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Position statement on GI endoscopy during the COVID-19 pandemic

The European Society of Gastrointestinal Endoscopy and the European Society of Gastroenterology and Endoscopy Nurses and Associates have joined forces to provide guidance on the use of endoscopy during the COVID-19 pandemic. Key recommendations include:

General comments

  • Staff should be triaged daily for risk factors, symptoms, and signs (daily measurement of temperature). Those at high-risk of COVID-19 should be isolated and tested.
  • Reuse of any disposable GI endoscopic device is strongly discouraged.
Pre-procedure risk management
  • Risk stratify patients for possible COVID-19 infection one day prior to GI endoscopy (by phone preferably) and again on the day of endoscopy.
  • Assess patient temperature before entering the endoscopy unit.
  • During assessment, surgical masks are recommended for both HCP and patient as well as a distance of ≥1-2 meters.
  • Separate pre- and post-GI endoscopy recovery areas or timeslots should be arranged for patients at high risk of COVID-19.
Intra-procedure risk management
  • The same personal protective equipment (PPE) is recommended for upper and lower GI endoscopies.
  • For high-risk or COVID-19-positive patients, endoscopy should be performed only if medically indicated and if available, in a negative-pressure room. If negative-pressure rooms are unavailable, use a dedicated room with adequate ventilation.
  • Consider the risk of COVID-19 vs postponing endoscopy.
  • Bedside endoscopy should be performed for ICU patients.
PPE stratified by patient risk
  • Low-risk patients: surgical mask, gloves, shoe covers, disposable hairnet, protective eyewear, water-proof disposable gowns
  • High-risk or positive patients: FFP2/FFP3 mask, two pairs of gloves, shoe covers, disposable hairnet, protective eyewear, water-proof disposable gowns.
The following procedures should always be performed
  •  Acute upper/lower GI bleeding with haemodynamic instability.
  •  Capsule/enteroscopy for urgent/emergent bleeding.
  •  Anaemia with haemodynamic instability.
  •  Foreign body in oesophagus and/or high-risk foreign body in the stomach.
  •  Obstructive jaundice.
  •  Acute ascending cholangitis.
Postpone these surveillance procedures (with no need to reschedule before 12 weeks)
  • Barrett’s oesophagus without dysplasia or low-grade dysplasia or after endoscopic treatment.
  • Gastric atrophy/intestinal metaplasia.
  • Inflammatory bowel disease.
  • Primary sclerosing cholangitis.
  • Post-endoscopic resection, surgical resection, or post-polypectomy surveillance.
  • Diagnosis/surveillance of Lynch syndrome and other hereditary syndromes.
  • Diagnosis of irritable bowel syndrome-like symptoms.
  • Diagnosis of reflux disease, dyspepsia without (alarm symptoms).
  • Screening in patients at high risk for oesophageal, gastric, colon, or pancreatic cancer.
  • Bariatric GI endoscopy procedures.
High-priority procedures
  • Treatment of high-grade dysplasia or early intramucosal cancer in the oesophagus, stomach, or large colonic polyps at high-risk of submucosal invasion.
  • Malignant stricture stenting.
  • PEG/PEJ/NJ tube.
  • Upper GI fistula/leakage.
  • Dysphagia or dyspepsia with alarm symptoms.
  • Upper GI bleeding without haemodynamic instability.
  • Rectal bleeding.
  • Colonoscopy for melena after negative upper-GI endoscopy.
  • Severe anaemia with no haemodynamic instability.
  • Tissue acquisition for initiation of therapy.
  • Colonoscopy within FOBT + CRC screening programme.
  • Foreign body in the stomach.
  • Dilation/stenting of benign stricture.
  • Radiologic evidence of mass.
  • Lymph node EUS sampling.
  • Gallstone-related pancreatitis.
  • Pancreatic mass/stricture.
  • Biliary stricture.
  • Non-urgent pancreatico-biliary stent replacement.
  • Necrosectomy.
Low-priority procedures
  • Endoscopic treatment of oesophageal or gastric low-grade dysplasia.
  • Duodenal polyp.
  • Ampullectomy.
  • Band ligation/non-emergency.
  • Iron deficiency anaemia.
  • Pancreatic cyst (depending on risk).
  • Biliary stricture/no urgency.
  • Submucosal lesion EUS sampling.
  • Achalasia.

References


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