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Multicentre prospective study of COVID-19 transmission following outpatient GI endoscopy in the UK
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  1. Bu'Hussain Hayee1,
  2. The SCOTS project group,
  3. James East2,3,
  4. Colin J Rees4,
  5. Ian Penman5
    1. 1King’s Health Partners Institute for Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
    2. 2Translational Gastroenterology Unit, John Radcliffe Hospital Department of Gastroenterology, Oxford, Oxfordshire, UK
    3. 3Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
    4. 4Population Health Sciences Institute, Newcastle University, Newcastle, UK
    5. 5Royal Infirmary of Edinburgh, Edinburgh, UK
    1. Correspondence to Dr Bu'Hussain Hayee, King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, London, UK; b.hayee{at}nhs.net

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    The COVID-19 pandemic has severely curtailed the practice of endoscopy (as an exemplar for outpatient diagnostic procedures) worldwide. Restart and recovery processes will be influenced by the need to protect patients and staff from disease transmission, but data on the risk of COVID-19 transmission after an endoscopy are sparse. This is of particular importance in later pandemic phases when the risk of harm from delayed or missed significant diagnoses is likely to far outweigh the risk of infection. The British Society of Gastroenterology guidance for restarting endoscopy included the stratification of diagnostic procedures according to aerosol generation or assessment of infectious risk as well as pragmatic guidance on the use of personal protective equipment (PPE). We sought to document the risk of COVID-19 transmission after endoscopy in this ‘COVID-minimised’ environment. Prospective data were collected from 18 UK centres for n=6208 procedures. Pre-endoscopy, 3 of 2611 (0.11%; 95% CI 0.00%–0.33%) asymptomatic patients tested positive for SARS-CoV-2 on nasopharyngeal swab. Based on follow-up telephone symptom screening of patients at 7 and 14 days, no cases of COVID-19 were detected by any centre after endoscopy in either patients or staff. Although these data cannot determine the relative contribution of each component of a COVID-minimised pathway, they provide clear support for such an approach. The rational use of PPE and infection control policies should be continued and will aid in planning for outpatient diagnostics in the COVID-19 recovery phase.

    In more detail

    The COVID-19 pandemic has had an extraordinary impact on the delivery of GI endoscopy, with an initial reduction to 12% of prepandemic levels in the UK.1 In the deceleration and early recovery phases (up to end July 2020), this had risen to 42% of repandemic levels.2 Recovery has been influenced by multiple factors including availability of staff, restrictions caused by longer room cleansing, physical …

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