Jessica A. Penney
- Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, Massachusetts
| | - Shira I. Doron
- Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, Massachusetts
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15
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Sahin T, Simsek C, Balaban HY. Practical points that gastrointestinal fellows should know in management of COVID-19. World J Clin Cases 2022; 10:5133-5145. [PMID: 35812670 PMCID: PMC9210885 DOI: 10.12998/wjcc.v10.i16.5133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/31/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Pandemics obligate providers to transform their clinical practice. An extensive effort has been put to find out feasible approaches for gastrointestinal diseases and also to manage coronavirus disease 2019 (COVID-19) related gastrointestinal conditions. Diarrhea, hepatitis, and pancreatitis can be seen in the COVID-19 course. Endoscopic procedures increase the risk of contamination for medical staff and patients despite precautions, therefore indications should be tailored to balance risks vs benefits. Furthermore, whether the immunosupression in inflammatory bowel diseases, liver transplantation, and autoimmune liver diseases increases COVID-19 related risks and how to modify immunosupression are topics of ongoing debate. This review aims to provide most up to date practical approaches that a gastrointestinal fellow should be aware on the problems and management of gastrointestinal and hepatobiliary diseases during the COVID-19 pandemic.
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Affiliation(s)
- Tevhide Sahin
- Department of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara 06100, Turkey
| | - Cem Simsek
- Department of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara 06100, Turkey
| | - Hatice Yasemin Balaban
- Department of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara 06100, Turkey
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16
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Casper M, Reichert MC, Rissland J, Smola S, Lammert F, Krawczyk M. Pre-endoscopy SARS-CoV-2 testing strategy during COVID-19 pandemic: the care must go on. Eur J Med Res 2022; 27:41. [PMID: 35303954 PMCID: PMC8931568 DOI: 10.1186/s40001-022-00672-5] [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: 11/21/2020] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background In response to the COVID-19 pandemic, endoscopic societies initially recommended reduction of endoscopic procedures. In particular non-urgent endoscopies should be postponed. However, this might lead to unnecessary delay in diagnosing gastrointestinal conditions. Methods Retrospectively we analysed the gastrointestinal endoscopies performed at the Central Endoscopy Unit of Saarland University Medical Center during seven weeks from 23 March to 10 May 2020 and present our real-world single-centre experience with an individualized rtPCR-based pre-endoscopy SARS-CoV-2 testing strategy. We also present our experience with this strategy in 2021. Results Altogether 359 gastrointestinal endoscopies were performed in the initial period. The testing strategy enabled us to conservatively handle endoscopy programme reduction (44% reduction as compared 2019) during the first wave of the COVID-19 pandemic. The results of COVID-19 rtPCR from nasopharyngeal swabs were available in 89% of patients prior to endoscopies. Apart from six patients with known COVID-19, all other tested patients were negative. The frequencies of endoscopic therapies and clinically significant findings did not differ between patients with or without SARS-CoV-2 tests. In 2021 we were able to unrestrictedly perform all requested endoscopic procedures (> 5000 procedures) by applying the rtPCR-based pre-endoscopy SARS-CoV-2 testing strategy, regardless of next waves of COVID-19. Only two out-patients (1893 out-patient procedures) were tested positive in the year 2021. Conclusion A structured pre-endoscopy SARS-CoV-2 testing strategy is feasible in the clinical routine of an endoscopy unit. rtPCR-based pre-endoscopy SARS-CoV-2 testing safely allowed unrestricted continuation of endoscopic procedures even in the presence of high incidence rates of COVID-19. Given the low frequency of positive tests, the absolute effect of pre-endoscopy testing on viral transmission may be low when FFP-2 masks are regularly used.
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Affiliation(s)
- M Casper
- Department of Medicine II - Gastroenterology, Hepatology and Endocrinology, Saarland University Medical Center, Saarland University, Kirrberger Straße 100, 66421, Homburg, Germany.
| | - M C Reichert
- Department of Medicine II - Gastroenterology, Hepatology and Endocrinology, Saarland University Medical Center, Saarland University, Kirrberger Straße 100, 66421, Homburg, Germany
| | - J Rissland
- Institute of Virology, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - S Smola
- Institute of Virology, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - F Lammert
- Department of Medicine II - Gastroenterology, Hepatology and Endocrinology, Saarland University Medical Center, Saarland University, Kirrberger Straße 100, 66421, Homburg, Germany.,Hannover Medical School, Hannover Health Sciences Campus, Hannover, Germany
| | - M Krawczyk
- Department of Medicine II - Gastroenterology, Hepatology and Endocrinology, Saarland University Medical Center, Saarland University, Kirrberger Straße 100, 66421, Homburg, Germany.,Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Center for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
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17
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Coronavirus Disease Transmission Prevented in an Endoscopy Unit with Universal Protective Measures and No Systematic Preprocedural Testing. J Clin Med 2022; 11:jcm11061681. [PMID: 35330006 PMCID: PMC8955929 DOI: 10.3390/jcm11061681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background and aims: Even after two years of pandemic, there are still uncertainties on how to proceed when we schedule endoscopic procedures. During the COVID-19 pandemic, some scientific societies recommended universal preprocedural testing for all patients. However, other societies recommended against and considered enough to maintain strict infection control strategies. Our aim was to evaluate this approach in order to see if it was safe for both patients and healthcare workers to proceed with the endoscopies without performing a systematic PCR on all patients. Methods: Retrospective chart review of all patients undergoing endoscopy without preprocedural COVID testing at our center from March 2020 to May 2021. PCR tests performed in the patients receiving an endoscopic procedure were analyzed, and patients who tested positive between 14 days before and after the endoscopic procedure were selected. The registry of the endoscopy unit members participating in these procedures was also analyzed. Results: A total of 10,132 procedures were performed in the unit with 26 patients infected with SARS-CoV-2. Nineteen of these procedures were performed in patients with unknown SARS-CoV-2 carrier status. In 23 (88.5%) cases, transmission occurred through social or familial contact, and in 3 (11.5%), transmission occurred in the hospital. Four health care workers became infected during this period and none of them were related to the endoscopic procedures performed in patients with COVID-19. Conclusions: SARS-CoV-2 positive testing in asymptomatic ambulatory patients is rare and the adequate use of individual protective measures emerges as the main way to control the spread of COVID-19 infection in endoscopy centers.
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18
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Alhalabi M, Eddin KA, Ali F, Abbas A. SARS-CoV-2 (COVID-19) pneumonia patient treated with two doses of infliximab within 2 weeks for acute severe ulcerative colitis: A case report. Medicine (Baltimore) 2022; 101:e28722. [PMID: 35089243 PMCID: PMC8797526 DOI: 10.1097/md.0000000000028722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 02/07/2023] Open
Abstract
RATIONALE The ongoing coronavirus pandemic has caused severe acute respiratory syndrome, posing a significant challenge for patients receiving immunotherapy for immune-mediated inflammatory diseases. As of January 2022, immunosuppressants such as tumor necrosis factor inhibitors (anti-TNFα) and azathioprine are inadvisable for an infectious disease caused by the SARS-CoV-2 virus (COVID-19). We continued infliximab as a second induction dose nine days after the onset of COVID-19 symptoms in a patient with acute severe ulcerative colitis. PATIENT CONCERNS We report the case of a 34-year-old male with 6 to 8 times bloody diarrhea, fever, and cramping abdominal pain. Ulcerative colitis was diagnosed 6 months earlier and treated with mesalamine 80 mg/kg/day and azathioprine 2.5 mg/kg/day. The patient had never undergone surgery before. Sigmoidoscopy revealed multiple ulcerations and spontaneous bleeding, and the colon samples tested negative for cytomegalovirus and Clostridium difficile. However, intravenous corticosteroids did not induce remission. A nasopharyngeal swab tested positive for SARS-CoV-2. DIAGNOSIS Acute severe ulcerative colitis and SARS-CoV-2 (COVID-19) pneumonia. INTERVENTIONS The second loading dose of infliximab was administered nine days after the diagnosis of COVID-19. OUTCOME The patient completed infliximab induction at a dose of 5 mg/kg at weeks 0, 2, and 6, with no complications. LESSONS It is unclear whether anti-TNF-α treatment improves or deteriorates COVID-19 patient outcomes, and this case demonstrates that infliximab can be used safely. Current guidelines make a weak recommendation to avoid using anti-TNFα agents in the presence of acute COVID-19 infection. There is an urgent need for research on biologics therapy.
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19
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Abstract
Pediatric gastroenterologists took on a variety of challenges during the coronavirus disease 2019 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically decreased numbers of in-person visits, adopting telehealth technologies, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the impact of the pandemic on trainee education, clinical experience, research, and job searches.
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Affiliation(s)
- Richard Taylor
- Pediatric Residency Program, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 5018, Cincinnati, OH 45229, USA
| | - Daniel Mallon
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2010, Cincinnati, OH 45229, USA.
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20
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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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21
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Kahn M, Zellmer S, Ebigbo A, Muzalyova A, Classen J, Grünherz V, Böser J, Breitling LP, Beyer A, Rosendahl J, Lammert F, Traidl-Hoffmann C, Messmann H, Römmele C. [Impact of Covid 19 on endoscopy in Germany]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:1278-1287. [PMID: 34687033 DOI: 10.1055/a-1649-8184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Practices and hospitals are facing great challenges in coping with the COVID-19-pandemic. So far, data on the impact of the pandemic on gastroenterological facilities are lacking, especially on a temporal course. A database is lacking, especially for the outpatient care sector. University Hospital of Augsburg was commissioned to generate data on this as a part of the collaborative project B-FAST of the Network of University Medicine (NUM). METHODS Gastroenterological institutions nationwide were surveyed by an online questionnaire. Recruitment was carried out via the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and the Professional Association of Gastroenterologists in Private Practice (bng). This manuscript provides an overview of data on the use of protective equipment, pre-interventional testing of patients, staff screening and economic impact over the course of the pandemic. RESULTS 429 facilities answered the questionnaire. Practices tested their patients pre-interventionally significantly less often than clinics (7.8% vs. 82.6%). In clinics, inpatients (93.1%) were tested significantly more often than outpatients (72.2%). The use of personal protective equipment (PPE) increased significantly during the pandemic. It was shown that over 70% of facilities screened their staff for SARS-CoV-2 without cause. Clinics cancelled elective procedures significantly more often than practices in quarter 4/2020. Procedures and turnover decreased in 2020 compared to the previous year. However, fewer facilities were affected by a loss of revenue than expected in previous studies. CONCLUSION Our data demonstrate the variable implementation of pre-interventional SARS-CoV-2 testing in outpatient and inpatient care. The use of adequate PPE and staff screening increased during the pandemic.
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Affiliation(s)
- Maria Kahn
- III. Medizinische Klinik - Gastroenterologie und Infektiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Stephan Zellmer
- III. Medizinische Klinik - Gastroenterologie und Infektiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- III. Medizinische Klinik - Gastroenterologie und Infektiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Anna Muzalyova
- III. Medizinische Klinik - Gastroenterologie und Infektiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Johanna Classen
- III. Medizinische Klinik - Gastroenterologie und Infektiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Vivien Grünherz
- III. Medizinische Klinik - Gastroenterologie und Infektiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Janis Böser
- III. Medizinische Klinik - Gastroenterologie und Infektiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Lutz P Breitling
- III. Medizinische Klinik - Gastroenterologie und Infektiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Albert Beyer
- Praxis für Gastroenterologie und gastrointestinale Onkologie, Altötting, Germany
| | - Jonas Rosendahl
- Universitätsklinik und Poliklinik für Innere Medizin I, Universitätsklinikum Halle, Halle, Germany
| | - Frank Lammert
- Vizepräsident und Vorstand für Krankenversorgung, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Christoph Römmele
- III. Medizinische Klinik - Gastroenterologie und Infektiologie, Universitätsklinikum Augsburg, Augsburg, Germany
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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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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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Sultan S, Siddique SM, Singh S, Altayar O, Caliendo AM, Davitkov P, Feuerstein JD, Kaul V, Lim JK, Mustafa RA, Falck-Ytter Y, Inadomi JM. AGA Rapid Review and Guideline for SARS-CoV2 Testing and Endoscopy Post-Vaccination: 2021 Update. Gastroenterology 2021; 161:1011-1029.e11. [PMID: 34029569 PMCID: PMC8139430 DOI: 10.1053/j.gastro.2021.05.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This guideline provides updated recommendations on the role of preprocedure testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in individuals undergoing endoscopy in the post-vaccination period and replaces the prior guideline from the American Gastroenterological Association (AGA) (released July 29, 2020). Since the start of the pandemic, our increased understanding of transmission has facilitated the implementation of practices to promote patient and health care worker (HCW) safety. Simultaneously, there has been increasing recognition of the potential harm associated with delays in patient care, as well as inefficiency of endoscopy units. With widespread vaccination of HCWs and the general population, a re-evaluation of AGA's prior recommendations was warranted. In order to update the role of preprocedure testing for SARS-CoV2, the AGA guideline panel reviewed the evidence on prevalence of asymptomatic SARS-CoV2 infections in individuals undergoing endoscopy; patient and HCW risk of infections that may be acquired immediately before, during, or after endoscopy; effectiveness of COVID-19 vaccine in reducing risk of infections and transmission; patient and HCW anxiety; patient delays in care and potential impact on cancer burden; and endoscopy volumes. The panel considered the certainty of the evidence, weighed the benefits and harms of routine preprocedure testing, and considered burden, equity, and cost using the Grading of Recommendations Assessment, Development and Evaluation framework. Based on very low certainty evidence, the panel made a conditional recommendation against routine preprocedure testing for SARS-CoV2 in patients scheduled to undergo endoscopy. The panel placed a high value on minimizing additional delays in patient care, acknowledging the reduced endoscopy volumes, downstream impact on delayed cancer diagnoses, and burden of testing on patients.
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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
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - 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
| | - Vivek Kaul
- Division of Gastroenterology and Hepatology at the University of Rochester Medical Center, Rochester, New York
| | - Joseph K Lim
- Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - John M Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Mathews SC, Natarajan Y, Sofia MA, Patel A, Francis D, Streett S, Siddique SM. Development of AGA's Policy Agenda During the COVID-19 Pandemic. Gastroenterology 2021; 161:765-769. [PMID: 33989662 PMCID: PMC8111881 DOI: 10.1053/j.gastro.2021.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 12/02/2022]
Affiliation(s)
| | | | | | - Amit Patel
- Duke University School of Medicine and Durham Veteran Affairs Medical Center, Durham, North Carolina
| | | | - Sarah Streett
- Stanford University School of Medicine, Palo Alto, California
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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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Affiliation(s)
| | - Haleh Vaziri
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Micheal Tadros
- Department of Medicine, Division of Gastroenterology-Hepatology, Albany Medical College, Albany, New York
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Zhang Y, Cen M, Hu M, Du L, Hu W, Kim JJ, Dai N. Prevalence and Persistent Shedding of Fecal SARS-CoV-2 RNA in Patients With COVID-19 Infection: A Systematic Review and Meta-analysis. Clin Transl Gastroenterol 2021; 12:e00343. [PMID: 33835096 PMCID: PMC8036078 DOI: 10.14309/ctg.0000000000000343] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The prevalence and shedding of fecal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA indicate coronavirus disease 2019 (COVID-19) infection in the gastrointestinal (GI) tract and likely infectivity. We performed a systemic review and meta-analysis to evaluate the prevalence and the duration of shedding of fecal RNA in patients with COVID-19 infection. METHODS PubMed, Embase, Web of Science, and Chinese databases Chinese National Knowledge Infrastructure and Wanfang Data up to June 2020 were searched for studies evaluating fecal SARS-CoV-2 RNA, including anal and rectal samples, in patients with confirmed COVID-19 infection. The pooled prevalence of fecal RNA in patients with detectable respiratory RNA was estimated. The days of shedding and days to loss of fecal and respiratory RNA from presentation were compared. RESULTS Thirty-five studies (N = 1,636) met criteria. The pooled prevalence of fecal RNA in COVID-19 patients was 43% (95% confidence interval [CI] 34%-52%). Higher proportion of patients with GI symptoms (52.4% vs 25.9%, odds ratio = 2.4, 95% CI 1.2-4.7) compared with no GI symptoms, specifically diarrhea (51.6% vs 24.0%, odds ratio = 3.0, 95% CI 1.9-4.8), had detectable fecal RNA. After loss of respiratory RNA, 27% (95% CI 15%-44%) of the patients had persistent shedding of fecal RNA. Days of RNA shedding in the feces were longer than respiratory samples (21.8 vs 14.7 days, mean difference = 7.1 days, 95% CI 1.2-13.0). Furthermore, days to loss of fecal RNA lagged respiratory RNA by a mean of 4.8 days (95% CI 2.2-7.5). DISCUSSION Fecal SARS-CoV-2 RNA is commonly detected in COVID-19 patients with a 3-fold increased risk with diarrhea. Shedding of fecal RNA lasted more than 3 weeks after presentation and a week after last detectable respiratory RNA.
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Affiliation(s)
- Yawen Zhang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengsha Cen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengjia Hu
- Department of Gastroenterology, The First Hospital of Jiaxing, Zhejiang, China
| | - Lijun Du
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weiling Hu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - John J. Kim
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, California, USA
| | - Ning Dai
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- School of Medicine, Zhejiang University City College, Hangzhou, Zhejiang, China
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Affiliation(s)
- Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Nian-Di Tan
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
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Dalal A, Sonika U, Kumar M, George R, Kumar A, Srivastava S, Sachdeva S, Sharma BC. COVID-19 Rapid Antigen Test: Role in Screening Prior to Gastrointestinal Endoscopy. Clin Endosc 2021; 54:522-525. [PMID: 33657784 PMCID: PMC8357579 DOI: 10.5946/ce.2020.295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/23/2020] [Indexed: 01/27/2023] Open
Abstract
Background/Aims The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19).
Methods This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages.
Results A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period.
Conclusions The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.
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Affiliation(s)
- Ashok Dalal
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Manish Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Roshan George
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Siddharth Srivastava
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Barjesh Chander Sharma
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
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32
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Leiman DA, Maratt JK, Ketwaroo GA. AGA Institute Quality Measure Development for the Diagnosis and Management of COVID-19. Gastroenterology 2021; 160:985-992. [PMID: 33242519 PMCID: PMC7683301 DOI: 10.1053/j.gastro.2020.11.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - Jennifer K Maratt
- Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gyanprakash A Ketwaroo
- Department of Medicine, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
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33
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Agrawal V, Yadav SK, Agarwal P, Sharma D. Strategies for Optimizing the Use of PPE During Surgery in COVID-19 Pandemic: Rapid Scoping Review of Guidelines. Indian J Surg 2021; 83:17-27. [PMID: 33424182 PMCID: PMC7785932 DOI: 10.1007/s12262-020-02713-x] [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] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/30/2020] [Indexed: 12/30/2022] Open
Abstract
Personal protective equipment (PPE) plays a fundamental role in the prevention of spread to Health Care Professionals (HCP) ; especially in a surgical setting. This scoping review of surgery guidelines was performed to appraise the quality of appropriate PPE recommendations and propose a strategy to optimize the PPE usage. This rapid scoping review of guidelines on surgery during COVID-19 was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol. Important databases were searched from January 1, 2020 to July 31, 2020, for relevant studies produced by a national/international academic association/organization, in English literature, using relevant keywords. Quality of evidence was graded according to GRADE guidelines. The searches yielded a total of 1725 studies, out of these 41 guidelines on surgery during COVID-19 matching with pre-defined criteria were evaluated. The level of evidence was uniformly rated "low," as assessed by GRADE guidelines and recommendations provided by them were mostly non-specific covering a narrow range of items. The crucial issue of optimization of PPE was not addressed at all. Economic implications demand optimization of PPE and conservation of resources. A simple decision-making algorithm addressing all the limitations of guidelines can be constructed, which allows HCPs to safeguard themselves and at the same time optimize/ conserving resources.
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Affiliation(s)
- Vikesh Agrawal
- Pediatric Surgery Division, Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Nagpur Road, Jabalpur, 482002 India
| | - Sanjay Kumar Yadav
- Pediatric Surgery Division, Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Nagpur Road, Jabalpur, 482002 India
| | - Pawan Agarwal
- Pediatric Surgery Division, Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Nagpur Road, Jabalpur, 482002 India
| | - Dhananjaya Sharma
- Pediatric Surgery Division, Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Nagpur Road, Jabalpur, 482002 India
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34
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Khorrami Minaei S, Garrido Durán C, García Hernández M, García Amengual I, Mena Ribas A. POOR AGREEMENT BETWEEN CLINICAL SCREENING AND UNIVERSAL PRE-PROCEDURE SARS-CoV-2 PCR TESTING PRIOR TO ENDOSCOPY. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:649-655. [DOI: 10.17235/reed.2021.7612/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Shaoul R, Day AS. Pediatric Endoscopy During COVID-19 Times. Front Pediatr 2021; 9:750717. [PMID: 34976888 PMCID: PMC8716625 DOI: 10.3389/fped.2021.750717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
The global COVID-19 pandemic has led to healthcare resources being diverted or stretched, especially during periods of lock-down in affected countries. Disruptions to normal services have resulted in reduced or delayed provision of endoscopy in many countries, with consequent impacts on diagnosis or management of digestive diseases and upon endoscopy training. This review article aims to highlight key aspects of the impact of the pandemic upon endoscopy services, with a focus upon endoscopy in children.
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Affiliation(s)
- Ron Shaoul
- Rambam Medical Center, Faculty of Medicine, Pediatric Gastroenterology and Nutrition Institute, Ruth Rappaport Children's Hospital of Haifa, Haifa, Israel
| | - Andrew S Day
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
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36
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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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37
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Walsh CM, Fishman DS, Lerner DG. Pediatric Endoscopy During the COVID-19 Pandemic: Implications of Universal Preprocedural Testing for PPE Utilization. J Pediatr Gastroenterol Nutr 2021; 72:e26-e28. [PMID: 33003165 DOI: 10.1097/mpg.0000000000002963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Department of Paediatrics and the Wilson Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX
| | - Diana G Lerner
- Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI
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38
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Srinivasan S, Sundaram S, Sharma P. COVID-19 and Endoscopy. Gastroenterol Hepatol (N Y) 2020; 16:519-524. [PMID: 34017224 PMCID: PMC8132668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused significant disruptions in health care. Gastrointestinal (GI) societies have strongly recommended the rescheduling of elective procedures to limit the spread of COVID-19 infection. This has impacted patients, endoscopists, fellows in training, and administrators in different ways. While the world adjusts to this new normal, GI experts and committees are addressing the challenging task of resuming endoscopy to restore care for patients. This article addresses the current challenges and stakeholder priorities involving endoscopy in the midst of the COVID-19 pandemic.
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Affiliation(s)
- Sachin Srinivasan
- Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
- Department of Internal Medicine, University of Kansas School of Medicine, Wichita, Kansas
| | - Suneha Sundaram
- Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
| | - Prateek Sharma
- Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
- Department of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas
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Francisco CP, Cua IH, Aguila EJ, Cabral-Prodigalidad PA, Sy-Janairo ML, Dumagpi JE, Raymundo NT, Gopez-Cervantes J, Co J. Moving Forward: Gradual Return of Gastroenterology Practice during the COVID-19 Pandemic. Dig Dis 2020; 39:140-149. [PMID: 32818948 PMCID: PMC7705935 DOI: 10.1159/000511008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic has caused disruption of routine gastroenterology practice, which has resulted in the suspension of elective endoscopic procedures and outpatient consults. For the past months, the strategy was to mitigate infection risk for the healthcare team while still providing essential service to patients. Prolonged suspension of the outpatient clinics and endoscopy practice, however, is deemed unsustainable and could even be detrimental. It can compromise patient care and result in poor outcomes; hence, a well-crafted plan is needed for the gradual resumption of clinic operations and endoscopic procedures. SUMMARY As the world begins to transition to the "new normal," there are new health and safety issues to consider. Adaptive measures like telemedicine and electronic health records should be utilized to facilitate patient care while minimizing exposure. Careful patient screening, adequate supply of personal protective equipment, effective infection-control policies, as well as appropriate administrative modifications are needed for a safe return of gastroenterology practice. Key Messages: Ensuring the safety of patients, caregivers, and healthcare workers should remain as top priority. To help ease the transition as we move forward from this pandemic, we present a review of recommendations to guide gastroenterologists and endoscopy unit administrators in the gradual return to gastroenterology practice.
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Affiliation(s)
- Carlos Paolo Francisco
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center Global City, Taguig City, Philippines,
| | - Ian Homer Cua
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center Global City, Taguig City, Philippines
| | - Enrik John Aguila
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center Global City, Taguig City, Philippines
| | | | - Marianne Linley Sy-Janairo
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center Global City, Taguig City, Philippines
| | - Joseph Erwin Dumagpi
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center Global City, Taguig City, Philippines
| | - Nikko Theodore Raymundo
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center Global City, Taguig City, Philippines
| | - Juliet Gopez-Cervantes
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center Global City, Taguig City, Philippines
| | - Jonard Co
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center Global City, Taguig City, Philippines
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