COVID-19 in the endoscopy unit: How likely is transmission of infection? Results from an international, multicenter study

Ioannis S Papanikolaou; Georgios Tziatzios; Alexandros Chatzidakis; Antonio Facciorusso; Stefano Francesco Crinò; Paraskevas Gkolfakis; Gjorgi Deriban; Mario Tadic; Goran Hauser; Antonios Vezakis; Ivan Jovanovic; Nicola Muscatiello; Anna Meneghetti; Konstantinos Miltiadou; Kalina Stardelova; Alojzije Lacković; Maria-Zoi Bourou; Srdjan Djuranovic; Konstantinos Triantafyllou

doi:10.4253/wjge.v13.i9.416

COVID-19 in the endoscopy unit: How likely is transmission of infection? Results from an international, multicenter study

World J Gastrointest Endosc. 2021 Sep 16;13(9):416-425. doi: 10.4253/wjge.v13.i9.416.

Authors

Ioannis S Papanikolaou¹, Georgios Tziatzios¹, Alexandros Chatzidakis¹, Antonio Facciorusso², Stefano Francesco Crinò³, Paraskevas Gkolfakis⁴, Gjorgi Deriban⁵, Mario Tadic⁶, Goran Hauser⁷, Antonios Vezakis⁸, Ivan Jovanovic⁹, Nicola Muscatiello², Anna Meneghetti³, Konstantinos Miltiadou¹, Kalina Stardelova⁵, Alojzije Lacković⁷, Maria-Zoi Bourou⁸, Srdjan Djuranovic⁹, Konstantinos Triantafyllou¹

Affiliations

¹ Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece.
² Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy.
³ Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy.
⁴ Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels 1070, Belgium.
⁵ University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia.
⁶ Department of Gastroenterology, Dubrava University Hospital Zagreb, Zagreb 10040, Croatia.
⁷ Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia.
⁸ 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece.
⁹ Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia.

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.

Keywords: COVID-19; Gastrointestinal endoscopy; Lockdown; Personal protection measures; SARS-CoV-2; Transmission.