1
|
Gonçalves M, Guimarães A, Carvalho T, Antunes P, Mendes S, Soares J, Gonçalves R, Arroja B, Rebelo A. Safety of Endoscopy Units during the COVID-19 Pandemic. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:4-10. [PMID: 38020825 PMCID: PMC10661713 DOI: 10.1159/000526125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2023]
Abstract
Introduction The COVID-19 pandemic drastically changed the daily routine of all healthcare systems worldwide, and endoscopy units were no exception. Endoscopic exams were considered to have a high risk of transmission, and therefore, the safety of endoscopy units and the consequent need for pre-endoscopy SARS-CoV-2 screening were questioned early on. The aim of our study was to assess the safety of endoscopy units during the COVID-19 pandemic, as well as the effectiveness/necessity for SARS-CoV-2 screening prior to endoscopies. Material and Methods This is a retrospective and single-center study carried out in a Portuguese tertiary hospital. All patients who underwent endoscopic procedures between September 1, 2020 and February 28, 2021 were included. The pre-endoscopy screening consisted of a specific questionnaire or a RT-PCR test for SARS-CoV-2 (nasal and oropharyngeal swab). Data were obtained through patient's clinical records and the Trace COVID platform. Results A total of 2,166 patients were included. Patients had a mean age of 61.8 years and were predominantly male (56.2%, n = 1,218). Eighty-one (3.7%) patients had previous SARS-CoV-2 infection, with a median difference of 74 days (IQ 40.5:160.5) between infection and endoscopy. Most patients (70.2%, n = 1,521) underwent PCR screening for SARS-CoV-2 up to 72 h before the procedure, with the remaining patients (29.8%, n = 645) answering a questionnaire of symptoms and risk contacts up to 3 days before endoscopy. Of the patients who underwent RT-PCR screening for SARS-CoV-2, 21 (1.4%) tested positive, and all were asymptomatic at the time of the screening. The evaluation for SARS-CoV-2 infection up to 14 days after the endoscopic exams identified 9 positive patients (0.42%) for SARS-CoV-2. The median difference in days between endoscopy and the diagnosis of infection was 10 days. Discussion/Conclusion Pre-endoscopy screening with RT-PCR test for SARS-CoV-2 identified a very small number of patients with COVID-19 infection as well as patients with COVID-19 infection in the following 14 days. Therefore, the risk of infection in endoscopy units is negligible if screening of symptoms and risk contacts is applied and individual protective equipment is used.
Collapse
Affiliation(s)
| | | | - Tânia Carvalho
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Pedro Antunes
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Sofia Mendes
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - João Soares
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | | | - Bruno Arroja
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Ana Rebelo
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| |
Collapse
|
2
|
Chaussade S, Pellat A, Chamseddine A, Corre F, Coriat R. Airborne transmission of SARS-Cov2: What consequences for digestive endoscopy? United European Gastroenterol J 2023; 11:171-178. [PMID: 36700355 PMCID: PMC10039792 DOI: 10.1002/ueg2.12355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/07/2022] [Indexed: 01/27/2023] Open
Abstract
The SARS-Cov-2 disease disrupted essential hospital procedures, such as gastrointestinal (GI) endoscopy, due to concerns about air transmission and the risk of exposing health care workers. With the spread of the pandemic, air transmission was considered as the main source of SARS-Cov2 transmission. This raised the problem of transmission by aerosolization of viral particles in operating rooms as well as endoscopy units. This is in line with the known airborne transmission of many other respiratory viruses. The risk of SARS-Cov-2 transmission during GI endoscopy was initially reduced by controlled measures, involving personal protections (mask…), restricted access to endoscopy rooms, and detection of infected patients. Gastrointestinal endoscopy generates aerosols, which may carry viruses. In addition, the endoscopy system may facilitate the diffusion of virus particles or fomites considering the forced-air cooling system used to maintain a stable temperature inside the box (25°C). The volume of air that goes through the light source box is high (240-300 m3 for a 1-h period). Moreover, the light system contains an air pump to inflate air inside the gut lumen. In order to isolate people from hazard, different levels of protection and solutions to avoid airborne transmission of microorganisms should be proposed, such as the reinforcement of personal protective equipment, the change in the way people work and engineering control of the risk.
Collapse
Affiliation(s)
- Stanislas Chaussade
- Gastroenterology and Digestive Oncology Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and Université Paris Cité, Paris, France
| | - Anna Pellat
- Gastroenterology and Digestive Oncology Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and Université Paris Cité, Paris, France
| | - Ali Chamseddine
- Gastroenterology and Digestive Oncology Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and Université Paris Cité, Paris, France
| | - Felix Corre
- Gastroenterology and Digestive Oncology Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and Université Paris Cité, Paris, France
| | - Romain Coriat
- Gastroenterology and Digestive Oncology Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and Université Paris Cité, Paris, France
| |
Collapse
|
3
|
Endoscopy After the COVID-19 Pandemic—What Will Be Different? CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2022; 20:46-59. [PMID: 35095262 PMCID: PMC8789548 DOI: 10.1007/s11938-022-00370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 10/26/2022]
|
4
|
Papanikolaou IS, Tziatzios G, Chatzidakis A, Facciorusso A, Crinò SF, Gkolfakis P, Deriban G, Tadic M, Hauser G, Vezakis A, Jovanovic I, Muscatiello N, Meneghetti A, Miltiadou K, Stardelova K, Lacković A, Bourou MZ, Djuranovic S, Triantafyllou K. COVID-19 in the endoscopy unit: How likely is transmission of infection? Results from an international, multicenter study. World J Gastrointest Endosc 2021; 13:416-425. [PMID: 34630891 PMCID: PMC8474700 DOI: 10.4253/wjge.v13.i9.416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) significantly affected endoscopy practice, as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units (PEU).
AIM To assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020).
METHODS Patients undergoing endoscopy in nine endoscopy units across six European countries during the period of the first European lockdown for COVID-19 (March-May 2020) were included. Prior to the endoscopy procedure, participants were stratified as low- or high- risk for potential COVID-19 infection according to the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) joint statement, and contacted 7-14 d later to assess COVID-19 infection status. PEU were questioned regarding COVID-19 symptoms and/or infection via questionnaire, while information regarding hospitalizations, intensive care unit-admissions and COVID-19-related deaths were collected. The number of weekly endoscopies at each center during the lockdown period was also recorded.
RESULTS A total of 1267 endoscopies were performed in 1222 individuals across nine European endoscopy departments in six countries. Eighty-seven (7%) were excluded because of initial positive testing. Of the 1135 pre-endoscopy low risk or polymerase chain reaction negative for COVID-19, 254 (22.4%) were tested post endoscopy and 8 were eventually found positive, resulting in an infection rate of 0.7% [(95%CI: 0.2-0.12]. The majority (6 of the 8 patients, 75%) had undergone esophagogastroduodenoscopy. Of the 163 PEU, 5 [3%; (95%CI: 0.4-5.7)] tested positive during the study period. A decrease of 68.7% (95%CI: 64.8-72.7) in the number of weekly endoscopies was recorded in all centers after March 2020. All centers implemented appropriate personal protective measures (PPM) from the initial phases of the lockdown.
CONCLUSION COVID-19 transmission in endoscopy units is highly unlikely in a lockdown setting, provided endoscopies are restricted to emergency cases and PPM are implemented.
Collapse
Affiliation(s)
- Ioannis S Papanikolaou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Alexandros Chatzidakis
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels 1070, Belgium
- Department of Medical Oncology, Institut Jules Bordet, Brussels 1000, Belgium
| | - Gjorgi Deriban
- University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia
| | - Mario Tadic
- Department of Gastroenterology, Dubrava University Hospital Zagreb, Zagreb 10040, Croatia
| | - Goran Hauser
- Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Antonios Vezakis
- 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Ivan Jovanovic
- Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy
| | - Anna Meneghetti
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy
| | - Konstantinos Miltiadou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Kalina Stardelova
- University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia
| | - Alojzije Lacković
- Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Maria-Zoi Bourou
- 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Srdjan Djuranovic
- Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| |
Collapse
|
5
|
Zerbato V, Di Bella S, Giuffrè M, Jaracz AW, Gobbo Y, Luppino D, Macor P, Segat L, Koncan R, D'Agaro P, Valentini M, Crocé LS, Ruscio M, Luzzati R. High fecal calprotectin levels are associated with SARS-CoV-2 intestinal shedding in COVID-19 patients: A proof-of-concept study. World J Gastroenterol 2021; 27:3130-3137. [PMID: 34168414 PMCID: PMC8192288 DOI: 10.3748/wjg.v27.i22.3130] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND One third of coronavirus disease 2019 (COVID-19) patients have gastrointestinal symptoms. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA has been detected in stool samples of approximately 50% of COVID-19 individuals. Fecal calprotectin is a marker of gastrointestinal inflammation in the general population. AIM To investigate if fecal calprotectin correlates with SARS-CoV-2 intestinal shedding in COVID-19 patients with pneumonia. METHODS Patients with SARS-CoV-2 pneumonia admitted to the Infectious Disease Unit (University Hospital of Trieste, Italy) from September to November 2020 were consecutively enrolled in the study. Fecal samples were collected and analyzed for quantification of fecal calprotectin (normal value < 50 mg/kg) and SARS-CoV-2 RNA presence by polymerase chain reaction (PCR). Inter-group differences were determined between patients with and without diarrhea and patients with and without detection of fecal SARS-CoV-2. RESULTS We enrolled 51 adults (40 males) with SARS-CoV-2 pneumonia. Ten patients (20%) presented with diarrhea. Real-time-PCR of SARS-CoV-2 in stools was positive in 39 patients (76%), in all patients with diarrhea (100%) and in more than two thirds (29/41, 71%) of patients without diarrhea. Obesity was one of the most common comorbidities (13 patients, 25%); all obese patients (100%) (P = 0.021) tested positive for fecal SARS-CoV-2. Median fecal calprotectin levels were 60 mg/kg [interquartile range (IQR) 21; 108]; higher fecal calprotectin levels were found in the group with SARS-CoV-2 in stools (74 mg/kg, IQR 29; 132.5) compared to the group without SARS-CoV-2 (39 mg/kg, IQR 14; 71) (P < 0.001). CONCLUSION High fecal calprotectin levels among COVID-19 patients correlate with SARS-CoV-2 detection in stools supporting the hypothesis that this virus can lead to bowel inflammation and potentially to the 'leaky gut' syndrome.
Collapse
Affiliation(s)
- Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste 34125, Italy
| | - Stefano Di Bella
- Infectious Diseases Unit, Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste 34123, Italy
| | - Mauro Giuffrè
- Liver Unit, Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste 34127, Italy
| | | | - Ylenia Gobbo
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste 34125, Italy
| | - Diego Luppino
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste 34125, Italy
| | - Paolo Macor
- Department of Life Sciences, Trieste University, Trieste 34127, Italy
| | - Ludovica Segat
- Department of Hygiene and Public Health Unit, Trieste University Hospital (ASUGI), Trieste 34125, Italy
| | - Raffaella Koncan
- Department of Hygiene and Public Health Unit, Trieste University Hospital (ASUGI), Trieste 34125, Italy
| | - Pierlanfranco D'Agaro
- Department of Hygiene and Public Health Unit, Trieste University Hospital (ASUGI), Trieste 34125, Italy
| | - Michael Valentini
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste 34125, Italy
| | - Lory Saveria Crocé
- Liver Unit, Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste 34127, Italy
| | - Maurizio Ruscio
- Division of Laboratory Medicine, Trieste University Hospital (ASUGI), Trieste 34125, Italy
| | - Roberto Luzzati
- Infectious Diseases Unit, Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste 34123, Italy
| |
Collapse
|
6
|
Shaoul R, Day AS. Pediatric Endoscopy During COVID-19 Times. Front Pediatr 2021; 9:750717. [PMID: 34976888 PMCID: PMC8716625 DOI: 10.3389/fped.2021.750717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
The global COVID-19 pandemic has led to healthcare resources being diverted or stretched, especially during periods of lock-down in affected countries. Disruptions to normal services have resulted in reduced or delayed provision of endoscopy in many countries, with consequent impacts on diagnosis or management of digestive diseases and upon endoscopy training. This review article aims to highlight key aspects of the impact of the pandemic upon endoscopy services, with a focus upon endoscopy in children.
Collapse
Affiliation(s)
- Ron Shaoul
- Rambam Medical Center, Faculty of Medicine, Pediatric Gastroenterology and Nutrition Institute, Ruth Rappaport Children's Hospital of Haifa, Haifa, Israel
| | - Andrew S Day
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| |
Collapse
|