Saudi Journal of Gastroenterology
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Year : 2020  |  Volume : 26  |  Issue : 5  |  Page : 285-286
Response to Almalki et al.: Resuming endoscopy services during the COVID-19 pandemic

1 Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada
2 Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
3 King Saud Bin Abdul-Aziz University of Health Sciences, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia

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Date of Web Publication07-Sep-2020

How to cite this article:
Almadi MA, Aljebreen AM, Azzam N, Batwa F. Response to Almalki et al.: Resuming endoscopy services during the COVID-19 pandemic. Saudi J Gastroenterol 2020;26:285-6

How to cite this URL:
Almadi MA, Aljebreen AM, Azzam N, Batwa F. Response to Almalki et al.: Resuming endoscopy services during the COVID-19 pandemic. Saudi J Gastroenterol [serial online] 2020 [cited 2020 Oct 31];26:285-6. Available from:

We thank Almalki et al.[1] for their insightful comments on the current situation of endoscopy services in the country, and we clearly share their concerns. The repercussions of the pandemic have been echoed not only in the original position statement from the Saudi Gastroenterology Association (SGA)[2] but also by numerous other societies. The pandemic has resulted in significant restrictions to patient care in the form of hospital visits, which adds insult to injury since challenges to access specialized care existed even before the pandemic.[3] The pandemic has also been a source of anxiety for patients and healthcare providers alike as depicted in a series of papers in the Journal in the last few months.[4],[5],[6],[7]

To be clear, the overall aim of the SGA statement was to facilitate performing procedures during the critical phase of the pandemic and to provide care to the most needy in the face of a looming shutdown of services. The statement was never intended to curtail the provision of services, but rather to ensure the safety and welfare of healthcare workers. It was also in-line with the recommendations of various other societies around the world like the American Gastroenterological Association (AGA),[8] Asian Pacific Society for Digestive Endoscopy (APSDE),[9] the chapter of gastroenterologists in Singapore,[10] as well as others.[11] To the contrary, we had hoped that this statement would increase the procedures that would be performed in the country during this period rather than the counterfactual cancellation of all procedures. Also, the statement was published in a time of great uncertainty, with constraints on personal protective equipment (PPE) as well as disruption of supply chains. It was drafted by a group of local experts from various regions of the country and from different healthcare sectors with the aim of incorporating the various challenges that were being experienced at the time, and to our knowledge, was widely accepted and welcomed.

Moreover, this could also be a potential silver lining in this pandemic, to use our resources in a more cost-efficient, beneficial manner, as there is a definite increase in demand and more limited supply due to infection control constraints. This should lead to strategies that improve aspects focusing on procedures with an anticipated higher yield, as well as focusing on improving bowel preparation quality[12],[13] and avoiding cancelling procedures and possibly shifting, even momentarily, from open-access systems to more controlled scheduling of patients after meticulous screening of requests. We have clearly demonstrated in the past that a significant proportion of those referrals in an open-access system were inappropriate.[14]

Saudi Arabia has recently witnessed a diminishing number of active and critical COVID-19 infected individuals. In this context, as a nudge towards re-instating endoscopy services, we delineated the current adapted practice at our center in Riyadh.[15] We have also participated in the development of a more detailed guideline with international representation on the management of endoscopic services.[16] This document has the value of bringing in experts from different areas that have been affected to variable degrees by the pandemic, and gives a balanced practical view while covering topics of point-of-care testing, and recommendations for services before, during, and after an encounter in endoscopy units. Additionally, the position statement of APSDE addresses a practical phased re-instatement of endoscopy services based on the resource availability in each institution as well as the burden of the disease in the community.[9]

Ultimately, the decision of re-instating endoscopy services will depend on each institution's situation in terms of the availability of PPE, testing capacity and turn-around time, local case loads, the case-mix of the patient-population served, logistical matters, and numerous other factors that would be an oversimplification to have a document describe. Nonetheless, we believe that the proposal that Azzam et al.[15] had presented is a good backbone to adapt when planning on scaling-up endoscopy services from the status existing during the pandemic.

Furthermore, it is only natural that we learn as we go forward, and try to make the best out of our current situation. The pandemic had created immense debate around how to best tackle problems, and there have been numerous proposals from various “experts”, but when the dust settles, it usually ends along the lines that Sir Arthur Conan Doyle describes as being “easy to be wise after the event.”

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Conflicts of interest

There are no conflicts of interest.

   References Top

Almalki AS, Khan M, AlAmeel T. A call for structured re-opening of endoscopy services during the Covid-19 pandemic. Saudi J Gastroenterol 2020;26:283-4.  Back to cited text no. 1
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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]  
El Mouzan MI, AlSaleem BI, Hasosah MY, Al-Hussaini AA, Al Anazi AH, Saadah OI, et al. Diagnostic delay of pediatric inflammatory bowel disease in Saudi Arabia. Saudi J Gastroenterol 2019;25:257-61.  Back to cited text no. 3
Al Sulais E, Mosli M, AlAmeel T. The psychological impact of COVID-19 pandemic on physicians in Saudi Arabia: A cross-sectional study. Saudi J Gastroenterol 2020;26:249-55.  Back to cited text no. 4
[PUBMED]  [Full text]  
Azzam NA, Aljebreen A, Almuhareb A, Almadi MA. Disability and quality of life before and during the COVID-19 outbreak: A cross-sectional study in inflammatory bowel disease patients. Saudi J Gastroenterol 2020;26:256-62.  Back to cited text no. 5
[PUBMED]  [Full text]  
Mosli M, Alourfi M, Alamoudi A, Hashim A, Saadah O, Al Sulais E, et al. A cross-sectional survey on the psychological impact of the COVID-19 pandemic on inflammatory bowel disease patients in Saudi Arabia. Saudi J Gastroenterol 2020;26:263-71.  Back to cited text no. 6
[PUBMED]  [Full text]  
Yoshida EM, Hussaini T, Alsahafi M. COVID-19 in gastroenterology and hepatology: Living with the realities of a historic 21st century pandemic. Saudi J Gastroenterol 2020;26:223-5.  Back to cited text no. 7
[PUBMED]  [Full text]  
Sultan S, Lim JK, Altayar O, Davitkov P, Feuerstein JD, Siddique SM, et al. AGA institute rapid recommendations for gastrointestinal procedures during the COVID-19 pandemic. Gastroenterology 2020;159:739-58.e4.  Back to cited text no. 8
Chiu PWY, Ng SC, Inoue H, Reddy DN, Hu EL, 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. 9
Ang TL, Li JW, Vu CKF, Ho GH, Chang JPE, Chong CH, et al. Chapter of Gastroenterologists professional guidance on risk mitigation for gastrointestinal endoscopy during COVID-19 pandemic in Singapore. Singapore Med J 2020;61:345-9.  Back to cited text no. 10
Castro Filho EC, Castro R, Fernandes FF, Pereira G, Perazzo H. Gastrointestinal endoscopy during the COVID-19 pandemic: An updated review of guidelines and statements from international and national societies. Gastrointest Endosc 2020;92:440-5.e6.  Back to cited text no. 11
Almadi MA, Alharbi O, Azzam N, Altayeb M, Thaniah S, Aljebreen A. Bowel preparation quality between hospitalized patients and outpatient colonoscopies. Saudi J Gastroenterol 2018;24:93-9.  Back to cited text no. 12
[PUBMED]  [Full text]  
Martel M, Menard C, Restellini S, Kherad O, Almadi M, Bouchard M, et al. Which patient-related factors determine optimal bowel preparation? Curr Treat Options Gastroenterol 2018;16:406-16.  Back to cited text no. 13
Aljebreen AM, Alswat K, Almadi MA. Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system. Saudi J Gastroenterol 2013;19:219-22.  Back to cited text no. 14
[PUBMED]  [Full text]  
Azzam N, Alotaibi N, Almadi M, Aljebreen A. Guidance and workflow of endoscopy reopening during COVID pandemic. Saudi J Gastroenterol 2020;26:279-82.  Back to cited text no. 15
[PUBMED]  [Full text]  
Bhandari P, Subramaniam S, Bourke MJ, et al. Recovery of endoscopy services in the era of COVID-19: recommendations from an international Delphi consensus. Gut. 2020;gutjnl-2020-322329. doi:10.1136/gutjnl-2020-322329. [published online ahead of print, 2020 Aug 14].  Back to cited text no. 16

Correspondence Address:
Dr. Majid A Almadi
Associate Professor of Medicine, Division of Gastroenterology, King Khalid University Hospital, King Saud University, P.O. Box 2925 (59), Riyadh - 11461

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjg.SJG_455_20

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