Risk of COVID-19 Transmission During Gastrointestinal Endoscopy
COVID-19 is a viral illness caused by a novel severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). It is highly contagious virus with human-to-human transmission being primarily attributed to direct contact or air droplets. It is highly infectious and contagious due to high-viable viral loads in the upper respiratory tract secretions of infected patients and also similar viral load being detected in both asymptomatic and symptomatic patients. The virus stability characteristics and modes of transmission via fomites and air droplets make gastrointestinal (GI) endoscopy a high-risk procedure for COVID-19 transmission. This review discusses the currently available literature on risk of transmission of SARS-CoV-2 during GI endoscopy.
16 May 2020 (online)
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 WHO. Pneumonia of unknown cause – China. Available at: http://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/. Accessed April 14, 2020
- 2 Zhu N, Zhang D, Wang W. et al. China Novel Coronavirus Investigating and Research Team. A novel Coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382 (08) 727-733
- 3 Virology: Coronaviruses. Nature 1968; 220: 650
- 4 Repici A, Maselli R, Colombo M. et al. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointest Endosc 2020; (e-pub ahead of print) DOI: /j.gie.2020.03.019.
- 5 Tyrrell DAJ, Myint SH. Coronaviruses. In: Baron S, ed. Medical Microbiology. 4th ed. Galveston (TX): University of Texas Medical Branch at Galveston; 1996 Available at Accessed April 14, 2020
- 6 Chatterjee P, Nagi N, Agarwal A. et al. The 2019 novel coronavirus disease (COVID-19) pandemic: a review of the current evidence. Indian J Med Res 2020; (e-pub ahead of print) DOI: /ijmr.IJMR_519_20.
- 7 Li LY, Wu W, Chen S. et al. Digestive system involvement of novel coronavirus infection: prevention and control infection from a gastroenterology perspective. J Dig Dis 2020; (e-pub ahead of print) DOI: https://doi.org/10.1111/1751-2980.12862.
- 8 Wong SC-Y, Kwong RT-S, Wu TC. et al. Risk of nosocomial transmission of coronavirus disease 2019: an experience in a general ward setting in Hong Kong. J Hosp Infect 2020; (e-pub ahead of print) DOI: https://doi.org/10.1016/j.jhin.2020.03.036.
- 9 Li Q, Guan X, Wu P. et al. Early transmission dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med 2020; 382 (13) 1199-1207
- 10 Marchese M, Capannolo A, Lombardi L, Di Carlo M, Marinangeli F, Fusco P. Use of a modified ventilation mask to avoid aerosolizing spread of droplets for short endoscopic procedures during coronavirus covid-19 outbreak. Gastrointest Endosc 2020; (e-pub ahead of print) DOI: https://doi.org/10.1016/j.gie.2020.03.3853.
- 11 Lei Z, Cao H, Jie Y. et al. A cross-sectional comparison of epidemiological and clinical features of patients with coronavirus disease (COVID-19) in Wuhan and outside Wuhan, China. Travel Med Infect Dis 2020; (April) 101664
- 12 van Doremalen N, Bushmaker T, Morris DH. et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020; 382 (16) 1564-1567
- 13 Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7 (04) e35797
- 14 Bin SY, Heo JY, Song M-S. et al. Environmental contamination and viral shedding in MERS patients during MERS-CoV outbreak in South Korea. Clin Infect Dis 2016; 62 (06) 755-760
- 15 Zou L, Ruan F, Huang M. et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020; 382 (12) 1177-1179
- 16 Bai Y, Yao L, Wei T. et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA 2020; (e-pub ahead of print) DOI: 10.1001/jama.2020.2565.
- 17 Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology 2020; (e-pub ahead of print) DOI: https://doi.org/10.1053/j.gastro.2020.02.055.
- 18 Xu J, Li Y, Gan F, Du Y, Yao Y. Salivary glands: potential reservoirs for COVID-19 asymptomatic infection. J Dent Res 2020; (e-pub ahead of print) DOI: 10.1177/0022034520918518.
- 19 Eldin C, Lagier J-C, Mailhe M, Gautret P. Probable aircraft transmission of COVID-19 in-flight from the Central African Republic to France. Travel Med Infect Dis 2020; (April) 101643
- 20 Soetikno R, Teoh AY, Kaltenbach T. et al. Considerations in performing endoscopy during the COVID-19 pandemic. Gastrointest Endosc 2020; (e-pub ahead of print) DOI: https://doi.org/10.1016/j.gie.2020.03.3758.
- 21 Perisetti A, Gajendran M, Boregowda U, et al. COVID-19 and gastrointestinal endoscopies: current insights and emergent strategies. Dig Endosc Off J Jpn Gastroenterol Endosc Soc 2020
- 22 Mohandas KM, Gopalakrishnan G. Mucocutaneous exposure to body fluids during digestive endoscopy: the need for universal precautions. Indian J Gastroenterol 1999; 18 (03) 109-111
- 23 Johnston ER, Habib-Bein N, Dueker JM. et al. Risk of bacterial exposure to the endoscopist’s face during endoscopy. Gastrointest Endosc 2019; 89 (04) 818-824
- 24 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; gutjnl-2020-321185
- 25 Group BMJP. Hot air?. BMJ 2001; 323: 1449
- 26 Calderwood AH, Day LW, Muthusamy VR. et al. ASGE Quality Assurance in Endoscopy Committee. ASGE guideline for infection control during GI endoscopy. Gastrointest Endosc 2018; 87 (05) 1167-1179
- 27 Beilenhoff U, Biering H, Blum R. et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) - Update 2018. Endoscopy 2018; 50 (12) 1205-1234
- 28 Repici A, Aragona G, Cengia G. et al. ITALIAN GI-COVID19 Working Group. Low risk of covid-19 transmission in GI endoscopy. Gut 22.04.2020; pii: gutjnl-2020-321341 DOI: 10.1136/gutjnl-2020-321341. [Epub ahead of print]