Temporal Analysis of Medicare Physician Reimbursement for Common Gastroenterology Procedures From 2007 to 2022

Introduction: As the U.S. population ages, gastroenterologists will provide care for an increasing number of older patients - many of whom use Medicare. In recent years there have been significant policy changes surrounding Medicare reimbursement for physicians. Understanding reimbursement trends can help reveal the financial impact of these policies on gastroenterologists. Our study aims to analyze the trends in Medicare reimbursement of common gastrointestinal (GI) services from 2007 to 2022. Method(s): The top 10 GI procedures and their respective CPT codes were identified through a joint list published by the American College of Gastroenterology, American Society of Gastrointestinal Endoscopy, and American Gastroenterological Association. The top 5 5 CPT codes relating to office/inpatient visits provided by gastroenterologists to Medicare Part B beneficiaries was identified using data from CMS. The Physician Fee Schedule Look-Up Tool from CMS was queried for the selected CPT codes from 2007 to 2022, to determine the facility reimbursement rate by Medicare for each service. The reimbursement data were adjusted to January 2022 U.S. dollars using the U.S. Department of Labor's Bureau of Labor Statistics' consumer price index inflation calculator. Result(s): The unadjusted physician reimbursement for GI procedures exhibited an average decrease of 7.0% (95% CI, 29.9% to 24.1%) from 2007 to 2022. After adjusting for inflation, the mean decrease in physician reimbursement for procedures was 33.0% (95% CI, 235.1% to 230.9%). The mean annual growth rate in reimbursement was 22.6% (95% CI, 22.8% to 22.4%). The unadjusted physician reimbursement for inpatient and outpatient visits exhibited an average increase of 32.1% (95% CI, 4.8% to 59.3%). After adjusting for inflation, physician reimbursement for patient visits exhibited a mean decrease of 4.92% (Figure 1). Conclusion(s): The analysis revealed a steady decline in adjusted and non-adjusted reimbursement between 2007 and 2022. Decreasing Medicare reimbursement may impact health outcomes, healthcare access, and patient satisfaction. Reimbursement policies must be scrutinized particularly in the light of high inflation and increased costs due to additional costs associated with care during the COVID-19 pandemic, staffing shortages, and increased staffing salaries. (Figure Presented).

Ndegree35 - Neurophysiology solving the vomiting dilemma

Objectives: Post Covid severe vomiting together with proximal muscle weakness is a misleading combination, this describes a rare but definite clinical association between myasthenia gravis and autonomic failure and strengthen the concept that subacute autonomic neuropathy is an autoimmune disorder. Content: A 39 ys old adult female presented with postCovid severe vomiting for one year with 40 kgs loss Upper gastrointestinal endoscopy revealed gastric dilatation associated with eosophageal and gastric stasis and hypertrophic pyloric stenosis. the gastroenterologist sought neurological consultation for the coexisting unexplained limb weakness before operation EMG & NCV was all normal except instability of the MUAPs Slow rate Repetitive supramaximal stimulation (RNS) revealed significant decremental response with no significant high rate stimulation incrementation Chest CT revealed an anterior mediastinal mass Surprisingly, She had an old CT during the covid infection that showed the same mass. Thoracoscopic resection revealed type B1 thymoma Following tumor resection, the patient improved gradually, Few months later endoscopy revealed a normal stomach with strong peristaltic waves and the patient was symptom free Infections are recognized to trigger exacerbations and crisis in MG Dysautonomia is not a commonly recognized feature of myasthenia gravis, but there have been rare reports of myasthenia gravis coexisting with autonomic failure, usually in association with thymoma. The autonomic dysfunction can present as isolated gastroparesis these observations support a rare but definite clinical association between myasthenia gravis and autonomic failure Neurophysiology could reveal undiagnosed MG with thymoma causing autonomic dysfunction in the form of gastroparesis and agonizing vomiting. Keywords: Myasthenia gravis;Gastroparesis;Autonomic failure;Thymoma;PostCovid vomiting. French language not detected for EMBFRA articles source xmlCopyright © 2023

The impact of COVID-19 on endoscopy and cancer screening: a focus on access and equity.

The SARS-CoV2 pandemic has had a profound and lasting impact on healthcare delivery. Gastrointestinal endoscopy services were limited during the early phases of the pandemic, which has resulted in ongoing procedural backlog. Procedural delays have had continuing effects including delayed colorectal cancer (CRC) diagnoses and exacerbation of existing disparities in the CRC-screening and treatment pathways. In this review, we outline these effects as well as the variety of strategies that have been proposed to eliminate this backlog, including increased endoscopy hours, re-triaging of referrals, and alternative CRC-screening strategies.

The hidden dangers of SARS-CoV-2 testing

A foreign body can be intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, location in gastrointestinal tract, patient's clinical conditions, occurrence of symptoms or onset of complications. In this short case, we present a middle age woman, who accidentally swallowed a portion of a nasopharyngeal swab half-broken during a diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Upper gastrointestinal endoscopy was promptly performed to prevent the swab from crossing the pylorus leading to serious complications and, therefore, risk of surgical intervention. The broken nasopharyngeal swab was detected in the gastric body, and immediately removed with a foreign body forceps. Our hospital performs many nasopharyngeal swabs and to our knowledge, this is only the second reported swab ingestion during SARS-CoV-2 test.Copyright © 2021 The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.

Recurrent intussusception with ileal perforation as a complication of Blue Rubber Bleb Nevus Syndrome in a pediatric patient

Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital condition, characterized by multiple venous malformations that may involve any organ system, most commonly the skin or the gastrointestinal tract. These lesions are often responsible for chronic blood loss and secondary anemia, and in rare situations may cause severe complications such as intussusception, volvulus, and intestinal infarction. Intussusception as a complication of BRBNS, although a known complication of the disease, has rarely been reported, especially in the Philippines. In the Philippine Society for Orphan Disorders, only 2 cases of BRBNS are currently included in the organization, including the patient presented in the case report. The treatment of BRBNS that involves the gastrointestinal tract depends on the extent of intestinal involvement and severity of the disease. The treatment aims to preserve the GI tract as much as possible due to the high recurrence in the disease. In this case report, we present a 13 year-old male with BRBNS with previous history of intussusception, successfully managed conservatively;however, upon recurrence, underwent exploratory laparotomy wherein a subcentimeter perforation in the antimesenteric border of the proximal ileum was noted, together with a gangrenous intussuscipiens, and multiple mulberry-like formations on the antimesenteric border of the small bowels. Histopathological findings of the resected bowels showed multiple cavernous hemangiomas consistent with BRBNS. The postoperative course of the patient was unremarkable.Copyright © 2023 The Authors

Impact of covid-19 pandemic on gastroenterology: Chronic gastroenterological diseases, iatrogenesis and endoscopy.

The current article describes the course and treatment of chronic gastrointestinal diseases during the COVID-19 pandemic. We analyzed articles about iatrogenic harm to the gastrointestinal tract by etiological and pathogenetic therapy of the COVID-19. National and international recommendations for gastrointestinal endoscopy for infected and uninfected patients are analyzed.Copyright © A.M. SHCHIKOTA, I.V. POGONCHENKOVA, E.A. TUROVA, M.A. RASSULOVA, M.S. FILIPPOV.

Application of a Novel Swallowable Telemetric Device for Real Time Luminal Blood Detection to Guide Timing of Enteroscopy in a Patient with Obscure-Occult Gastrointestinal Bleeding: A Case Report

Background and aim: Gastrointestinal (GI) bleeding is deemed "obscure" when upper and lower GI endoscopy reveal no bleeding site. While the term "overt" is used in cases where visible blood passage is observed or reported, cases without macroscopic bleeding stigmata are defined "occult". Although small bowel origin accounts for only about 5% of all GI bleedings, it makes up the majority of obscure GI bleedings. Diagnostic work-up and treatment of small bowel GI bleedings can be challenging, especially when overt bleeding symptoms are absent. Material(s) and Method(s): We report the case of a frail patient with multiple comorbidities and evidence of bleeding small bowel angiodysplastic lesions on videocapsule assisted enteroscopy (VCE). Device assisted enteroscopy (DAE), planned in order to treat the bleeding lesions, was delayed after the patient contracted SARSCoV- 2 infection. Eight weeks after, in the absence of clinical signs of bleeding, a device for real time luminal blood detection (HemoPillR acute, Ovesco) was applied to guide timing of enteroscopy. Result(s): The 71 year old male patient was on dual anti platelet therapy and had persistent clinical features of iron deficiency anemia (Hemoglobin 8,0g/dl). Upper and lower GI endoscopy were negative for potential bleeding sources. VCE showed three small lesions suspect for angiodysplasia within 1 to 13 minutes after pylorus passage. Upon recovery from SARS-CoV-2 infection and congestive heart failure with respiratory insufficiency, we administered HemoPillRacute orally, without previous bowel preparation. The measurement showed a peak HemoPillR-Index (HI max) at 1h 47min after capsule administration (Fig. 1) and was therefore indicative of a small bowel bleeding site, best approachable by antegrade oral route, in keeping with the prior VCE findings. On subsequent DAE, performed through spiral enteroscopy, the small bowel angiodysplastic lesions were successfully treated. [Figure presented] Conclusion(s): Our case report illustrates how a novel telemetric blood detection measurement was able to confirm luminal blood presence and successfully guide timing of therapeutic DAE in a patient with obscure-occult GI bleeding, without the need for repetition of VCE.Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.

Impact of Covid-19 on Endoscopic Demography: A Cross Sectional Study

Background: Pandemics are never easy to deal with, especially this new covid pandemic which has exposed the vulnerability and multiple lacunae in our existing health care. In this midst of chaos and uncertainty delivering endoscopic services had become a nightmare, as endoscopy is a procedure done in the aero digestive tract and also an aerosol generating procedure. This led to a lot of enigma and skepticism in selection of patients and precautions to be taken while performing procedures. Objective(s): To Know the Feasibility and Utility of endoscopy as diagnostic and therapeutic services in Covid pandemic in the midst of chaos and uncertainties. Material(s) and Method(s): It is a retrospective study conducted from May 2020 to December 2020 in a Tertiary care Gastro hospital. Patients were screened clinically by Questionnaire highlighting the travel history, contact history, and residing history (hot spots for covid). X-Ray, HRCT and RT-PCR was done to exclude high risk cases. Clinical screening for symptoms, Vitals, Spo2 was done on all the patients. The procedures were performed using standard endoscopy equipment with appropriate COVID 19 protocols. Result(s): One thousand two hundred and eighty (1280) patients aged between 20 years to > 70 years were referred and undertake upper and lower GI endoscopy in a Tertiary Care gastro hospital. Majority of the cases who underwent endoscopy were in the age group 31-40 years 317 (24.8%). They comprised of 59.9% males and 40.1% females. Common endoscopic diagnoses were Gastric erosions 31.4% followed by Normal Upper gastrointestinal endoscopy (UGIE) / Lax Gastroesophageal (GE) Junction 17.4%. The most common symptom was dyspepsia seen in 725 (56.6%) of the patients, followed by dysphagia in 92 (7.2%), abdominal discomfort 64 (5%). Conclusion(s): This study highlights, with proper history and clinical screening and appropriate precautions it was possible to provide endoscopy service to the needy without a strict protocol and expensive pre-endoscopy work up like HRCT and RT-PCR for all patients, without compromising patient or staff safety. Patients with alarm symptoms like Dysphagia and GI Bleed benefited the most, many patients with functional GI Disorders also were reassured with negative endoscopy and counseling. As during these times, people were in panic mode with all negative things happening around;many of these functional patients with overlap anxiety disorders were scared to death. A positive diagnosis is very important while managing most of these GI disorders.Copyright © 2022 Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.

COVID-19 and gastrointestinal endoscopy-proper strategies related to pandemic changes.

The outbreak of coronavirus disease 2019 (COVID-19) in December 2019 was associated with new challenges in many fields of medicine. Preventing transmission of the virus and infection of professional healthcare workers became of major concern in our daily clinical practice during the pandemic. Viral particles within aerosols can be detected up to 3h after aerosolization. Recent work defined endoscopic procedures of the upper gastrointestinal tract as being aerosol-generating procedures (AGPs);thus, they can carry the possibility of transmitting airborne viruses to personnel. Because severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is primarily transmitted by aerosols and/or droplets, the use of personal protective equipment (PPE) is warranted. Guideline recommendations from the WHO and other societies were also modified early to include PPE as an infection prevention measure. The strict use of PPE has proven to be an effective prevention strategy over the 3 years since its implementation. With the introduction of vaccinations against SARS-CoV-2, increasing immunization of the population, and a changing pandemic infection pattern, the requirements for endoscopic departments in hospitals and outpatient care settings continued to change. In the postpandemic situation, there are only minor restrictions that affect the new "postpandemic reality", thus, allowing endoscopic services to be performed without major restrictions. Here, we present a review of recent and most relevant knowledge to summarize the prophylactic measures that must be taken to perform endoscopy under safe conditions during the COVID-19 pandemic.Copyright © 2023, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Leser-Trelat sign: can it follow COVID-19 infection?

Seborrhoeic keratosis is a benign brownish-black skin lesion that is almost always seen in middle-aged and elderly populations. The sudden onset and rapid increase in size and/ or number of seborrhoeic keratoses is called the Leser-Trelat sign, suggesting a paraneoplastic manifestation of internal malignancy. However, eruptive seborrhoeic keratoses are also described in some nonmalignant conditions such as human papillomavirus infection and HIV infection. Herein, we report a case with Leser-Trelat sign in a patient following COVID-19 infection. A 50-year-old man presented to our dermatology clinic complaining of the sudden appearance of multiple warty-like lesions on his back, which had occurred 2 months after recovery from COVID-19 infection. According to his medical history, the patient presented with cough, fever and dyspnoea about 2 months prior to the appearance of his skin lesions. He was referred to a health centre, where a nasopharyngeal swab was taken, and his polymerase chain reaction test for COVID-19 was positive. In addition, bilateral patchy ground-glass infiltration was reported in his high-resolution computed tomography (HRCT) scan, all in favour of COVID- 19 infection. The patient was then treated with acetaminophen, dexamethasone (intramuscular injection), salmeterol and a fluticasone inhaler, and his symptoms improved. Two months after recovery from his mild COVID-19 infection, several small asymptomatic pigmented verrucous papules appeared on his back. Physical examination revealed multiple rough, oval-shaped, brownish papules of varying size. Dermatoscopy of the lesions was also performed. Both clinical and dermoscopic findings were in favour of seborrhoeic keratosis. In order to reach a final diagnosis, a skin biopsy was performed, and microscopic examination of the biopsy specimen showed hyperkeratosis and well-defined epidermal hyperplasia composed mainly of the proliferation of benignlooking basaloid cells and fewer squamoid cells and horn cysts and increased melanin, mostly at the dermoepidermal junction. The dermis showed no significant change. Based on the above findings, the patient was diagnosed with eruptive seborrhoeic keratosis. To determine the possible cause of this eruption, the patient was further evaluated. In his past medical history, he was generally healthy before his COVID-19 infection and had no history of comorbidities. The patient underwent a workup to rule out any internal malignancies. Laboratory tests revealed normal results and included a complete blood count, liver and kidney function tests, electrolytes, prostate-specific antigen and urine analysis. Gastrointestinal endoscopy and colonoscopy ruled out any gastrointestinal malignancy. Chest X-ray and HRCT revealed no malignant lesion. In addition, the patient's abdominopelvic sonography was normal. The patient had no family history of similar skin lesions and gave no history of any chronic inflammatory skin diseases or viral conditions. Therefore, the appearance of the Leser-Trelat sign after COVID- 19 infection was a possibility in this patient. The role of transforming growth factor-alpha and tumour necrosis-alpha in eruptive seborrhoeic keratoses, as well as in COVID-19 infection, can be a common area of interest to explore in the aetiology of this entity.

Pre-Endoscopic viral screening of children during the Covid-19 pandemic

Aim: Transmission of SARS-CoV-2 infection can easily occur through direct or close contact with infected people, just as with other infectious diseases. Therefore, it is important to detect it prior to the intervention for protecting the health of both the healthcare worker and the patient. In the study, it was aimed to determine the seropositivity rates of acute respiratory syndrome coronavirus 2, hepatitis A, hepatitis B, hepatitis C virus and human immune deficiency virus infections among children who underwent gastrointestinal endoscopy. Material(s) and Method(s): The study was conducted at the Department of Pediatric Gastroenterology of the Karabuk University in Turkey from December 2020 to December of 2021. A total of 175 children were included in the study. The study was divided into three age groups as follows: 1-6 years old, 7-12 years old and 13-18 years old. All children were screened for acute respiratory syndrome coronavirus 2, hepatitis A, hepatitis B, hepatitis C virus and human immune deficiency virus infections. Result(s): The median age was 12.5 years (1-18). The seroprevalence of acute respiratory syndrome coronavirus 2, Anti-HAV IgM, Anti-HAV IgG, HBsAg, Anti-HBs, Anti-HCV, Anti-HIV and were detected 0.57%, 0.57%, 42.8%, 0%, 58.8%, 1.1% and 0 % respectively. The seroprevalence of Anti-HAV IgG was significantly higher in children aged 1-6 years than in the group aged 13-18 years (95.7 vs 25.2: chi2=48.1, p=0.001). Discussion(s): Although seroprevalence rates prior to endoscopy were low in this study, viral screening, except for hepatitis A infection, is essential for the safety of both patients and healthcare.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Gas leakages from gastrointestinal endoscopy system-its visualization and semi-quantification utilizing schlieren optical system in the swine models.

BACKGROUND AND AIMS: With the global epidemic of SARS-CoV-2, there has been a growing concern regarding the risk of aerosol exposure to healthcare workers and patients during medical/surgical interventions. The Schlieren device is capable of visualizing fine gas-flows by using refractive index differences in the medium. We aimed to reveal the existence of gas leakage from gastro-intestinal endoscopy system by utilizing Schlieren device and to clarify the factors which relates to the amount of gas leakage. METHODS: The experiments were performed on the excised swine stomach while maintaining a constant pressure environment in the stomach. The System Schlieren (SS100,KatoKoken) was used to visualize possible gas leakages from forceps plugs of endoscopy. We attempted to semi-quantify the leakage by referring to the image of the gas from the forceps plug and by measuring the initial velocity and diffusion area of the leakage. RESULTS: Regardless of the type of forceps plugs, a certain amount of leakage was detected during both insertion and removal of forceps. The initial velocity and the diffusion area of the leakage increased with the increase in intragastric pressure. Semi-quantitative comparison showed that there was a difference in the amount of gas leakage among various forceps plugs. Furthermore, the amount of gas leakage was significantly greater in the forceps plugs that were used repeatedly. CONCLUSION: It was possible to visualize gas leakages from the gastrointestinal endoscope system using the Schlieren optical device. Avoiding too high intragastric pressure and not using deteriorated plugs may reduce the risk of aerosol exposure.

Anbar 2nd International Medical Conference, AIMCO 2022

The proceedings contain 24 papers. The topics discussed include: a newly synthetic compound of ibuprofen and gabapentin as a novel analgesic and anti-inflammatory therapeutic agent: a pharmacological study in rats' experimental models;acute aortic dissection: clinical characteristics and outcomes;assessment of diagnostic procedures and tools of COVID-19 among Iraqi patients: a systematic review;association between alcohol consumption, cigarette smoking, and helicobacter pylori infection in Iraqi patients submitted to gastrointestinal endoscopy;association of white blood cell counts, procalcitonin, C-reactive protein, interleukin-6, troponin, and ferritin with mortality in severe COVID-19;bilateral intratonsillar abscesses: a first case report in an adult patient;and disaster medicine curricula in Saudi Arabian medical schools.

ENDOSCOPY SITUATION AND GASTROENTEROLOGICAL MEDICAL CARE IN BHUTAN

Since October 2019, I worked for 2 years as an endoscopist at Jigme Dorji Wangchuck National Referral Hospital, located at Thimphu, Bhutan. Though this period overlapped the COVID-19 pandemic, I was involved in approximately 4, 000 cases of upper gastrointestinal (GI) endoscopy, 350 cases of colonoscopy, and 140 cases of ERCP. In Bhutan, the infection rate of Helicobacter pylori is higher than 70%, and even among young adults the rate is alarming. Gastric cancer is a malignant disease with the highest mortality and is mostly detected in advanced stages. Therefore, a national flagship project that takes aim at the eradication of H. pylori and early detection of gastric cancer has been recently created. Endoscopic health examinations named Endoscopy Camp are being conducted every weekend. In this article, we showed how upper GI endoscopy, colonoscopy, and ERCP is developing in Bhutan, which still lacks sufficient medical resources. We hope more Japanese endoscopists take an active interest in developing countries' medical care. Copyright © 2022 Japan Gastroenterological Endoscopy Society. All rights reserved.

Impact of COVID-19 pandemic on the diagnosis of gastrointestinal cancer

Coronavirus disease 2019 (COVID-19) pandemic has had a major impact every aspect of life all over the world with severe consequences. This study aimed to evaluate the impact of COVID-19 pandemic on the number of gastrointestinal endoscopy procedures and resulting cancer detection rate at our center. This was a retrospective and single-center study. The 6-month period from March 11 to September 11, 2020 (lockdown period) was compared with the same months of 2018 and 2019 (pre-pandemic period) in terms of the number of endoscopic procedures performed at our gastroenterology unit, malignancy detection rate and clinicopathological characteristics of patients. The data were analyzed using the SPSS Statistics 22.0 software package. A 33% reduction was observed in the number of endoscopic procedures during the pandemic compared to pre-pandemic years and the difference was significant (p<0.001). Despite the decrease in endoscopic activity, cancer detection increased during the pandemic (p=0.057). Male sex and age 65 years or older were non-significantly more common among patients diagnosed with cancer on endoscopic biopsy during the pandemic compared to the pre-pandemic era but the difference was non-significant (p=0.983, p=0.241). Patients diagnosed with cancer during the pandemic were more likely to present at an advanced stage. The most common cancers were those originating from the colon and rectum and adenocarcinoma was the most prevalent pathological diagnosis. The distributions of tumor location and pathological diagnosis of the patients were not significantly different among the years (p=0,494, p=0,849). In conclusion, a reduction was found in the overall number of endoscopic procedures during the lockdown. However, despite the decrease in the number of procedures, cancer detection rate and the rate of admission at advanced stages were increased at a non-significant level. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.

Gastrointestinal Manifestations in Covid-19:A Prospective Study

Introduction: Gastrointestinal manifestations are common during coronavirus disease (COVID-19) infection. They can occur before respiratory symptoms, resulting in a diagnostic delay and an increased risk of disease transmission. Aims & Methods: The current study reports major gastrointestinal manifestations as initial symptoms of COVID-19. This prospective, descriptive, cross-sectional, and single-center study of 713 cases was conducted in a field hospital over a 5-week period from June 21 to July 25, 2020. Result(s): The average age of our patients was 31.95 years. Clinically, on admission, anorexia was the main symptom, present in 32.3% of patients. Gastrointestinal manifestations were present in 14.9% of patients, including watery diarrhea in 8.6% of cases, nausea and/or vomiting in 4.6% of cases, and abdominal pain in 1.6% of cases. Six hundred thirty-two patients were treated in accordance with one of the two therapeutic protocols recommended by the National Ministry of Health. The treatment-related effects that occurred in 61.4% of patients were primarily digestive in 55.3% of cases. In multivariate analysis, following adjustment of the studied parameters, only the presence of gastroin- testinal manifestations (odds ratio [OR]: 1.478 confidence interval [CI]: 1.286-1.698;p < 0.001) and treat- ment side effects (OR = 1.069, CI: 1.020-1.119, p = 0.005) altered the rate of negative polymerase chain reaction (PCR) tests on day 10. Conclusion(s): Gastrointestinal manifestations are common during COVID- 19 and seem to be linked to a longer duration of disease. SARS-CoV-2 (the causative virus of COVID-19) can persist in the digestive tract, with the possibility of fecal-oral transmission. Therefore, hygiene is extremely important, espe- cially handwashing and strict precautions when performing gastrointestinal endoscopy and handling stools from infected patients.

Effect of COVID-19 on gastrointestinal endoscopy practice: a systematic review.

BACKGROUND: Since the emergence of the novel corona virus (SARS-Cov-2) in the late 2019 and not only the endoscopy practice and training but also the health care systems around the globe suffers. This systematic review focused the impact of Corona Virus Disease (COVID-19) on the endoscopy practice. METHODS: A web search of different databases combining different search terms describing the endoscopy practice and the COVID-19 pandemic was done. Articles were screened for selection of relevant articles in two steps: title and abstract step and full-text screening step, by two independent reviewers and any debate was solved by a third reviewer. RESULTS: Final studies included in qualitative synthesis were 47. The data shown in the relevant articles were evident for marked reduction in the volume of endoscopy, marked affection of colorectal cancer screening, impairments in the workflow, deficiency in personal protective equipment (PPE) and increased likelihood of catching the infection among both the staff and the patients. CONCLUSION: The main outcomes from this review are rescheduling of endoscopy procedures to be suitable with the situation of COVID-19 pandemic in each Country. Also, the endorsement of the importance of PPE use for health care workers and screening of COVID-19 infection pre-procedure.Key messagesThe data focussing Gastrointestinal Endoscopy and COVID-19 emerged from different areas around the globe. The data presented on the published studies were heterogeneous. However, there were remarkable reductions in the volume of GI endoscopy worldwideStaff reallocation added a burden to endoscopy practiceThere was a real risk for COVID-19 spread among both the staff and the patients.

Involvement of the digestive system in covid-19. A review. / Afectación del aparato digestivo en la covid-19. Una revisión sobre el tema.

The SARS-CoV-2 pandemic is leading to high mortality and a global health crisis. The primary involvement is respiratory; however, the virus can also affect other organs, such as the gastrointestinal tract and liver. The most common symptoms are anorexia and diarrhea. In about half of the cases, viral RNA could be detected in the stool, which is another line of transmission and diagnosis. covid19 has a worse prognosis in patients with comorbidities, although there is not enough evidence in case of previous digestive diseases. Digestive endoscopies may give rise to aerosols, which make them techniques with a high risk of infection. Experts and scientific organizations worldwide have developed guidelines for preventive measures. The available evidence on gastrointestinal and hepatic involvement, the impact on patients with previous digestive diseases and operating guidelines for Endoscopy Units during the pandemic are reviewed.

GRANULOMATOSIS POLYANGIITIS MASQUERADING AS COVID-19: A DIAGNOSTIC DILEMMA DURING THE PANDEMIC

SESSION TITLE: Pulmonary Manifestations of Systemic Disease Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Granulomatous polyangiitis (GPA), previously known as Wegener's granulomatosis, is a rare syndrome characterized by inflammation of small and medium sized vessels. The clinical presentation can be very heterogenous and differentiation from an infectious disease can be challenging initially. Here, we present a case of a young male presenting with respiratory symptoms during the pandemic, presumed to have coronavirus disease 2019 (COVID-19) though after extensive workup was later diagnosed with GPA. CASE PRESENTATION: A 19-year-old male presented to the emergency department (ED) with complaints of low-grade fever and dry cough for one week. He reported having abdominal pain, fatigue, loss of appetite and polyarthralgia. An outpatient upper gastrointestinal endoscopy revealed gastritis and duodenitis. In the ED, his vitals included a temperature of 101.8°F, blood pressure of 115/65mmHg, heart rate of 99/min, respiratory rate of 18/minute and oxygen saturation of 99% on room air. COVID-19 testing was negative. A computerized tomography of the chest revealed extensive ground glass opacities. He was presumptively diagnosed with COVID-19 and started on dexamethasone therapy along with azithromycin for atypical pneumonia. However multiple tests for SARS-CoV-2 were negative. Another consideration was COVID-19 induced multisystem inflammatory syndrome given the patients young age. Infectious workup included negative testing for human immunodeficiency virus, Legionella, tick borne diseases and mycoplasma. As febrile episodes continued, he developed microcytic anemia, microscopic hematuria, and petechial rash on his ankles. Antinuclear antigen screen was negative, but C-antineutrophil cytoplasmic and anti-proteinase-3 antibodies were positive. Renal biopsy revealed GPA. He was prescribed pulse dose steroids and transitioned to immunotherapy. DISCUSSION: GPA is a challenging diagnosis given multiple system involvement, though early identification and initiation of treatment are important to prevent long term sequalae. In our case, acute onset febrile illness and pulmonary ground glass opacities led to repeated COVID-19 testing potentially delaying the diagnosis. Ultimately, the correct diagnosis was made and confirmed on renal biopsy. We believe our case highlight the importance of keeping a broad differential and considering vasculitis in these situations for prompt diagnosis. CONCLUSIONS: GPA can often mimic respiratory infectious processes, a high index of suspicion is necessary for timely diagnosis. Reference #1: Selvaraj V, Moustafa A, Dapaah-Afriyie K, et alCOVID-19-induced granulomatosis with polyangiitis. BMJ Case Reports CP 2021;14:e242142 Reference #2: Qurratulain, Q., Ahmed, A., & Jones, Q. (2021). Lesson of the month: Severe granulomatosis with polyangiitis (GPA): a diagnostic challenge during the COVID-19 pandemic. Clinical Medicine, 21(1), 79. DISCLOSURES: No relevant relationships by Aamna Khan No relevant relationships by Usama Sadiq No relevant relationships by Rehan Saeed

Assessment of COVID-19 response on hepatitis B virus and hepatitis C virus prevention and treatment from nationwide survey in Japan

Objectives: Elimination of Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) require continuous interventions. This study aimed to assess the response and impact of COVID-19 on Hepatitis prevention and treatment in Japan. This international joint research was conducted by three research groups of Ministry of Health, Labour and Welfare (MHLW) in Japan with The Task Force for Global Health and in cooperation with Japan Society of Hepatology (JSH). Materials and Methods: We have conducted this cross-sectional study by questionnaire survey both in Japanese and English language on online Microsoft forms platform from 24 August to 03 October 2021. The questionnaire was designed to address the impact of COVID-19 on hepatitis treatment, testing, screening;mitigation strategies;response to COVID-19;and perceived benefits of COVID-19. Results: Total 196 medical doctors have participated from 35 prefectures among them 49.5% are in administrative positions. 55.6% of participants responded about no interruption while 11.7% reported supply chain disruptions during the survey period. 1-25% decrease in HBV screening, testing was reported by 38.8% and 43.9% participants, respectively. Decease of 1-25% in HCV screening, testing and were reported by 39.8% and 43.4% participants, respectively. However, no decline to initiate HBV and HCV treatment was reported by 53.6% and 45.4%, respectively. But extend of hospital visits was reported by 65.3%. The survey response illustrated the decrease in patients' imaging (65.8%), lab testing (68.4%), HCC screening (55.1%), gastrointestinal endoscopy (87.2%), and liver biopsy (43.4%). Patient anxiety and fear (67.4%), loss of staff to COVID-19 response (49.0%), and limited availability of staff (46.4%) are responded as challenges to resume services to pre-COVID-19 level. Conclusion: A greater decrease has been noticed in HBV and HCV testing, screening, and other associated liver diseases than treatment initiation in Japan. However, anxiety and fear of patients, lack of staff and facilities are major challenges to overcome such situation.