ESGE and ESGENA Position Statement on gastrointestinal endoscopy and COVID-19: An update on guidance during the post-lockdown phase and selected results from a membership survey
In response to the prolonged lockdown period and implemented measures of social distancing/personal hygiene, most European countries are now (June 2020) experiencing a suppression of the COVID-19 viral pandemic . This post-outbreak sustained (i. e., > 14 days) viral deceleration is being referred to as the “post-lockdown” phase of the COVID-19 pandemic. Sadly, at its height, the COVID-19 pandemic led to innumerable deaths throughout Europe, including many frontline health care professionals (HCPs) fighting the virus . Therefore, we must remain vigilant in protecting HCPs, including our endoscopy unit personnel, by continuing to follow personal protective equipment (PPE) recommendations .
It must be stressed however, that the observed deceleration of the viral outbreak is not equivalent to the disappearance of COVID-19 transmission, as a large reservoir of the virus remains present in most European countries . This generates the risk of future COVID-19 outbreaks as the protocols of infection control are gradually relaxed, as multiple viral outbreak clusters in various countries are now showing. Therefore, strategies aiming to triage, separate, and track gastrointestinal (GI) endoscopy patients, as outlined in our original Position Statement, remain highly relevant and necessary in this new post-lockdown phase of the pandemic . An additional new tool, potentially available for GI endoscopy units to further assist in patient care, is pre-endoscopy viral testing to more accurately triage patients and/or health care personnel through the identification of COVID-19 viral RNA using nasopharyngeal swabbing .
The prolonged lockdown period across Europe resulted in the cancellation of elective GI endoscopies as only emergent/urgent endoscopies were performed . As GI endoscopy is largely used for screening, early diagnosis, and treatment of digestive tract cancers, there is a growing concern about a possible mid- or long-term increase in the GI cancer burden because of the many elective GI endoscopy procedures that were cancelled . Competition for endoscopy slots between those cancelled endoscopy procedures and those procedures previously scheduled is now occurring and needs to be addressed. We must do this by striking a careful balance between the ongoing need to maintain infection prevention and control (IPC) protocols within the endoscopy unit and the need to increase endoscopy procedure capacity. Despite there being an excessive backlog of endoscopy cases, there remains no consensus on the best way to efficiently yet safely re-open access for elective endoscopy procedures. Moreover, the status of COVID-19 in Europe is neither uniform nor generalizable across the continent since some regions of Europe may not yet be in the “post-lockdown” phase of the pandemic.
The aim of this present Position Statement is to provide updated evidence-based guidance on endoscopy practice for the post-lockdown phase of the COVID-19 pandemic. Moreover, in this updated Position Statement, guidance is given on IPC in the post-lockdown period, on the emerging role of COVID-19 viral testing, and on issues related to returning to full endoscopy capacity. Unless otherwise stated, all the guidance statements from the original Position Statement of the European Society for Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) remain valid and applicable in the post-lockdown phase . Last, to better understand how the COVID-19 pandemic was impacting endoscopy units in Europe, ESGE and ESGENA surveyed their members on the status of their endoscopy practice as related to the COVID-19 pandemic. Thus, in addition to the updated guidance recommendations offered within this Position Statement, we also report selected results from our member survey.
* Co-first authors
08 July 2020 (online)
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- 1 European Centre for Disease Prevention and Control. COVID-19 situation update worldwide, as of 3 June 2020. https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases Accessed: 3 Jun 2020
- 2 In memoriam: Healthcare workers who have died of COVID-19. Medscape. https://www.medscape.com/viewarticle/927976 Accessed 1 May 2020.
- 3 Gralnek IM, Hassan C, Beilenhoff U. et al. ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy 2020; 52: 483-490
- 4 European Centre for Disease Prevention and Control. COVID-19 situation update for the EU/EEA and the UK, as of 3 June 2020. https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea Accessed: 3 Jun 2020.
- 5 Gupta S, Shahidi N, Gilroy N. et al. Proposal for the return to routine endoscopy during the COVID-19 pandemic. Gastrointest Endosc 2020; DOI: 10.1016/j.gie.2020.04.050.
- 6 Repici A, Pace F, Gabbiadini R. et al. Endoscopy units and the COVID-19 outbreak: a multi-center experience from Italy. Gastroenterology 2020; DOI: 10.1053/j.gastro.2020.04.003.
- 7 Gralnek IM, Hassan C, Dinis-Ribeiro M. COVID-19 and endoscopy: implications for healthcare and digestive cancer screening. Nat Rev Gastroenterol Hepatol 2020; DOI: 10.1038/s41575-020-0312-x.
- 8 Repici A, Maselli R, Colombo M. et al. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointest Endosc 2020; 92: 192-197 DOI: 10.1016/j.gie.2020.03.019.
- 9 Lui RN, Wong SH, Sánchez-Luna SA. et al. Overview of guidance for endoscopy during the coronavirus disease 2019 pandemic. J Gastroenterol Hepatol 2020; 35: 749-759
- 10 World Health Organization. Critical preparedness, readiness and response actions for COVID-19. https://www.who.int/publications/i/item/critical-preparedness-readiness-and-response-actions-for-covid-19
- 11 World Health Organization. Considerations in adjusting public health and social measures in the context of COVID-19: interim guidance. https://www.who.int/publications-detail/considerations-in-adjusting-public-health-and-social-measures-in-the-context-of-covid-19-interim-guidance
- 12 Sultan S, Lim JK, Altayar O. et al. AGA Institute rapid recommendations for gastrointestinal procedures during the COVID-19 pandemic. Gastroenterology 2020; DOI: 10.1053/j.gastro.2020.03.072.
- 13 World Health Organization. Contact tracing in the context of COVID-19. https://www.who.int/publications-detail/contact-tracing-in-the-context-of-covid-19
- 14 Tran K, Cimon K, Severn M. et al. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7: e35797 DOI: https://doi.org/10.1371/journal.pone.0035797.
- 15 Wang Y, Tong J, Qin Y. et al. Characterization of an asymptomatic cohort of SARS-COV-2 infected individuals outside of Wuhan, China. Clin Infect Dis 2020; DOI: https://doi.org/10.1093/cid/ciaa629.
- 16 Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41: 145-151 DOI: 10.3760/cma.j.issn.0254-6450.2020.02.003.
- 17 Mizumoto K, Kagaya K, Zarebski A. et al. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill 2020; 25 DOI: 10.2807/1560-7917.ES.2020.25.10.2000180.
- 18 Nishiura H, Kobayashi T, Miyama T. et al. Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). Int J Infect Dis 2020; 94: 154-155
- 19 Gudbjartsson DF, Helgason A, Jonsson H. et al. Spread of SARS-CoV-2 in the Icelandic population. N Engl J Med 2020; 382: 2302-2315
- 20 Gao Z, Xu Y, Sun C. et al. A systematic review of asymptomatic infections with COVID-19. J Microbiol Immunol Infect 2020; May 15; S1684118220301134. DOI: 10.1016/j.jmii.2020.05.001.
- 21 Wölfel R, Corman VM, Guggemos W. et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020; 581: 465-469
- 22 Smithgall MC, Scherberkova I, Whittier S. et al. Comparison of Cepheid Xpert Xpress and Abbott ID Now to Roche Cobas for the rapid detection of SARS-CoV-2. J Clin Virol 2020; 128: 104428 DOI: 10.1016/j.jcv.2020.104428.
- 23 Corman VM, Landt O, Kaiser M. et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020; 25: 2000045 DOI: 10.2807/1560-7917.ES.2020.25.3.2000045.
- 24 Pfefferle S, Reucher S, Nörz D. et al. Evaluation of a quantitative RT-PCR assay for the detection of the emerging coronavirus SARS-CoV-2 using a high throughput system. Euro Surveill 2020; 25: 2000152 DOI: 10.2807/1560-7917.ES.2020.25.9.2000152.
- 25 Long Y, Hu T, Liu L. et al. Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis. J Evid Based Med 2020; 13: 93-101
- 26 Corral JE, Hoogenboom SA, Kröner PT. et al. COVID-19 polymerase chain reaction testing before endoscopy: an economic analysis. Gastrointest Endosc 2020; S0016-5107(20)34248-6. DOI: 10.1016/j.gie.2020.04.049.
- 27 Mertens P, De Vos N, Martiny D. et al. Development and potential usefulness of the COVID-19 Ag Respi-Strip diagnostic assay in a pandemic context. Front Med (Lausanne) 2020; DOI: 10.3389/fmed.2020.00225.
- 28 World Health Organization. Advice on the use of point-of-care immunodiagnostic tests for COVID-19: scientific brief. https://www.who.int/publications/i/item/advice-on-the-use-of-point-of-care-immunodiagnostic-tests-for-covid-19-scientific-brief
- 29 Krammer F, Simon V. Serology assays to manage COVID-19. Science 2020; 368: 1060-1061 DOI: 10.1126/science.abc1227.