Resumption of activity in gastroenterology departments. Recommendations by SEPD, AEEH, GETECCU and AEG

Qualitative study about the perception of patients with inflammatory bowel disease: A descriptive observational study

The main aim of this study was to identify the perceptions of people suffering from inflammatory bowel diseases (IBD) regarding the need for specialised nursing care, based on their opinions from their own experience. A qualitative design with an inductive approach based on constructivist grounded theory was conducted using a questionnaire. Almost 63 % of respondents felt that a nursing intervention was necessary for the patient's self-care and supported the care of the environment of the patient with IBD in need of care. Approximately 75 % of respondents felt that the initial nursing consultation following diagnosis of IBD was essential to address all aspects of the patient's daily life and environment for quality care and follow-up. More than 87 % of respondents felt it was important for nurses to recognise the need for referral to other professionals when caring for IBD patients and their environment to maximise their wellbeing. The percentage of females who answered yes to this last question was significantly higher than that of males (p = 0.025). Some 67.1 % of respondents felt that nurses should be responsible for informing the patient and those around them of the steps to be taken following diagnosis and what these consist of. More than 94 % of all respondents felt that IBD patients and their carers should have a plan and time for specific and appropriate education on this topic. More than 80 % of respondents agreed that the progression, monitoring, and management of their IBD should be supervised by a nurse in addition to their specialist doctor to achieve an optimal level of quality. In conclusion, this study shows that patients suffering from IBD consider the role of the nurse to be crucial in the diagnosis, management and treatment of their disease and highlights the need for specialised nurses in inflammatory bowel disease who can provide patients with high-quality healthcare.

Short-term impact of the COVID-19 pandemic on a population-based screening program for colorectal cancer in Catalonia (Spain)

The COVID-19 pandemic caused the suspension at all levels of the Catalan FIT-based CRC screening program on March 12, 2020. Screening invitations to FIT were resumed on September 1, 2020. We aimed to assess the short-term impact of the pandemic and describe strategies implemented to minimize harm by the disruption of the FIT-based CRC screening in the Metropolitan Area of Barcelona. We analyzed participation rate, colonoscopy adherence, time intervals to colonoscopy, detection rates, and advanced-stage cancers in 2019 and 2020. To identify perceived distress levels during the suspension of the screening we conducted a phone interview. As a result of the suspension, 43% of the individuals due for screening did not receive their invitation by December 31, 2020. A percent decrease of 5.1% in participation and of 8.9% in colonoscopy adherence among invitees between January-March was observed, with a recovery to 2019 levels when the screening activities were restarted. The time interval between a positive test to colonoscopy was longer in 2020 than in 2019. A decrease in advanced neoplasia rate and an increase in later stages of CRC were also observed. Individuals with a positive test did not report higher levels of perceived distress compared to those with a negative test. Although the disruption of screening had a temporary impact on participation and colonoscopy adherence, timing delay continues and a large backlog in the invitation of the target population remains. Thus, it is critical to implement strategies to minimize the long-term effects.

Impact of the COVID-19 Pandemic on Gastroenterology Department Activity: The Gastroenterologist's Perspective Nationwide and the Real Impact in a Portuguese Center

Background

Several gastroenterology societies have created recommendations in order to reduce nonessential exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Our aim is to evaluate the national gastroenterologists' perspective on the impact of COVID-19 and the impact of reorganization of a gastroenterology department during the COVID-19 pandemic.

Methods

For the first purpose, an online survey was distributed to gastroenterologists nationwide. For the second purpose, the authors conducted an analysis of some endoscopic procedures performed at the Gastroenterology Department of the Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E) between March 16 and May 8 during the years 2019 and 2020.

Results

Sixty-seven gastroenterologists answered our survey. Only 14.9% were residents and 86.6% worked in a hospital with COVID-19 patients, with 16.4% assigned to assist those patients. All of the departments suffered modifications. Ninety percent of the residents affirmed that their activity had changed. Ninety-four percent declared having nonessential endoscopic procedures postponed, and 85.1% maintained in-person medical visits, 88.1% were already having remote consultations, and 11.9% did not have any clinical visit. In our gastroenterology unit, the number of endoscopic procedures decreased by 73.1% from 2019 to 2020. In 2020, the proportion of urgent procedures was higher compared to 2019.

Conclusion

The advent of COVID-19 has led to important changes in gastroenterology activities in Portugal, and national gastroenterology units are complying with the recommendations. Furthermore, Portuguese gastroenterologists believed that the decrease in endoscopic activity can compromise residents' education and training. The gastroenterology department at CHVNG/E has shown a significant reduction in the number of endoscopic procedures.

Roadmap to resuming care for liver diseases after coronavirus disease-2019

The global pandemic of coronavirus disease-2019 (COVID-19) has led to significant disruptions in healthcare delivery. Patients with chronic liver diseases require a high level of care and are therefore particularly vulnerable to disruptions in medical services during COVID-19. Recent data have also identified chronic liver disease as an independent risk factor for COVID-19 related hospital mortality. In response to the pandemic, national and international societies have recommended interim changes to the management of patients with liver diseases. These modifications included the implementation of telehealth, postponement or cancelation of elective procedures, and other non-urgent patient care-related activities. There is concern that reduced access to diagnosis and treatment can also lead to increased morbidity in patients with liver diseases and we may witness a delayed surge of hospitalizations related to decompensated liver disease after the COVID-19 pandemic has receded. Therefore, it is paramount that liver practices craft a comprehensive plan for safe resumption of clinical operations while minimizing the risk of exposure to patients and health-care professionals. Here, we provide a broad roadmap for how to safely resume care for patients with chronic liver disease according to various phases of the pandemic with particular emphasis on outpatient care, liver transplantation, liver cancer care, and endoscopy.

Pre-procedural antibody testing for SARS-CoV-2 in the routine endoscopic practice

METHODS

a retrospective multicenter cohort study was performed of all endoscopic procedures performed between April 27 and June 15, 2020. A screening questionnaire (SQ) was performed with patients three days prior to the procedure and 14 days after. Furthermore, a serologic SARS-CoV-2 test was performed 48 hours before.

RESULTS

two hundred and eleven consecutive patients with endoscopic procedures were included. No patients had a positive SQ, either on entry to the study or 14 days later. Only four patients (1.9 % [95 % CI: 0.07-4.8 %]) were positive for antibodies.

CONCLUSION

the pre-endoscopy seroprevalence of SARS-CoV-2 is low in this cohort. Pre-procedural SARS-CoV-2 antibody testing does not add any benefit over clinical SQ to identify active COVID-19 patients.

Safety in digestive endoscopy during the ongoing COVID-19 pandemic

We read with interest the study by Hernández-Camba et al. about the low value of antibody testing for COVID-19 before endoscopic procedures and we would like to make some comments. Nine months after the first state of alarm was declared in Spain due to the SARS-CoV-2 pandemic, we knew that infections in endoscopy staff were scarce if adequate protection was worn and non-urgent procedures were postponed in patients with an active infection. Therefore, the conclusions of the study currently appear to be self-evident. However, things were different at the time it was performed.