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2.
Rev Esp Enferm Dig ; 112(4): 319-322, 2020 04.
Article in English | MEDLINE | ID: covidwho-1264719

ABSTRACT

Infection with SARS-CoV-2 coronavirus, and the disease this agent may induce, are a cause of notable concern for the general population and, of course, among our professionals and patients. Gastrointestinal (GI) endoscopy is a high-risk diagnostic-therapeutic procedure in the case of upper GI examinations, and a moderate to low-risk intervention when involving lower GI explorations. The presence of SARS-CoV-2 RNA in the feces of patients infected with the virus, and occasionally in colonic biopsy samples, has been consistently documented. In fact, viral elimination in the feces may be more prolonged than viral identification in respiratory tract secretions. Furthermore, viral transmission may occur in asymptomatic individuals. However, as of this moment no information has been reported on the possibility of viral transmission, even to professionals, via this route.


Subject(s)
Betacoronavirus , Coronavirus Infections , Endoscopy, Gastrointestinal/methods , Pandemics , Pneumonia, Viral , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Feces/virology , Gastroenterology/trends , Humans , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Virus Shedding
4.
Rom J Intern Med ; 59(2): 166-173, 2021 Jun 01.
Article in English | MEDLINE | ID: covidwho-1171557

ABSTRACT

Introduction. An on-going coronavirus disease 2019 (COVID-19) has become a challenge all over the world. Since an endoscopy unit and its staff are at potentially high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we conducted a survey for the management of the gastrointestinal endoscopic practice, personal protective equipment (PPE), and risk assessment for COVID-19 during the pandemic at multiple facilities.Methods. The 11-item survey questionnaire was sent to representative respondent of Department of Gastroenterology, Osaka City University Hospital, and its 19 related facilities.Results. A total of 18 facilities submitted valid responses and a total of 373 health care professionals (HCPs) participated. All facilities (18/18: 100%) were screening patients at risk for SARS-CoV-2 infection before endoscopy. During the pandemic, we found that the total volume of endoscopic procedures decreased by 44%. Eleven facilities (11/18: 61%) followed recommendations of the Japan Gastroenterological Endoscopy Society (JGES); consequently, about 35%-50% of esophagogastroduodenoscopy and colonoscopy were canceled. Mask (surgical mask or N95 mask), face shield/goggle, gloves (one or two sets), and gown (with long or short sleeves) were being used by endoscopists, nurses, endoscopy technicians, and endoscope cleaning staff in all the facilities (18/18: 100%). SARS-CoV-2 infection risk assessment of HCPs was conducted daily in all the facilities (18/18: 100%), resulting in no subsequent SARS-CoV-2 infection in HCPs.Conclusion. COVID-19 has had a dramatic impact on the gastrointestinal endoscopic practice. The recommendations of the JGES were appropriate as preventive measures for the SARSCoV-2 infection in the endoscopy unit and its staff.


Subject(s)
COVID-19 , Endoscopy, Gastrointestinal , Infection Control , Occupational Exposure/prevention & control , Risk Assessment , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Endoscopy, Gastrointestinal/methods , Endoscopy, Gastrointestinal/standards , Health Care Surveys , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Japan/epidemiology , Personal Protective Equipment/classification , Personal Protective Equipment/standards , Personal Protective Equipment/supply & distribution , SARS-CoV-2 , Safety Management/trends
6.
Am J Gastroenterol ; 116(1): 202-205, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1068052

ABSTRACT

INTRODUCTION: During the coronavirus disease 2019 pandemic, whether endoscopy generates aerosols needs to be determined. METHODS: In patients undergoing upper gastrointestinal endoscopy with an enclosure covering their heads, 0.3-10-µm aerosols were measured for 60 seconds before, during, and after endoscopy by an optical counter. Whether aerosols increased in the situation with and without endoscopy was examined. RESULTS: The analysis included 103 consecutive patients undergoing endoscopy and 90 control patients. Aerosols increased significantly during endoscopy compared with the control group. Body mass index and burping were significant factors related to increased aerosols during endoscopy. DISCUSSION: Upper gastrointestinal endoscopy was an aerosol-generating procedure.


Subject(s)
Aerosols/analysis , COVID-19 , Disease Transmission, Infectious/prevention & control , Endoscopy, Gastrointestinal , Gastrointestinal Diseases/diagnosis , Infection Control , Respiratory Protective Devices/virology , Respiratory System , COVID-19/epidemiology , COVID-19/prevention & control , Endoscopy, Gastrointestinal/adverse effects , Endoscopy, Gastrointestinal/methods , Female , Humans , Infection Control/instrumentation , Infection Control/methods , Japan/epidemiology , Male , Materials Testing , Middle Aged , Outcome Assessment, Health Care , Respiratory System/physiopathology , Respiratory System/virology , SARS-CoV-2
7.
Curr Opin Gastroenterol ; 37(1): 23-29, 2021 01.
Article in English | MEDLINE | ID: covidwho-1031398

ABSTRACT

PURPOSE OF REVIEW: The COVID-19 pandemic has impacted the practicing gastroenterologist in several ways. Although majority of COVID-19 patients present with respiratory symptoms, gastrointestinal symptoms are also seen. COVID-19 has also disrupted gastrointestinal endoscopy services in numerous ways. There are also concerns regarding the impact of these changes on gastrointestinal cancer screening and management of chronic gastrointestinal diseases. The purpose of this review is to provide an overview of the implications of COVID-19 for the practicing gastroenterologist. RECENT FINDINGS: COVID-19 patients can have gastrointestinal symptoms including diarrhea, nausea and vomiting, abdominal pain and anorexia. Separate from the management of COVID-19 patients, there has been a reduction in endoscopy volume worldwide. This has also resulted in reduction/cessation of in-person clinic visits and an increasing use of telemedicine services. In addition, patients with certain chronic diseases like chronic liver disease or inflammatory bowel disease may have worse outcomes during the COVID-19 pandemic. SUMMARY: Gastroenterologists need to rapidly adapt to the challenges being faced and need to make both systems and practice-based changes to the endoscopy unit and outpatient clinic practices. Gastroenterologists should stay up-to-date with the rapidly evolving literature regarding gastrointestinal symptoms in COVID-19 patients as well as its impact on chronic gastrointestinal illnesses.


Subject(s)
COVID-19 , Gastroenterology/methods , Gastrointestinal Diseases , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , COVID-19 Testing , Chronic Disease , Endoscopy, Gastrointestinal/methods , Gastroenterology/organization & administration , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/therapy , Gastrointestinal Diseases/virology , Global Health , Health Care Rationing/methods , Health Services Accessibility , Humans , Infection Control/methods , Practice Patterns, Physicians' , Telemedicine/methods
8.
A A Pract ; 14(14): e01371, 2020 Dec 21.
Article in English | MEDLINE | ID: covidwho-992617

ABSTRACT

Respiratory failure in coronavirus disease 2019 (COVID-19) patients with prolonged endotracheal intubation may require a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement to facilitate recovery. Both techniques are considered high-risk aerosol-generating procedures and present a heightened risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for operating room personnel. We designed, simulated, and implemented a portable, continuous negative pressure, operative field barrier system using standard equipment available in hospitals to enhance health care provider safety during high-risk aerosol-generating procedures.


Subject(s)
COVID-19/complications , COVID-19/transmission , Endoscopy, Gastrointestinal/methods , Gastrostomy/methods , Minimally Invasive Surgical Procedures/methods , Tracheostomy/methods , Aerosols , Air Pressure , COVID-19/prevention & control , Enteral Nutrition , Filtration , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Male , Middle Aged , Operating Rooms , Patient Isolation
9.
World J Gastroenterol ; 26(38): 5749-5758, 2020 Oct 14.
Article in English | MEDLINE | ID: covidwho-902690

ABSTRACT

Since the outbreak of the coronavirus disease 2019 (COVID-19), various measures have been taken to protect against the infection. As droplet and contact transmission are the main routes of COVID-19 infection, endoscopy centers are considered to be high-risk areas for exposure to COVID-19. We have undertaken several countermeasures in our endoscopic center during the pandemic, and have gained significant experience in terms of prevention and control of COVID-19. We here present our experience and strategies adopted for preventing hospital infection in our endoscopy center during the COVID-19 pandemic. We describe our management of the environment, endoscope, patients, and medical staff, and our self-made masks.


Subject(s)
Disinfection , Endoscopy, Gastrointestinal/methods , Environment Design , Infection Control/organization & administration , Personnel Staffing and Scheduling , Betacoronavirus , COVID-19 , China , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Humans , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS-CoV-2
11.
J Crohns Colitis ; 14(14 Suppl 3): S791-S797, 2020 Oct 21.
Article in English | MEDLINE | ID: covidwho-883090

ABSTRACT

Endoscopy is an essential component in the management of inflammatory bowel disease [IBD]. There is a risk of SARS-CoV-2 transmission during endoscopic procedures. The International Organization for the study of IBD [IOIBD] has developed 11 position statements, based on an online survey, that focus on how to prioritise endoscopies in IBD patients during the COVID-19 pandemic, alternative modes for disease monitoring, and ways to triage the high number of postponed endoscopies after the pandemic. We propose to pre-screen patients for suspected or confirmed COVID-19 and test for SARS-CoV-2 before endoscopy if available. High priority endoscopies during pandemic include acute gastrointestinal bleed, acute severe ulcerative colitis, new IBD diagnosis, cholangitis in primary sclerosing cholangitis, and partial bowel obstruction. Alternative modes of monitoring using clinical symptoms, serum inflammatory markers, and faecal calprotectin should be considered during the pandemic. Prioritising access to endoscopy in the post-pandemic period should be guided by control of COVID-19 in the local community and availability of manpower and personal protective equipment. Endoscopy should be considered within 3 months after the pandemic for patients with a past history of dysplasia and endoscopic resection for dysplastic lesion. Endoscopy should be considered 3-6 months after the pandemic for assessment of postoperative recurrence or new biologic initiation. Endoscopy can be postponed until after 6 months of pandemic for routine IBD surveillance and assessment of mucosal healing.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Endoscopy, Gastrointestinal/standards , Health Care Rationing/standards , Infection Control/standards , Inflammatory Bowel Diseases/diagnostic imaging , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Triage/standards , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/standards , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Endoscopy, Gastrointestinal/methods , Global Health , Health Care Rationing/methods , Health Services Accessibility/standards , Humans , Infection Control/methods , Inflammatory Bowel Diseases/complications , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Triage/methods
13.
Indian J Gastroenterol ; 39(3): 220-231, 2020 06.
Article in English | MEDLINE | ID: covidwho-710811

ABSTRACT

The world is witnessing a serious public health threat in the wake of the third corona virus pandemic, a novel corona virus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). The Corona Virus Disease-19 (COVID-19) is not limited to the respiratory system but has widespread involvement including the gastrointestinal (GI) tract and liver, with evidence of prolonged fecal shedding and feco-oral transmission. This finding has stirred up a hornet's nest of not only a newer modality of the spread of the virus but also a risk of the unpredictable duration of the infective potential of the shedders. We reviewed the literature on fecal shedding and possible implications on prevention and surveillance strategies. The pandemic is changing the management of underlying chronic diseases such as inflammatory bowel disease (IBD) and other diseases. Moreover, for the gastroenterologist, doing endoscopic procedures in this COVID-19 era poses a high risk of contamination, as it is an aerosol-generating procedure. There is a daily influx of data on this disease, and multiple societies are coming up with various recommendations. We provide a comprehensive review of all the reported GI manifestations of COVID-19 infection and the side effects of confounding drugs. We have summarized the management recommendations for diseases such as IBD with COVID-19 and nutritional recommendations and provided a concise review of the endoscopy guidelines by the various societies. This review provides a comprehensive account and a lucid guide covering various aspects of gastroenterology practice during this COVID-19 pandemic.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Endoscopy, Gastrointestinal , Feces/virology , Gastroenterology , Inflammatory Bowel Diseases , Pandemics , Pneumonia, Viral , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Disease Management , Endoscopy, Gastrointestinal/adverse effects , Endoscopy, Gastrointestinal/methods , Gastroenterology/methods , Gastroenterology/trends , Gastrointestinal Tract/virology , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS-CoV-2
15.
Arch Dis Child ; 105(12): 1186-1191, 2020 12.
Article in English | MEDLINE | ID: covidwho-690253

ABSTRACT

BACKGROUND: COVID-19 has impacted on healthcare provision. Anecdotally, investigations for children with inflammatory bowel disease (IBD) have been restricted, resulting in diagnosis with no histological confirmation and potential secondary morbidity. In this study, we detail practice across the UK to assess impact on services and document the impact of the pandemic. METHODS: For the month of April 2020, 20 tertiary paediatric IBD centres were invited to contribute data detailing: (1) diagnosis/management of suspected new patients with IBD; (2) facilities available; (3) ongoing management of IBD; and (4) direct impact of COVID-19 on patients with IBD. RESULTS: All centres contributed. Two centres retained routine endoscopy, with three unable to perform even urgent IBD endoscopy. 122 patients were diagnosed with IBD, and 53.3% (n=65) were presumed diagnoses and had not undergone endoscopy with histological confirmation. The most common induction was exclusive enteral nutrition (44.6%). No patients with a presumed rather than confirmed diagnosis were started on anti-tumour necrosis factor (TNF) therapy.Most IBD follow-up appointments were able to occur using phone/webcam or face to face. No biologics/immunomodulators were stopped. All centres were able to continue IBD surgery if required, with 14 procedures occurring across seven centres. CONCLUSIONS: Diagnostic IBD practice has been hugely impacted by COVID-19, with >50% of new diagnoses not having endoscopy. To date, therapy and review of known paediatric patients with IBD has continued. Planning and resourcing for recovery is crucial to minimise continued secondary morbidity.


Subject(s)
COVID-19 , Child Health Services , Endoscopy, Gastrointestinal , Health Services Accessibility , Inflammatory Bowel Diseases , Tumor Necrosis Factor Inhibitors/therapeutic use , Adolescent , Ambulatory Care Facilities/statistics & numerical data , Ambulatory Care Facilities/supply & distribution , COVID-19/epidemiology , COVID-19/prevention & control , Child , Child Health Services/statistics & numerical data , Child Health Services/supply & distribution , Communicable Disease Control/methods , Endoscopy, Gastrointestinal/methods , Endoscopy, Gastrointestinal/statistics & numerical data , Enteral Nutrition/methods , Enteral Nutrition/statistics & numerical data , Female , Health Care Surveys , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Health Services Needs and Demand , Humans , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Male , SARS-CoV-2 , United Kingdom/epidemiology
17.
Dig Endosc ; 32(5): 651-657, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-647831

ABSTRACT

Some situations may require endoscopy during the COVID-19 (Coronavirus Disease 2019) pandemic. Here, we describe the necessary precautions in the form of clinical questions and answers (Q&A) regarding the safe deployment of gastrointestinal endoscopy in such situations while protecting endoscopy staff and patients from infection. Non-urgent endoscopy should be postponed. The risk of infection in patients should be evaluated in advance by questionnaire and body temperature. The health of staff must be checked every day. Decisions to employ endoscopy should be based on the institutional conditions and aims of endoscopy. All endoscopic staff need to wear appropriate personal protective equipment (PPE). The endoscope and other devices should be cleaned and disinfected after procedures in accordance with the relevant guidelines. Optimal management of the endoscopy unit is required. Endoscopy for infected patients or those with suspected infection demands exceptional caution. When a patient who undergoes endoscopy is later found to have COVID-19, the members of staff involved are considered exposed to the virus and must not work for at least 14 days if their PPE is considered insufficient. When PPE resources are limited, some equipment may be used continuously throughout a shift as long as it is not contaminated. Details of the aforementioned protective measures are described.


Subject(s)
Coronavirus Infections/prevention & control , Endoscopy, Gastrointestinal/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/epidemiology , Endoscopy, Gastrointestinal/adverse effects , Female , Humans , Infection Control/methods , Male , Occupational Health , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Safety Management , Surveys and Questionnaires
20.
Ann Agric Environ Med ; 27(2): 171-174, 2020 Jun 19.
Article in English | MEDLINE | ID: covidwho-614680

ABSTRACT

INTRODUCTION: On 11 March 2020, the Director-General of the World Health Organization (WHO) announced COVID-19 (Coronavirus Disease 2019) as a global pandemic Currently, no vaccines are available and there is little evidence of the efficacy of potential therapeutic agents. Furthermore, there is presumably no pre-existing immunity in the population to the new coronavirus, and it is as-sumed that everyone in the population is susceptible. OBJECTIVE: The aim of the procedures described in the article is to minimize the risk of human-to-human transmission of the SARS-CoV-2 (Severe acute respiratory syndrome - coronavirus 2) virus during procedures carried out in endoscopic laboratories. BRIEF DESCRIPTION OF THE STATE OF THE ART: SARS-CoV-2 infection can be asymptomatic, cause severe pneumonia, or lead to death. Symptoms of COVID-19 range from none (asymptomatic) to severe pneumonia and it can be fatal. Case studies to-date indicate that this infection causes a mild illness (i.e. pneumonia or mild pneumonia) in approximately 80% of cases, and most cases recove; 14% have a more severe illness, 6% experience a critical illness. The vast majority of the most serious illnesses and deaths have occurred among the elderly and people with other chronic underlying diseases. Average progression times include: • in mild cases: from the onset of symptoms to recovery in almost 2 weeks; • in severe cases: from the onset of symptoms to recovery in 3-6 weeks, and from symptoms to death in 2-8 weeks. CONCLUSIONS: Special precautions should be taken and procedures followed when performing invasive medical procedures in endoscopic laboratories in patients with specific or clinically probable SARS-CoV-2 infection. This article contains up-to-date information as at 04/04/2020.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Endoscopy, Gastrointestinal/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , COVID-19 , Coronavirus Infections/virology , Disinfection , Humans , Medical Waste Disposal , Pneumonia, Viral/virology , SARS-CoV-2
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