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3.
United European Gastroenterol J ; 9(7): 787-796, 2021 09.
Article in English | MEDLINE | ID: covidwho-1260575

ABSTRACT

BACKGROUND: The novel Coronavirus (SARS-CoV-2) has caused almost 2 million deaths worldwide. Both Food and Drug Administration and European Medicines Agency have recently approved the first COVID-19 vaccines, and a few more are going to be approved soon. METHODS: Several different approaches have been used to stimulate the immune system in mounting a humoral response. As more traditional approaches are under investigation (inactivated virus vaccines, protein subunit vaccines, recombinant virus vaccines), more recent and innovative strategies have been tried (non-replicating viral vector vaccines, RNA based vaccines, DNA based vaccines). RESULTS: Since vaccinations campaigns started in December 2020 in both the US and Europe, gastroenterologists will be one of the main sources of information regarding SARS-CoV 2 vaccination for patients in their practice, including vulnerable patients such as those with Inflammatory Bowel Disease (IBD), patients with chronic liver disease, and GI cancer patients. CONCLUSIONS: Thus, we must ourselves be well educated and updated in order to provide unambiguous counseling to these categories of vulnerable patients. In this commentary, we aim to provide a comprehensive review of both approved COVID-19 vaccines and the ones still under development, and explore potential risks, benefits and prioritization of vaccination.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , /therapeutic use , /therapeutic use , Gastroenterology , Gastrointestinal Neoplasms/therapy , Humans , Inflammatory Bowel Diseases/therapy , Liver Diseases/therapy , SARS-CoV-2
7.
Tech Innov Gastrointest Endosc ; 23(2): 212-214, 2021.
Article in English | MEDLINE | ID: covidwho-957431

ABSTRACT

The main barrier for a young researcher in the field of endoscopy is that too much is known about virtually every aspect not only of the natural history, but also of the efficacy and safety of different Gastrointestinal (GI) techniques. The main fuel for research remains uncertainty, and this has been the primary characteristic of COVID-19. The unprecedented visibility of the main papers on the natural history and medical management of COVID-19 on all the main worldwide medical Journals has had an effect of drainage on the reports of COVID-19 in GI endoscopy, suddenly opening up the interest of main GI journals to this topic. Furthermore, given the nature and the urgency of the topic, these high-ranking journals have accepted study designs outside rigorous randomized controlled trials and/or systematic reviews and meta-analysis, what used to be the "conditio sine qua non" for being considered for publication. Suddenly, rigorous guidelines have been replaced by expert-derived suggestions on the basis that the best possible guidance is better than no guidance. This situation has been a great occasion for young researchers to gain visibility even without having access to the complex means and long time-spans needed to finalize a randomized trial.

9.
Endoscopy ; 53(2): 162-165, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-780072

ABSTRACT

BACKGROUND: During the COVID-19 outbreak in Italy, only fast-track endoscopic procedures have been performed; nevertheless, a significant drop in their number has been reported. We evaluated whether the pandemic has impacted the appropriateness and diagnostic yield of fast-track endoscopic procedures compared with those performed in 2019. METHODS: This retrospective study involved endoscopy services in Northern Italy. We compared data regarding endoscopic procedures performed in March and April 2020 with those performed during the same period in 2019. RESULTS: In 2020, there was a 53.6 % reduction in the number of fast-track endoscopic procedures compared with 2019. Patients undergoing endoscopy in 2020 were younger than in 2019. Both appropriate referral and diagnostic yield increased in 2020 for both upper and lower endoscopy. A higher rate of cancer was diagnosed in 2020 by upper endoscopy (3.6 % vs. 6.6 %; P = 0.04). CONCLUSIONS: The high level of inappropriate endoscopy referrals registered in 2019 significantly improved during the COVID-19 outbreak of 2020, with an increase in the diagnostic yield.


Subject(s)
COVID-19 , Endoscopy/statistics & numerical data , Neoplasms/diagnostic imaging , Pandemics , Humans , Italy/epidemiology , Retrospective Studies
10.
Gut ; 69(11): 1915-1924, 2020 11.
Article in English | MEDLINE | ID: covidwho-724057

ABSTRACT

The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.


Subject(s)
Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Endoscopy, Digestive System/statistics & numerical data , Occupational Health , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , COVID-19 , Consensus , Coronavirus Infections/epidemiology , Delphi Technique , Endoscopy, Digestive System/methods , Female , Follow-Up Studies , Humans , Incidence , Internationality , Male , Pandemics/statistics & numerical data , Patient Safety , Pneumonia, Viral/epidemiology , Risk Assessment , Time Factors , United States
11.
Endosc Int Open ; 8(8): E1097-E1101, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-711892

ABSTRACT

Background and study aims As with all other fields of medical practice, gastrointestinal endoscopy has been impacted by the COVID-19 pandemic. However, data on the impact of the pandemic in Africa, especially sub-Saharan Africa are lacking. Methods A web-based survey was conducted by the International Working Group of the European Society for Gastrointestinal Endoscopy and the World Endoscopy Organization to determine the impact and effects the COVID-19 pandemic has had on endoscopists in African countries. Results Thirty-one gastroenterologists from 14 countries in north, central, and sub-Saharan Africa responded to the survey. The majority of respondents reduced their endoscopy volume considerably. Personal protective equipment including FFP-2 masks were available in almost all participating centers. Pre-endoscopy screening was performed as well. Conclusion The COVID-19 pandemic has had a substantial impact on gastrointestinal endoscopy in most African countries; however, the impact may not have been as devastating as expected.

12.
Endoscopy ; 53(2): 173-177, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-708886

ABSTRACT

INTRODUCTION: We aimed to report the impact of the pandemic lockdown period on the treatment and prognosis of superficial gastrointestinal neoplastic lesions. METHODS: A survey was completed by 11 centers from four continents regarding postponements during the early lockdown period of the pandemic, and the same period in 2019. RESULTS: In 2020, 55 % of the scheduled procedures were deferred, which was 11 times higher than in 2019; the main reasons were directly related to COVID-19. In countries that were highly affected, this proportion rose to 76 % vs. 26 % in those where there was less impact. Despite the absolute reduction, the relative distribution in 2019 vs. 2020 was similar, the only exception being duodenal lesions (affected by a 92 % reduction in mucosectomies). Although it is expected that the majority of postponements will not affect the stage (based on the results from biopsies and/or endoscopic appearance), 3 % of delayed procedures will probably require surgery. CONCLUSIONS: The lockdown period caused by the SARS-CoV-2 pandemic led to a substantial reduction in the number of endoscopic resections for neoplastic lesions. Nevertheless, based on clinical judgment, the planned median delay will not worsen the prognosis of the affected patients.


Subject(s)
COVID-19 , Endoscopy, Gastrointestinal/statistics & numerical data , Gastrointestinal Neoplasms/surgery , Pandemics , Cross-Sectional Studies , Humans , Internationality
14.
Endosc Int Open ; 8(7): E985-E989, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-629939

ABSTRACT

Background and aim As the post-peak phase of the epidemic is approaching, there is an urgent need of an action plan to help resume endoscopy activity. To manage the Covid-19 pandemic-imposed backlog of postponed colonoscopy examinations, an efficient approach is needed. The practice of on-demand sedation with benzodiazepines and/or opiates will allow most patients to complete a water-aided examination with minimal or no sedation. Other methods reported to minimize patient discomfort during colonoscopy can be used, in addition to water-aided techniques. Unsedated or minimally sedated patients who do not require recovery or require a shorter one allow rapid turnaround. The practice obviates the need for assistance with deep sedation from anesthesiologists, who may be in short supply. Trainee education in water-aided colonoscopy has been demonstrated to confer benefits. This review provides some insights into the impact of Covid-19 on endoscopy services, challenges ahead, and possible solutions to help recovery of colonoscopy work and training.

17.
Dis. Esophagus ; 5(33): 1-4, 20200501.
Article in English | WHO COVID, ELSEVIER | ID: covidwho-133655

ABSTRACT

This is an official guidance statement of The International Society of the Diseases of the Esophagus (ISDE) to address all the operators involved in management of patients affected by upper gastrointestinal diseases during COVID-19 pandemic. This guidance is based on the best available evidence to date and will be updated as new evidence becomes available.

18.
Endoscopy ; 52(6): 483-490, 2020 06.
Article in English | MEDLINE | ID: covidwho-72296

ABSTRACT

We are currently living in the throes of the COVID-19 pandemic that imposes a significant stress on health care providers and facilities. Europe is severely affected with an exponential increase in incident infections and deaths. The clinical manifestations of COVID-19 can be subtle, encompassing a broad spectrum from asymptomatic mild disease to severe respiratory illness. Health care professionals in endoscopy units are at increased risk of infection from COVID-19. Infection prevention and control has been shown to be dramatically effective in assuring the safety of both health care professionals and patients. The European Society of Gastrointestinal Endoscopy (www.esge.com) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (www.esgena.org) are joining forces to provide guidance during this pandemic to help assure the highest level of endoscopy care and protection against COVID-19 for both patients and endoscopy unit personnel. This guidance is based upon the best available evidence regarding assessment of risk during the current status of the pandemic and a consensus on which procedures to perform and the priorities on resumption. We appreciate the gaps in knowledge and evidence, especially on the proper strategy(ies) for the resumption of normal endoscopy practice during the upcoming phases and end of the pandemic and therefore a list of potential research questions is presented. New evidence may result in an updated statement.


Subject(s)
Coronavirus Infections/transmission , Endoscopy, Gastrointestinal/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Pneumonia, Viral/transmission , Risk Management/standards , COVID-19 , Coronavirus Infections/prevention & control , Endoscopy, Gastrointestinal/methods , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Risk Management/methods
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