Summary of recommendations for patient selection in GI endoscopy during the COVID-19 pandemic
Articles grouped by country: | China*†‡ | USA§¶ | UK**†† | Spain‡‡ | Singapore |
Patient selection in endoscopy | Triaging:
Screening protocol:
PPE recommendation (general staff):
Contingency plan for high-risk patients detected in endoscopy:
| Triaging:
Screening protocol for6:
Classify risk:
PPE recommendation (general staff):
Contingency plan for high-risk patients detected in endoscopy:
| Triaging:
Need to continue procedures: acute upper GI bleeding, oesophageal obstruction (foreign bodies, food bolus, pinhole stricture or cancer requiring urgent stenting), endoscopic vacuum therapy for perorations/leaks, acute cholangitis or jaundice secondary to biliary obstruction, acute biliary pancreatitis, cholangitis with stone and jaundice, infected pancreatic collections, walled-off pancreatic necrosis, urgent inpatient nutrition support (enteral feeding tubes), gastrointestinal obstruction needing urgent decompression or stenting. Defer until further notice procedures: All routine symptomatic referrals, planned POEM, pneumatic dilatation for achalasia, elective PEG, stricture dilatation, APC for GAVE, RFA, pneumatic dilatation, ampullectomy, bariatric endoscopy Low-risk follow-up and repeat scopes—oesophagitis healing, gastric ulcer healing, ‘poor views’, check post-therapy, for example, EMR, RFA, polypectomy (unless high-risk neoplasia present), and so on. Surveillance polyp check, IBD, Barrett’s (unless high-risk neoplasia present), non-urgent enteroscopy, EUS for ‘benign’ indications—biliary dilatation, possible stones, submucosal lesions, pancreatic cysts without high-risk features. Other ERCP cases—stones where there has been no recent cholangitis and a stent is in place; therapy for chronic pancreatitis; metal stent removal or change; ampullectomy follow-up. Flexible sigmoidoscopy should stop unless discussed with local commissioners. Patients undergoing endoscopy/biopsy as part of clinical trials. Case-by-case decision: 2-week wait cancer referrals, FIT positive bowel screening colonoscopy, planned EMR/ESD for complex polyps or high-risk lesions, new suspected IBD, cancer staging EUS, small bowel endoscopy. (General guidance, non-exhaustive list). Screening protocol:
PPE recommendation (general staff):
Contingency plan for high-risk patients detected in endoscopy:
| Triaging:
Screening protocol:
Contingency plan for high-risk patients detected in endoscopy:
PPE recommendation (general staff):
Contingency plan for high-risk patients detected in endoscopy:
| Triaging
Screening protocol:
All suspected and confirmed COVID-19 patients to be managed in designated isolation areas. PPE recommendation (general staff):
Contingency plan for high-risk patients detected in endoscopy:
|
Articles grouped by the country of publication; recommendations may not necessarily reflect national guidance if any.
*Subspecialty group of Gastroenterology, the Society of Paediatrics, Chinese Medical Association. (Prevention and control program on 2019 novel coronavirus infection in children’s digestive endoscopy centre). Zhonghua Er Ke Za Zhi 2020;58, 175–178.
†Luo et al (Standardised diagnosis and treatment of colorectal cancer during the outbreak of novel coronavirus pneumonia in Renji hospital). Zhonghua Wei Chang Wai Ke Za Zhi 23, 2020; E003.
‡Gou et al (Treatment of pancreatic diseases and prevention of infection during outbreak of 2019 coronavirus disease). Zhonghua Wai Ke Za Zhi 2020;58, E006.
§Pochapin et al American College of Gastroenterology COVID-19 and recommendations for gastroenterologists. 2020.
¶Repici et al Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointestinal Endoscopy 2020.
**British Society of Gastroenterology and British Association for the Study of the Liver. COVID-19: Advice for healthcare professionals in Gastroenterology and Hepatology. 2020.
††Public Health England. COVID-19: Guidance for infection prevention and control in healthcare settings (Version 1.0). 2020.
‡‡Sociedad Española de Patología Digestiva (SEPD) (Updated SEPD recommendations on infection by the SARS-CoV-2 coronavirus.)
APC, argon plasma coagulation; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; EUS, endoscopic ultrasonography; FIT, faecal immunochemical test; GAVE, gastric antral vascular ectasia; GI, gastrointestinal; IBD, inflammatory bowel disease; PEG, percutaneous endoscopic gastrostomy; POEM, peroral endoscopic myotomy; PPE, personal protective equipment; RFA, radio frequency ablation.