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Multicentre prospective study of COVID-19 transmission following outpatient GI endoscopy in the UK
  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}

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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.

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    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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    • Collaborators Amyn Haji, Shraddha Gulati: King’s College Hospital NHS Foundation Trust, London; Joel Mawdsley, Freya Parker: Guy’s & St Thomas’s Hospitals, London; Ed Seward, Melanie Corpus: University College London Hospital, London; Srisha Hebbar, Rajeev Desai: Royal Stoke University Hospital; Nick Kennedy, Bridget Cann: Royal Devon and Exeter Hospital, Exeter; Rajesh Rameshshankar, Aymer Postgate: Hillingdon Hospital, London; John Greenaway, Martin Fletcher: South Tees Hospitals NHS Foundation Trust; Mo Thoufeeq, Thomas Archer: Sheffield Teaching Hospitals NHS Foundation Trust; David Nylander, John Leeds: Newcastle-upon-Tyne Hospitals NHS Foundation Trust; Gareth Corbett, Huma Asmat: Addenbrookes Hospital, Cambridge; Mohammed Raheel Anjum, Aravinth Murugananthan: Royal Wolverhampton NHS Trust; Adam Humphries, Sarah Marshall, Angad Dhillon, Romanov Nable: St Mark’s Hospital, London; Sunil Dolwani, Lavanya Shenbagaraj: Cardiff and Vale University Health Board; Pradeep Bhandari, Michelle Baker-Moffat: Queen Alexandra Hospital, Portsmouth; Ajay Verma, Vicki Lewin: Kettering General Hospital, Kettering; Colin Noble, Nick Church: Royal Infirmary of Edinburgh; Aisling Murphy, Adam Bailey: John Radcliffe Hospital, Oxford; Sergio Coda, Sas Banerjee: Barking and Havering NHS Trust, London.

    • Contributors Data collation and analysis was performed by BHH. All authors contributed to the study concept and design, manuscript writing and editing.

    • Funding JEE was funded by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre.

    • Disclaimer The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR or the Department of Health. James East has served on clinical advisory board for Lumendi and Boston Scientific; Clinical advisory board and ownership, Satisfai Health; Speaker fees, Falk.

    • Competing interests CR has received grant funding from ARC Medical, Norgine Pharmaceuticals UK, Olympus Medical UK, 3D Matrix and an expert witness for ARC Medical. BHH has received grant funding from Olympus Medical UK, Fujifilm Europe, Takeda Pharmaceuticals UK and AbbVie UK. Clinical advisory board and ownership: Ampersand Health, Surgease Medical Ltd. IP has received speaker fees from Medtronic and Boston Scientific, UK.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

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