Saudi Journal of Gastroenterology
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LETTER TO THE EDITOR  
Year : 2020  |  Volume : 26  |  Issue : 5  |  Page : 279-282
Guidance and workflow of endoscopy reopening during COVID-19 pandemic


Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia

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Date of Web Publication21-Aug-2020
 

How to cite this article:
Azzam N, Alotaibi N, Almadi M, Aljebreen A. Guidance and workflow of endoscopy reopening during COVID-19 pandemic. Saudi J Gastroenterol 2020;26:279-82

How to cite this URL:
Azzam N, Alotaibi N, Almadi M, Aljebreen A. Guidance and workflow of endoscopy reopening during COVID-19 pandemic. Saudi J Gastroenterol [serial online] 2020 [cited 2020 Oct 26];26:279-82. Available from: https://www.saudijgastro.com/text.asp?2020/26/5/279/292950




On March 19, 2020 the WHO declared coronavirus disease (COVID-19), caused by SARS-CoV-2, as a pandemic and it was crucial during the rapid spread of COVID-19 to postpone all elective and non-emergency endoscopic procedures.[1] In April 2020 the Saudi Gastroenterology Association published a position statement to guide gastroenterologists in Saudi Arabia on endoscopy services during the COVID-19 pandemic,[2] similar to other international societies worldwide.[3],[4] The pandemic has led to a challenge for endoscopists as many urgent cases were deferred. In order to care for our patients, it was a must to resume endoscopic services gradually for those cases as soon as it is feasible with the least possible risk of exposing staff, patients, and healthcare providers. The decision of reopening ultimately depends on each endoscopy unit and the capacity of healthcare institution in terms of testing and tracing as well as staffing. The endoscopy unit at King Saud University Medical City (KSUMC) decided to start the process of reopening especially with substantial decrease in the number of COVID-19 cases requiring ventilators. A task-force was formed to provide a roadmap for safe reopening, which in turn could facilitate and guide other units towards restarting outpatient and routine procedures, with a phased approach based upon categories.[2] Nevertheless, the suggested protocol should be updated based on best available local public health information from the Ministry of Health.

The main purpose of this commentary is to present recommendations during the gradual reopening of endoscopy units, where indeed it is anticipated that readiness to resume endoscopic procedures will vary based on the status of each endoscopy unit and the guidance from the concerned health authorities. Our unit, which performs around 6000 procedures annually, had more than 800 requests pending since the start of the pandemic, with numerous inquiries from patients seeking information about the risk of infection or the precautions to be taken when attending the unit.

Currently, there are no formal evidence-based recommendations from clinical societies or healthcare authorities on resuming endoscopy procedures although, a few reports from international societies are emerging[5],[6] highlighting the potential rearrangements of care and resetting of the endoscopy flow. During the preparation we faced multiple layers of complexity on the reopening scenario, however, this is a novel situation with limited options and we tried our best to keep the process simple and applicable. [Table 1] shows the general information which addresses the staff's, patients, and caregivers, safety recommendations pre-procedure and on the day of the procedure. Scheduling the procedures was prioritized based on its urgency and the potential of serious outcomes if the procedure was delayed. The reopening was divided into three phases and [Table 2] shows the details of each phase along with the workflow. A significant number of COVID-19 infections are being transmitted from asymptomatic individuals[7] thus requiring all patients to be tested for SARS-CoV-2 within 48-72 hours of a scheduled procedure. Flowcharts 1 and 2 demonstrate the specific steps for pre-procedure protocols for phases 1 and 2 respectively, and the role of individual endoscopy staff as shown in [Figure 1]a and [Figure 1]b.
Table 1: General Information for the endoscopy staff and patients prior to and on the day of the procedure

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Table 2: Definition and workflow of the re-opening phases

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Figure 1: (a). Flowchart 1 demonstrate the specific steps for pre-procedure protocols for phase one. (b). Flowchart 2 demonstrate the specific steps for pre-procedure protocols for phase two

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In conclusion, the COVID-19 pandemic will continue to be a burden on our healthcare systems. The decision to reopen endoscopy units should be taken based on the locally available resources respecting infection control recommendations. Finally reopening endoscopic activity should be made in phases with clear guidance for each phase.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Centers for Disease Control and Prevention Coronavirus Disease 2019. Available from: https://www.cdc.gov/coronavirus/2019-nCoV/index.html. [Last accessed on 2020 Jul 22].  Back to cited text no. 1
    
2.
Almadi MA, Aljebreen AM, Azzam N, Alammar N, Aljahdli ES, Alsohaibani FI, et al. COVID-19 and endoscopy services in intermediately affected countries: A position statement from the Saudi Gastroenterology Association. Saudi J Gastroenterol 2020;26:240-8.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Gralnek IM, Hassan C, Beilenhoff U, Antonelli G, Ebigbo A, Pellisè M, et al. ESGE and ESGENA position statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy 2020;52:483-90.  Back to cited text no. 3
    
4.
Chiu PWY, Ng SC, Inoue H, Reddy DN, Ling Hu E, Cho JY, et al. Practice of endoscopy during COVID-19 pandemic: Position statements of the Asian Pacific Society for digestive endoscopy (APSDE-COVID statements). Gut 2020;69:991-6.  Back to cited text no. 4
    
5.
Ménard C, Waschke K, Tse F, Borgaonkar M, Forbes N, Barkun A, et al. COVID-19: Framework for the resumption of endoscopic activities from the Canadian Association of Gastroenterology. J Can Assoc Gastroenterol 2020;gwaa016.doi: https://doi.org/10.1093/jcag/gwaa016. [Lastaccessed on 2020 Jul 22].  Back to cited text no. 5
    
6.
Manes G, Repici A, Radaelli F, Bezzio C, Colombo M, Saibeni S. Planning phase two for endoscopic units in Northern Italy after the COVID-19 lockdown: An exit strategy with a lot of critical issues and a few opportunities. Dig Liver Dis 2020;52:823-8.  Back to cited text no. 6
    
7.
Lai CC, Liu YH, Wang CY, Wang YH, Hsueh SC, Yen MY, et al. Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths. J Microbiol Immunol Infect 2020;53:404-12.  Back to cited text no. 7
    

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Correspondence Address:
Dr. Nahla Azzam
Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh- 12372
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjg.SJG_425_20

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