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.

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.