COVID-19: Effect on gastroenterology and hepatology service provision and training: Lessons learnt and planning for the future

Table 1 Summary of advice on Endoscopy service provision during the peak of COVID-19 pandemic from major societies around the world (March-April, 2020)

World Endoscopy Organization[18]

Postpone routine and elective procedures.

Take patient temperature at presentation, and screen for travel to high risk area, contact with COVID patient and occupational exposure.

Upper GI procedures (OGD, EUS, ERCP) carry highest risk of aerosolization.

Colonoscopy and flexible sigmoidoscopy carries some risk of aerosols generation.

In a positive patient or those at high risk of COVID, only perform highly urgent/emergent procedures.

Use enhanced PPE during Upper GI procedures, and standard PPE with surgical mask during lower GI procedure but use enhanced PPE if available or if high risk patient.

Perform GI endoscopy in negative pressure room if available.

If, endo-tracheal intubation required, perform in negative pressure room and minimize staff in the room during intubation.

Standard endoscope reprocessing is sufficient to kill COVID virus.

Essential person only in the room to conserve PPE.

Consider pre-procedure COVID testing for risk stratification.

European Society of Gastrointestinal Endoscopy[17]

Postpone all elective and surveillance endoscopy.

Case by case triage for non-urgent/emergent procedures.

Appropriate training of staff on the infection prevention strategies for COVID.

Health Care Professionals in endoscopy units should be triaged daily for sign symptoms of COVID and tested if needed.

COVID can effectively be inactivated by commonly used disinfectants having virucidal activity, so, reprocessing of flexible endoscopes and endoscopic accessories should be performed according to published guidelines.

Cleaning the endoscopy unit with virucidal agents is recommended as infection by contact is possible.

If feasible, online care should be provided (e.g. telemedicine) for pre-procedure clinics and assessment.

Before procedure, both patient and health care professional to use surgical face mask and face shield/visor if available. Temperature check all patients.

Relatives and caregivers should not have access to the GI endoscopy unit.

For patients who are considered at high risk for COVID, separate pre- and post-GI endoscopy recovery areas(or timeslots) should be arranged.

Same enhanced personal protection measures are recommended for all procedures, both upper or lower GI endoscopies for simplification.

Use negative pressure procedure rooms if available for high risk or positive COVID patients.

Post-procedure, consider tracing and contacting patients at 7 d and 14 d to inquire about any new COVID diagnosis, or development of COVID symptom.

American Society for Gastrointestinal Endoscopy[19]

Postpone on urgent procedures.

On arrival patients have their temperature checked and screened for COVID symptoms, contact or travel history.

Guidance on use of PPE.

Use negative pressure rooms if available.

Reprocessing of endoscopes as per standard guidelines.

Contact patient 14 d after the procedure to inquire about any COVID symptoms.

British Society of Gastroenterology[25,31]

All non-emergency GI endoscopic procedures should stop immediately, including Bowel Cancer Screening and fast-track referrals.

All emergency upper GI endoscopic procedures are classified as AGPs, irrespective of the COVID status of the patient, because the virus can be shed before any symptoms are present.

All staff in the room should wear PPE.

Case by case triage of cancer suspicious and other referrals.

Maintain a separate Urgent Deferred Waiting List to prioritise their proactive follow-up and investigation when services resume.

Subsequent guidance recommended to consider pre-procedural symptom screen and COVID testing with separation of high risk COVID sites from COVID minimised sites for low risk patients.

Indian Society of Gastroenterology[21]

Postponed routine non-urgent procedures

Screen patients pre-procedures with symptoms screen, travel and contact history.

Take temperature of all patients pre-procedure.

Minimum number of staff in the procedure room.

Use appropriate PPE based on risk assessment and stratification.

Standard disinfection processes are effective against COVID.

Surgical masks for patients’ use too, if they have respiratory symptoms.

AGP: Aerosol-generating procedure; ERCP: Endoscopic retrograde cholangiopancreatography; EUS: Endoscopic ultrasound; GI: Gastro-intestinal; OGD: Oesophago-Gastro-Duodenoscopy; PPE: personal protective equipment.