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Low risk of COVID-19 transmission in GI endoscopy
  1. Alessandro Repici1,2,
  2. Giovanni Aragona3,
  3. Gianpaolo Cengia4,
  4. Paolo Cantù5,
  5. Marco Spadaccini1,2,
  6. Roberta Maselli1,
  7. Silvia Carrara1,
  8. Andrea Anderloni1,
  9. Alessandro Fugazza1,
  10. Fabio Pace6,
  11. Thomas Rösch7
  12. On behalf of the ITALIAN GI-COVID19 Working Group
  1. 1 Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Lombardia, Italy
  2. 2 Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
  3. 3 Department of Internal Medicine, Guglielmo da Saliceto Hospital, Piacenza, Emilia-Romagna, Italy
  4. 4 Endoscopy Unit, Manerbio Hospital, Manerbio, Lombardy, Italy
  5. 5 Gastroenterology and Endoscopy Unit, Ospedale Maggiore Policlinico, Milano, Lombardia, Italy
  6. 6 UOC Gastroenterology and Digestive Endoscopy, Hospital Bolognini Seriate, Seriate, Lombardia, Italy
  7. 7 Interdisciplinary Endoscopy, University Hospital Hamburg Eppendorf Center of Experimental Medicine, Hamburg, Hamburg, Germany
  1. Correspondence to Professor Alessandro Repici, Gastroenerology and endoscopy Unit, Humanitas Research Hospital Department of Gastroenterology, Rozzano 20089, Lombardia, Italy; alessandro.repici{at}

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Reported experience from the recent worldwide COVID-19 outbreak suggests that GI endoscopy is a potential source of infection for healthcare workers (HCW); less is known about patient risk through performance of GI endoscopy as a high-risk medical procedure. Two case series from Northern Italy were recorded, one on 851 patients from one large tertiary referral centre and the other on 968 HCWs from 41 hospitals in the area. All 851 patients endoscoped in Humanitas University Hospital between 27 January and 13 March received a 2-week follow-up call; the response rate was 94.2%. Of these 802 patients, only 1 became COVID-19 positive; 7 further cases developed fever and cough (3 tested negative). None of these eight cases (1.0%) required hospitalisation. In the other study, 42 hospitals in Northern Italy were invited to join a survey with regard to COVID-19 positivity among HCWs, and 41 responded; centres with positive cases were interviewed in detail. Of 968 HCWs in these centres, 42 (4.3%) were tested positive for COVID-19, and 6 (0.6%) had to be temporarily hospitalised (for a mean of 8 days, none on intensive care unit (ICU)). Of these 42 cases, 85.7% occurred before the introduction of safety measures, including personal protective equipment (PPE) and case selection/reduction in GI endoscopy. Clustering of HCW infection (54.7% of all cases) was observed in three centres. This data suggest that GI endoscopy appears to be relatively safe for both patients and medical personnel when using adequate protective measures.

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As of 31 March 2020, Italy and especially its Northern regions became the epicentre of the novel coronavirus (severe acute respiratory syndrome-CoV-2) outbreak, with more than 100 000 documented infections and a higher mortality rate than that reported in other countries. According to recent data issued by the Italian Health Authority, more than 10% of all infections in …

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  • Contributors AR, RM, SC, AA, AF, MS, TR and PC designed the study. TR and AR drafted the manuscript. All authors participated in the data collection and revised and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.