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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(04): E543-E551
DOI: 10.1055/a-1400-9135
Guideline

Resuming endoscopy during COVID-19 pandemic: ESGE, WEO and WGO Joint Cascade Guideline for Resource Limited Settings

Giulio Antonelli
 1   Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
 2   Department of Translational and Precision Medicine, “Sapienza” University of Rome, Italy
 3   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli (N.O.C.), Rome, Italy
,
John Gásdal Karstensen
 4   Gastro Unit, Hvidovre Hospital, Hvidovre, Denmark
 5   Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
,
Purnima Bhat
 6   ANU Medical School/Canberra Hospital -Gastroenterology, Garran, Australia
,
Uchenna Ijoma
 7   III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
,
Chukwuemeka Osuagwu
 8   Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
,
Hailemichael Desalegn
 9   Department of Internal Medicine, St. Paulʼs Hospital Millennium Medical College, Addis Ababa, Ethiopia
,
Hanna Abera
 7   III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
,
Claire Guy
10   European Society of Gastrointestinal Endoscopy – Munich, Germany
,
Peter Vilmann
11   Gastro Unit, Copenhagen University Hospital Herlev – Herlev, Denmark
,
Mario Dinis-Ribeiro
12   CIDES/CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal
,
Thierry Ponchon
13   Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
,
Luis Carlos Sabbagh
14   Department of Gastroenterology, Reina Sofia and Colombia University Clinics, Bogota, Colombia
,
Nonthalee Pausawasdi
15   Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Govind Makharia
16   All India Institute of Medical Sciences, New Delhi, India
,
Cesare Hassan
 1   Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
Andrew Veitch
17   Department of Gastroenterology, Royal Wolverhampton NHS Trust, UK
,
Lars Aabakken‡
18   Department of Transplantation Medicine, Faculty of Medicine, Oslo University Hospital – Rikshospitalet, Oslo, Norway
,
Alanna Ebigbo‡
 7   III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
,
for the Endoscopy and COVID-19 Cascade Working Group, European Society of Gastrointestinal Endoscopy, World Endoscopy Organization and World Gastroenterology Organization › Author Affiliations
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Resuming endoscopy during COVID-19 pandemic: ESGE, WEO and WGO Joint Cascade Guideline for Resource Limited SettingsEndosc Int Open 2021; 09(04): C4-C4
DOI: 10.1055/a-1480-4036

Introduction

The ongoing COVID-19 pandemic has forced endoscopy units to stop or markedly reduce all elective endoscopic procedures and has consequently contracted endoscopic capacity throughout the world, with growing concern for a mid- and long-term increase in the burden of gastrointestinal diseases [1] [2] [3] [4]. The reopening of endoscopic services is crucial to resume elective procedures but must be balanced with the need to protect healthcare personnel who are already over-represented in terms of COVID 19 morbidity and mortality [5] [6] [7].

Resumption of partial or full endoscopy capacity depends on implementation of several interventions, such as availability of Personal Protective Equipment (PPE), COVID-19 testing, distancing and separation according to the level of infection, use of telemedicine, availability of vaccines and others. At least some of these interventions are resource-consuming, representing a limitation in developing countries [8].

The European Society of Gastrointestinal Endoscopy (ESGE), the American Society of Gastrointestinal Endoscopy (ASGE) and the British Society of Gastroenterology (BSG) have all issued position statements providing guidance and recommendations for the resumption of endoscopic activity following peaks/waves of COVID-19 [5] [6] [9] [10]. The majority of recommendations in the position papers are based on expert opinions and early survey-based or observational evidence. Many recommendations are resource-sensitive and may be unavailable in low-resource settings due to issues such as extensive costs, personnel unavailability, lack of sufficient healthcare professional training and logistical limitations [8] [11].

At the time this paper was drafted, nearly 3 million cases and 70 000 coronavirus-related deaths had been reported in the African Continent, with the majority of states still reporting a high rate of community transmission [12]. Furthermore, the availability and the access to COVID-19 vaccination in African countries may be limited [13].

The European Society of Gastrointestinal Endoscopy (ESGE) and the World Gastroenterology Organization (WGO) have been publishing Cascade guidelines aiming to apply existing data and adapt existing guidelines for use in resource-limited settings [14] [15] [16] [17] [18] [19]. This Cascade guideline is the result of a joint effort of ESGE, WEO and WGO, aiming to standardize guidance for resumption of gastrointestinal endoscopy in the different phases of the COVID-19 pandemic also in resource limited settings.



Publication History

Received: 28 January 2021

Accepted: 23 February 2021

Article published online:
17 March 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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