AGA, DHPA issue new guidance to resume endoscopies during COVID-19
Click Here to Manage Email Alerts
American Gastroenterological Association and the Digestive Health Physicians Association issued a joint guidance for resumption of elective endoscopy during the COVID-19 pandemic, according to a press release.
The release states recommendations will be applied by individual facilities based on local conditions and will be affected by guidance from federal, state and local authorities. The guidance includes:
- Elective endoscopic procedures may resume when the rate of new COVID-19 cases substantially decreases in the relevant geographic area for at least 14 days. This decision should consider federal, state and local recommendations, availability of local health care system resources, and ability to offer a safe environment for staff and patients.
- Prioritize scheduled endoscopies by level of urgency, based on patient considerations and a physician’s professional judgement.
- All patients should receive PCR-based testing for active COVID-19 infection wherever possible. Testing should be performed within 48 hours of the procedure. If pre-procedure COVID-19 testing cannot be conducted, patients should keep a daily temperature log for 10 days before the procedure and be administered a symptom questionnaire and temperature check on the day of procedure.
- Endoscopy staff should be screened daily with temperature check and surveyed for COVID-19 exposure and symptoms. Policies should be implemented to facilitate social distancing for patients, visitors and staff. Policies may include mask use by all center personnel, appropriate spacing, restrict accompanying visitors, required masks for patients and visitors, staggered procedure start times, individual workstations for staff, organization of workflow patterns and job descriptions to minimize cross-contamination.
- Based upon availability of pre-procedure PCR-based COVID-19 testing, if no test was done, all procedure room personnel should wear N95 masks or similar. With a positive test, either postpone procedure or move to inpatient setting and with a negative test, standard surgical masks are acceptable for all endoscopy personnel. If no testing was done and N95 masks or similar are not available, delay resumption of endoscopic procedures until resources are available.
- Personal protective equipment considerations should include: Use of shoe covers; use of scrubs for endoscopy, changing street clothes prior to entering or leaving facility; use of water-resistant gowns; wear double gloves and use surgical head coverings.
- Endoscopes may be reprocessed following standard guidelines for manual cleaning after disinfection.
- Routine endotracheal intubation of patients who underwent elective upper endoscopy is not recommended. To minimize aerosolization, consider supplemental oxygen delivery by mask.
References:
Perspective
Back to Top
Prabhleen Chahal, MD
The joint guidance helps us to reopen endoscopy units around the country with a protocoled and streamlined approach. I agree with the AGA guidelines. Some challenges in the endoscopy world include rapid access to COVID-19 testing for some patients, who, for a variety of reasons, find it difficult to get testing done within 48 hours in an outpatient setting. We follow the CDC guidelines and approach those patients using N95 masks as we would in somebody who were positive. When we take care of a COVID-19 positive patient, an endoscopy room is dedicated and prepared for the procedure while allocating sufficient time to do the procedure. We wear appropriate PPE and directly take the patient to the endoscopy room. After conclusion of the procedure, the patient is recovered in the endoscopy room and directly back to their hospital room, thus eliminating the exposure in the pre-procedure and post procedure recovery area. We have much more to learn about COVID-19, including how likely it is for asymptomatic carriers to spread the disease if they are asymptomatic and positive. We are getting more and more information about the virus so hopefully the guidelines will be more detailed in the future to eliminate some of the gray areas.
Program Director, Advanced Endoscopy Fellowship Program
Cleveland Clinic
Click Here to Manage Email Alerts