Subscribe to RSS

DOI: 10.1055/a-1196-1711
Covid-19 pandemic impact on colonoscopy service and suggestions for managing recovery

Abstract
Background and aim As the post-peak phase of the epidemic is approaching, there is an urgent need of an action plan to help resume endoscopy activity. To manage the Covid-19 pandemic-imposed backlog of postponed colonoscopy examinations, an efficient approach is needed. The practice of on-demand sedation with benzodiazepines and/or opiates will allow most patients to complete a water-aided examination with minimal or no sedation. Other methods reported to minimize patient discomfort during colonoscopy can be used, in addition to water-aided techniques. Unsedated or minimally sedated patients who do not require recovery or require a shorter one allow rapid turnaround. The practice obviates the need for assistance with deep sedation from anesthesiologists, who may be in short supply. Trainee education in water-aided colonoscopy has been demonstrated to confer benefits. This review provides some insights into the impact of Covid-19 on endoscopy services, challenges ahead, and possible solutions to help recovery of colonoscopy work and training.
Publication History
Received: 19 May 2020
Accepted: 05 June 2020
Article published online:
24 June 2020
© 2020. Owner and Copyright ©
© Georg Thieme Verlag KG
Stuttgart · New York
-
References
- 1 Istituto Superiore di Sanità. Interim guidance for rational use of SARS-COV-2 infection protections in health and socio-health activities in the current SARS-COV-2 emerging scenario. Version of May 10, 2020 (in Italian). Online (last accessed: 24.05.2020): https://www.iss.it/documents/20126/0/Rapporto+ISS+COVID+2_+Protezioni_REV+2.pdf/318ebe4a-6b1e-dc6e-fa19-434658a92df3?t=1589836417348
- 2 Chiu PWY, Ng SC, Inoue H. et al. Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements). Gut 2020; 69: 991-996
- 3 Gralnek IM, Hassan C, Beilenhoff U. et al. ESGE and ESGENA position statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy 2020; [Epub ahead of print]
- 4 Johnston ER, Habib-Bein N, Dueker JM. et al. Risk of bacterial exposure to the endoscopistʼs face during endoscopy. Gastrointest Endosc 2019; 89: 818-824
- 5 Cheung KS, Hung IF, Chan PP. et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis. Gastroenterology 2020; [Epub ahead of print]
- 6 Lauby-Secretan B, Vilahur N, Bianchini F. et al. The IARC perspective on colorectal cancer screening. N Engl J Med 2018; 378: 1734-1740
- 7 Regulations.gov. Temporary policy for compounding of certain drugs for hospitalized patients by outsourcing facilities during the COVID-19 public health emergency – Guidance for the industry. Online (last accessed: 24.05.2020): https://www.fda.gov/regulatory-information/search-fda-guidance-documents/temporary-policy-compounding-certain-drugs-hospitalized-patients-outsourcing-facilities-during-covid
- 8 Bretthauer M, Hoff GS, Thiis-Evensen E. et al. Air and carbon dioxide volumes insufflated during colonoscopy. Gastrointest Endosc 2003; 58: 203-206
- 9 Cadoni S, Gallittu P, Leung FW. et al. Impact of carbon dioxide insufflation and water exchange on postcolonoscopy outcomes in patient receiving on demand sedation: a randomized controlled trial. Gastrointest Endosc 2016; 85: 1-9
- 10 Fuccio L, Frazzoni L, Hassan C. et al. Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies. Gastrointest Endosc 2018; 88: 589-597.e11
- 11 Facciorusso A, Triantafyllou K, Murad MH. et al. Compared abilities of endoscopic techniques to increase colon adenoma detection rates: a network meta-analysis. Clin Gastroenterol Hepatol 2019; 17: 2439-2454
- 12 Vemulapalli KC, Rex DK. Water immersion simplifies cecal intubation in patients with redundant colons and previous incomplete colonoscopies. Gastrointest Endosc 2012; 76: 812-817
- 13 Friedland S, Leung FW. Learning and teaching the water method (with videos). J Interv Gastroenterol 2011; 1: 127-129
- 14 Leung FW. Methods of reducing discomfort during colonoscopy. Dig Dis Sci 2008; 53: 1462-1467
- 15 Domínguez-Ortega L, Rodríguez-Muňoz S. The effectiveness of clinical hypnosis in the digestive endoscopy: A multiple case report. Am J Clin Hypn 2010; 53: 101-107
- 16 Bampoe S, Odor PM, Lucas DN. Novel coronavirus SARS-CoV-2 and COVID-19. Practice recommendations for obstetric anaesthesia: What We have learned thus far. Int J Obstet Anesth 2020; 43: 1-8
- 17 Waschke KA, Anderson J, Macintosh D. et al. Training the gastrointestinal endoscopy trainer. Best Pract Res Clin Gastroenterol 2016; 30: 409-419
- 18 Leung CW, Kaltenbach T, Soetikno R. et al. Water immersion versus standard colonoscopy insertion technique: randomized trial shows promise for minimal sedation. Endoscopy 2010; 42: 557-563
- 19 Ngo C, Leung JW, Mann KS. et al. Interim report of a randomized cross-over study comparing clinical performance of novice trainee endoscopists using conventional air insufflation versus warm water infusion colonoscopy. J Interv Gastroenterol 2012; 2: 135-139
- 20 Azevedo R, Leitão C, Pinto J. et al. Can water exchange improve patient tolerance in unsedated colonoscopy a prospective comparative study. GE Port J Gastroenterol 2018; 25: 166-174