FELLOW EXPERIENCES WITH ENDOSCOPY SIMULATION BEFORE AND DURING THE COVID-19 PANDEMIC: AN INTERNATIONAL SURVEY

Background With the COVID-19 pandemic there was an acute drop in procedural volume for trainees, highlighting the need and potential of simulation-based training (SBT). Prior to the pandemic, the uptake of simulation was poorly categorized and inconsistent across programs despite the variety of endoscopic simulators available. We aimed to evaluate the current state of endoscopy training internationally in the wake of the pandemic as perceived by trainees. Methods This cross-sectional study utilized a survey composed of 21 questions eliciting demographic data, COVID-19-related training experiences, and experience with SBT. This survey was distributed internationally (USA, Canada, EU, Philippines, Singapore) to gastroenterology trainees between August 2021 to October 2021. Results The questionnaire was completed by 182 fellows, with 55 (30.2%) from the USA and 127 (69.8%) from other countries. Of the respondents, 79.1% were fellows during the first year of the pandemic. A majority (69.2%) found endoscopy training in general to be negatively impacted. Of those who reported a negative impact from the pandemic, 75.0% attributed it to a decline in endoscopic volume, 40.0% to institutional/regional guidelines, 25.0% to a shortage of personal protective equipment. Overall, 47.2% of respondents believed COVID-19 will negatively affect their endoscopic proficiency upon fellowship completion. A total of 71 respondents (39.0%) had experienced SBT before or during fellowship, with 27 from the USA (49.1% of respondents from USA) and 44 from other countries (34.6% of respondents from other countries). In the USA, 63.0% had used virtual reality (VR), 37.0% mechanical models, and 37.0% animal models compared to 47.7% VR, 68.2% mechanical models, and 27.3% animal models in other countries. Respondents agreed that SBT was most helpful with developing technical skills such as ergonomic handling, torque steering, and fine tip control. A majority (52.1%) found SBT appropriate to their level of training. Respondents believed increased access to SBT (43.7%) and mentored training (54.9%) would improve the experience. Conclusion While current data supports the use of SBT early in training, the cumulative uptake of SBT across programs before and during the COVID-19 pandemic remained low. In the USA and abroad, fellows perceive a negative impact of COVID-19 on their training and proficiency upon graduation. Compared to other countries, the USA had higher utilization of VR and lower utilization of mechanical models. Decrease in endoscopic volume was reported as the main factor negatively impacting endoscopic training. This survey highlights the potential benefit of SBT with low case volumes and further prospective evaluation of SBT in achieving endoscopic competence. (Table Presented)

Covid-19: exploring the "new normal" in gastroenterology training.

The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented disruptions in fellowship training programs worldwide. In gastroenterology, the strain in healthcare service provision and the emphasis on preventing viral transmission has adversely impacted hands-on training opportunities, with trainees facing the constant pressure to meet training requirements under the continuous threat of viral transmission. Emerging evidence highlight the scale of the problem, specifically with regard to endoscopy competence due to cancellation of elective endoscopic procedures, provision of inpatient and outpatient consultative care as well as academic education and the mental well-being of trainees. As such, it has been necessary for trainees, trainers and training programs collectively to adapt to these challenges and incorporate novel and adaptive solutions to circumvent these training barriers. This review aims to summarise data on the global impact of COVID-19 on gastroenterology training and the practical interventions that could be implemented.

Covid-19 in the endoscopy unit: How likely is transmission of infection results from an international, multicenter study

Introduction: COVID-19 significantly affected endoscopic practice, as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units (PEU). This multicenter study aimed to assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020). Aims & Methods: Patients undergoing endoscopy during the period of the first European lockdown for COVID-19 (March-May 2020) were included. Those deemed as low risk or negative for COVID-19 via polymerase chain reaction (PCR) testing were contacted 7-14 days later to assess infection status. Information for possible COVID-19 infection of PEU and number of weekly endoscopies in each center during the lockdown period were also recorded. Results: One thousand two hundred sixty-seven endoscopies were performed in 1222 individuals, across 9 European centers (6 countries). Among the 1135 pre-endoscopically low risk or PCR negative for COP0911 VID-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 patients, i.e., 75%) turned positive after esophagogastroduodenoscopy (EGD). Of these, 4 (50%) were considered obviously irrelevant to endoscopy, but for the other 50% the route of transmission remained obscure. Data regarding 163 PEU was recorded;5 [3%;95%CI: 0.4-5.7) tested positive during the study period. In 4 of them (2% of the total), the infection was considered to be associated to their work environment. 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 endoscopic units is highly unlikely in a lockdown setting, provided endoscopies are reduced to emergency cases and PPM are implemented.

Assessment of the clinical impact of postponing endoscopic procedures using riskstratification during COVID-19 pandemic: A prospective systematic multicentric study

Aims During the COVID-19 outbreak, we adopted in March 2020 our own risk stratification triage policy facing massivecancellation/postponing of all endoscopic procedures not considered urgent or immediately necessary. At the end of the firstwave endoscopy activity resumed progressively. We aimed to assess the impact of procedure postponing on patientoutcome. Methods Six weeks after cancellation policy initiation, the endoscopic reporting system of two tertiary hospitals wasmodified to allow prospective completion of our electronic database. From 01/05/2020 to 30/08/2020, for each procedure,endoscopists were asked to precise whether: 1) the examination was postponed due to the COVID-19 outbreak;2) theexamination revealed a significant diagnosis (SD, e.g: neoplasia diagnosis and management, diagnosis and management ofgastrointestinal bleeding lesion, stricture management, cyst and abdominal collection drainage, resection of large(pre)neoplastic lesions, gastrointestinal leak management, etc) and 3) if postponing the examination had a significantimpact on patient's management. Results During this period, among 5283 procedures performed, 476 (9 %) had been tagged as postponed procedures (PP)[esophagogastroduodenoscopy 50.8 %, colonoscopy 43.5 %, ERCP 2.5 %, EUS 2.7 %, enteroscopy: 0.4 %;medianpostponing delay 71 (52-91) days]. 8.1 % were postponed by the patient and 91.9 % by the hospital. Examinations revealeda SD in 70 cases in the PP group (14.7 %) and in 672 (14 %) in the non-PP group during the same period (p = 0.72). In 14cases (2.9 %) postponing the examination had a significant impact on patient management;4 patients received a delayeddiagnosis on management of cancer, 3 patients developed biliopancreatic complications and appropriate management wasprovided with delay in 2 and 3 patients with severe functional and inflammatory bowel diseases, respectively and 2 hadsevere esophagitis worsening. Conclusions Based on the analysis of PP procedures, the triage policy adopted during first wave COVID outbreak appearedadequate in terms of proportion of SD and impact on patient management.

COVID-19 in endoscopy: How likely is trasnmission of infection? Results from aninternational, multicenter study

Aims COVID-19 has significantly affected endoscopic practice, as GI-endoscopy is considered a risky procedure fortransmission of infection towards personnel of endoscopy units (PEU) and patients. ESGE recommended reduction of non-emergency endoscopies, personal protection measures (PPM) and post-endoscopy calls to patients, to check their COVID-19 status. This study aimed to assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020). Methods Demographic data, patients' COVID-19 status before and after endoscopy, clinical data for those developingCOVID-19, implementation of PPM, number and type of overall endoscopies, as well as information for possible COVID-19infection of patients and PEU were retrospectively recorded. Results 1267 endoscopies (EGDs:46 %, colonoscopies/rectosigmoidoscopies:35 %, ERCPs:14 %, EUS:4 %) were performedin 1222 patients (mean age:63.4 y.o., males:59 %, inpatients:44 %) in 9 centers (6 countries). Pre-endoscopic testing forCOVID-19 was available for 326 (26.7 %) patients;87(7 %) tested positive. 7-14 days after endoscopy, 1204 patients werecontacted by telephone. Among 1135 pre-endoscopically COVID-19 negative patients 254 were tested post-endoscopy and8 were found positive (0.6 % of the total), with 6, 1 and 1 cases turning positive after EGD, colonoscopy and EUS,respectively. Of these, 4 were considered “obviously” irrelevant to endoscopy, but for the other 4 (3 post-EGD and 1 post-colonoscopy) the route of transmission remained obscure. Appropriate PPM were implemented and adhered to in allcenters;moreover, a significant reduction in the number of endoscopies was noted in all centers after March 2020. Finally,data regarding 163 PEU was recorded;5 (3 %) tested positive during the study period. In 4 of them (2 % of the total), theinfection was considered to be associated to their work environment. Conclusions COVID-19 transmission in endoscopic units is highly unlikely in a lockdown setting, provided endoscopies arereduced to emergency cases and appropriate PPM are implemented and followed.