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1.
Gastroenterology ; 161(3): 1011-1029.e11, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1240783

ABSTRACT

This guideline provides updated recommendations on the role of preprocedure testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in individuals undergoing endoscopy in the post-vaccination period and replaces the prior guideline from the American Gastroenterological Association (AGA) (released July 29, 2020). Since the start of the pandemic, our increased understanding of transmission has facilitated the implementation of practices to promote patient and health care worker (HCW) safety. Simultaneously, there has been increasing recognition of the potential harm associated with delays in patient care, as well as inefficiency of endoscopy units. With widespread vaccination of HCWs and the general population, a re-evaluation of AGA's prior recommendations was warranted. In order to update the role of preprocedure testing for SARS-CoV2, the AGA guideline panel reviewed the evidence on prevalence of asymptomatic SARS-CoV2 infections in individuals undergoing endoscopy; patient and HCW risk of infections that may be acquired immediately before, during, or after endoscopy; effectiveness of COVID-19 vaccine in reducing risk of infections and transmission; patient and HCW anxiety; patient delays in care and potential impact on cancer burden; and endoscopy volumes. The panel considered the certainty of the evidence, weighed the benefits and harms of routine preprocedure testing, and considered burden, equity, and cost using the Grading of Recommendations Assessment, Development and Evaluation framework. Based on very low certainty evidence, the panel made a conditional recommendation against routine preprocedure testing for SARS-CoV2 in patients scheduled to undergo endoscopy. The panel placed a high value on minimizing additional delays in patient care, acknowledging the reduced endoscopy volumes, downstream impact on delayed cancer diagnoses, and burden of testing on patients.


Subject(s)
COVID-19 , Endoscopy , Mass Screening/standards , Pandemics , COVID-19/diagnosis , COVID-19/therapy , COVID-19 Vaccines/therapeutic use , Endoscopy/standards , Gastroenterology/standards , Humans , SARS-CoV-2 , Vaccination
2.
Otolaryngol Clin North Am ; 54(1): 11-23, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1235961

ABSTRACT

A new era of surgical visualization and magnification is poised to disrupt the field of otology and neurotology. The once revolutionary benefits of the binocular microscope now are shared with rigid endoscopes and exoscopes. These 2 modalities are complementary. The endoscope improves visualization of the hidden recesses through the external auditory canal or canal-up mastoidectomy. The exoscope provides an immersive visual experience and superior ergonomics compared with binocular microscopy. Endoscopes and exoscopes are poised to disrupt the standard of care for surgical visualization and magnification in otology and neurotology.


Subject(s)
COVID-19 , Endoscopes/standards , Endoscopy/instrumentation , Neurotology/instrumentation , Otolaryngology/instrumentation , Pandemics , Ear Canal/surgery , Endoscopy/standards , Equipment Design/standards , Humans , Mastoidectomy/instrumentation , Microsurgery/instrumentation , Minimally Invasive Surgical Procedures/instrumentation , Neurosurgical Procedures/instrumentation , Neurotology/standards , Otolaryngology/standards , Standard of Care/standards , United States
3.
Turk J Gastroenterol ; 32(2): 113-115, 2021 02.
Article in English | MEDLINE | ID: covidwho-1219172

ABSTRACT

In the midst of Coronavirus-19 (COVID-19) pandemic, endoscopic procedures have been separated for only urgent and semi-urgent cases for the last few months to prevent transmission in endoscopy units. This approach will perhaps resolve the burden of elective procedures in the months ahead of us. As we observe a downtrend in new cases of COVID-19 in Turkey, a strategy for reopening endoscopy units is required. We are stepping into a time period where we should not only re-provide the essential services to our patients but also maintain the safety of healthcare workers and preserve the valuable personal protective equipment as well. Herein, we aim to share the available knowledge in performing endoscopy during the pandemic and the set-up plan of a tertiary center in Istanbul for reopening the endoscopy unit in the era of the COVID-19 pandemic.


Subject(s)
COVID-19/prevention & control , Endoscopy/standards , Infection Control/standards , Tertiary Care Centers/standards , Health Personnel/standards , Humans , Infection Control/methods , Personal Protective Equipment/standards , Personal Protective Equipment/supply & distribution , SARS-CoV-2 , Turkey
4.
Clin Otolaryngol ; 46(4): 809-815, 2021 07.
Article in English | MEDLINE | ID: covidwho-1138108

ABSTRACT

OBJECTIVES: Many routine sinonasal procedures utilising powered instruments are regarded as aerosol-generating. This study aimed to assess how different instrument settings affect detectable droplet spread and patterns of aerosolised droplet spread during simulated sinonasal surgery in order to identify mitigation strategies. DESIGN: Simulation series using three-dimensional (3-D) printed sinonasal model. Fluorescein droplet spread was assessed following microdebriding and drilling of fluorescein-soaked grapes and bones, respectively. SETTING: University dry lab. PARTICIPANTS: 3-D printed sinonasal model. MAIN OUTCOME MEASURES: Patterns of aerosolised droplet spread. RESULTS AND CONCLUSION: There were no observed fluorescein droplets or splatter in the measured surgical field after microdebridement of nasal polyps at aspecific irrigation rate and suction pressure. Activation of the microdebrider in the presence of excess fluid in the nasal cavity (reduced or blocked suction pressure, excessive irrigation fluid or bleeding) resulted in detectable droplet spread. Drilling with either coarse diamond or cutting burs resulted in detectable droplets and greater spread was observed when drilling within the anterior nasal cavity. High-speed drilling is a high-risk AGP but the addition of suction using a third hand technique reduces detectable droplet spread outside the nasal cavity. Using the instrument outside the nasal cavity inadvertently, or when unblocking, produces greater droplet spread and requires more caution.


Subject(s)
COVID-19/epidemiology , Disease Transmission, Infectious/prevention & control , Endoscopy/standards , Otorhinolaryngologic Surgical Procedures/standards , Paranasal Sinuses/surgery , SARS-CoV-2 , Cadaver , Humans , Pandemics
8.
Dig Dis Sci ; 66(8): 2545-2554, 2021 08.
Article in English | MEDLINE | ID: covidwho-758086

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the practice of endoscopy, but characteristics of COVID patients undergoing endoscopy have not been adequately described. AIMS: To compare findings, clinical outcomes, and patient characteristics of endoscopies performed during the pandemic in patients with and without COVID-19. METHODS: This was a retrospective multicenter study of adult endoscopies at six academic hospitals in New York between March 16 and April 30, 2020. Patient and procedure characteristics including age, sex, indication, findings, interventions, and outcomes were compared in patients testing positive, negative, or untested for COVID-19. RESULTS: Six hundred and five endoscopies were performed on 545 patients during the study period. There were 84 (13.9%), 255 (42.2%), and 266 (44.0%) procedures on COVID-positive, negative, and untested patients, respectively. COVID patients were more likely to undergo endoscopy for gastrointestinal bleeding or gastrostomy tube placement, and COVID patients with gastrointestinal bleeding more often required hemostatic interventions on multivariable logistic regression. COVID patients had increased length of stay, intensive care unit admission, and intubation rate. Twenty-seven of 521 patients (5.2%) with no or negative COVID testing prior to endoscopy later tested positive, a median of 13.5 days post-procedure. CONCLUSIONS: Endoscopies in COVID patients were more likely to require interventions, due either to more severe illness or a higher threshold to perform endoscopy. A significant number of patients endoscoped without testing were subsequently found to be COVID-positive. Gastroenterologists in areas affected by the pandemic must adapt to changing patterns of endoscopy practice and ensure pre-endoscopy COVID testing.


Subject(s)
COVID-19 Testing/trends , COVID-19/epidemiology , Endoscopy/trends , Aged , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19 Testing/standards , Endoscopy/standards , Female , Humans , Male , Middle Aged , New York City/epidemiology , Pandemics , Retrospective Studies , Treatment Outcome
9.
Eur J Obstet Gynecol Reprod Biol ; 253: 133-140, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-733869

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised some important interrogations on minimally invasive gynaecological surgery. The International Society for Gynecologic Endoscopy (ISGE) has taken upon itself the task of providing guidance and best practice policies for all practicing gynaecological endoscopists. Factors affecting decision making processes in minimal invasive surgery (MIS) vary depending on factors such as the phase of the pandemic, policies on control and prevention, expertise and existing infrastructure. Our responsibility remains ensuring the safety of all health care providers, ancillary staff and patients during this unusual period. We reviewed the current literature related to gynecological and endoscopic surgery during the Coronavirus Disease 19 (COVID-19) crisis. Regarding elective surgery, universal testing for SARS-CoV-2 infection should be carried out wherever possible 40 h prior to surgery. In case of confirmed positive case of SARS-CoV-2, surgery should be delayed. Priority should be given to relatively urgent cases such as malignancies. ISGE supports medical optimization and delaying surgery for benign non-life-threatening surgeries. When possible, we recommend to perform cases by laparoscopy and to allow early discharges. Any procedure with risk of bowel involvement should be performed by open surgery as studies have found a high amount of viral RNA (ribonucleic acid) in stool. Regarding urgent surgery, each unit should create a risk assessment flow chart based on capacity. Patients should be screened for symptoms and symptomatic patients must be tested. In the event that a confirmed case of SARS-CoV-2 is found, every attempt should be made to optimize medical management and defer surgery until the patient has recovered and only emergency or life-threatening surgery should be performed in these cases. We recommend to avoid intubation and ventilation in SARS-CoV-2 positive patients and if at all possible local or regional anesthesia should be utilized. Patients who screen or test negative may have general anesthesia and laparoscopic surgery while strict protocols of infection control are upheld. Surgery in screen-positive as well as SARS-CoV-2 positive patients that cannot be safely postponed should be undertaken with full PPE with ensuring that only essential personnel are exposed. If available, negative pressure theatres should be used for patients who are positive or screen high risk. During open and vaginal procedures, suction can be used to minimize droplet and bioaerosol spread. In a patient who screens low risk or tests negative, although carrier and false negatives cannot be excluded, laparoscopy should be strongly considered. We recommend, during minimal access surgeries, to use strategies to reduce production of bioaerosols (such as minimal use of energy, experienced surgeon), to reduce leakage of smoke aerosols (for example, minimizing the number of ports used and size of incisions, as well as reducing the operating pressures) and to promote safe elimination of smoke during surgery and during the ports' closure (such as using gas filters and smoke evacuation systems). During the post-peak period of pandemic, debriefing and mental health screening for staff is recommended. Psychological support should be provided as needed. In conclusion, based on the existent evidence, ISGE largely supports the current international trends favoring laparoscopy over laparotomy on a case by case risk evaluation basis, recognizing the different levels of skill and access to minimally invasive procedures across various countries.


Subject(s)
Coronavirus Infections/prevention & control , Endoscopy/standards , Gynecologic Surgical Procedures/standards , Infection Control/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Betacoronavirus , COVID-19 , Coronavirus Infections/etiology , Elective Surgical Procedures/adverse effects , Elective Surgical Procedures/standards , Female , Gynecologic Surgical Procedures/adverse effects , Humans , Pneumonia, Viral/etiology , SARS-CoV-2 , Societies, Medical
13.
J Laryngol Otol ; 134(8): 744-746, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-717086

ABSTRACT

BACKGROUND: Fibre-optic nasoendoscopy and fibre-optic laryngoscopy are high-risk procedures in the coronavirus disease 2019 era, as they are potential aerosol-generating procedures. Barrier protection remains key to preventing transmission. METHODS: A device was developed that patients can wear to reduce potential aerosol contamination of the surroundings. CONCLUSION: This device is simple, reproducible, easy to use, economical and well-tolerated. Full personal protection equipment should additionally be worn by the operator.


Subject(s)
Body Fluids/virology , Coronavirus Infections/transmission , Endoscopy/adverse effects , Laryngoscopy/standards , Personal Protective Equipment/virology , Pneumonia, Viral/transmission , Aerosols , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Disease Transmission, Infectious/prevention & control , Endoscopy/standards , Equipment Design , Humans , Nose/diagnostic imaging , Otolaryngologists/statistics & numerical data , Pandemics , Personal Protective Equipment/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2 , Surveys and Questionnaires
14.
J Endocrinol Invest ; 44(3): 635-636, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-639909

ABSTRACT

PURPOSE: During the Covid-19 pandemic every hospital has had to change its internal organization. Different institutions have highlighted the risks connected with endoscopic endonasal surgery. The goal of this paper is to illustrate the feasibility of pituitary region surgery during the SARS-CoV-2 pandemic. METHODS: After two negative Covid tests were obtained, three patients with macro GH-secreting tumors, and two patients with micro ACTH-secreting tumors resistant to medical treatment underwent surgery during the pandemic. During the surgery, every patient was treated as if they were positive. RESULTS: Neither operator, nor patient have developed Covid symptoms. The two neurosurgeons performing the operations underwent two Covid swab, which resulted negative. CONCLUSIONS: Pituitary surgery is a high risk non-urgent surgery. However, the method described has so far been effective and is safe for both patients and healthcare providers.


Subject(s)
ACTH-Secreting Pituitary Adenoma/surgery , Adenoma/surgery , COVID-19 , Growth Hormone-Secreting Pituitary Adenoma/surgery , Infection Control , Neurosurgical Procedures/methods , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing/standards , Cross Infection/prevention & control , Endoscopy/methods , Endoscopy/standards , Feasibility Studies , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/standards , Italy/epidemiology , Neurosurgical Procedures/standards , Nose/surgery , Pandemics , Patient Safety/standards , Patient Selection , Protective Clothing , Protective Devices , Retrospective Studies , SARS-CoV-2/physiology
18.
Clinics ; 75: e1989, 2020. graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-608407

ABSTRACT

OBJECTIVES: The present coronavirus disease (COVID-19) pandemic has ushered in an unprecedented era of quality control that has necessitated advanced safety precautions and the need to ensure the adequate protection of healthcare professionals (HCPs). Endoscopy units, endoscopists, and other HCP may be at a significant risk for transmission of the virus. Given the immense burden on the healthcare system and surge in the number of patients with COVID-19, well-designed protocols and recommendations are needed. We aimed to systematically characterize our approach to endoscopic procedures in a quaternary university hospital setting and provide summary protocol recommendations. METHOD: This descriptive study details a COVID-19-specific protocol designed to minimize infection risks to patients and healthcare workers in the endoscopy unit. RESULTS: Our institution, located in São Paulo, Brazil, includes a 900-bed hospital, with a 200-bed-specific intensive care unit exclusively designed for patients with moderate and severe COVID-19. We highlighted recommendations for infection prevention and control during endoscopic procedures, including appropriate triage and screening, outpatient management and procedural recommendations, role and usage of personal protective equipment (PPE), and role and procedural logistics involving COVID-19-positive patients. We also detailed hospital protocols for reprocessing endoscopes and cleaning rooms and also provided recommendations to minimize severe acute respiratory syndrome coronavirus 2 transmission. CONCLUSION: This COVID-19-specific administrative and clinical protocol can be replicated or adapted in multiple institutions and endoscopy units worldwide. Furthermore, the recommendations and summary protocol may improve patient and HCP safety in these trying times.


Subject(s)
Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Coronavirus Infections/prevention & control , Endoscopy/standards , Pandemics/prevention & control , Betacoronavirus , Hospitals, University/standards , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Brazil , Risk Factors , Health Personnel/standards , Practice Guidelines as Topic , Coronavirus Infections/transmission , Endoscopy/methods , Personal Protective Equipment/standards , SARS-CoV-2 , COVID-19
20.
J Gastroenterol Hepatol ; 35(5): 749-759, 2020 May.
Article in English | MEDLINE | ID: covidwho-196926

ABSTRACT

From its beginning in December 2019, the coronavirus disease 2019 outbreak has spread globally from Wuhan and is now declared a pandemic by the World Health Organization. The sheer scale and severity of this pandemic is unprecedented in the modern era. Although primarily a respiratory tract infection transmitted by direct contact and droplets, during aerosol-generating procedures, there is a possibility of airborne transmission. In addition, emerging evidence suggests possible fecal-oral spread of the virus. Clinical departments that perform endoscopy are faced with daunting challenges during this pandemic. To date, multiple position statements and guidelines have been issued by various professional organizations to recommend practices in endoscopic procedures. This article aims to summarize and discuss available evidence for these practices, to provide guidance for endoscopy to enhance patient safety, avoid nosocomial outbreaks, protect healthcare personnel, and ensure rational use of personal protective equipment. Responses adapted to national recommendations and local infection control guidelines and tailored to the availability of medical resources are imminently needed to fight the coronavirus disease 2019 pandemic.


Subject(s)
Coronavirus Infections/transmission , Disease Transmission, Infectious/prevention & control , Endoscopy, Gastrointestinal/standards , Hospital Units/standards , Infection Control/standards , Pandemics , Pneumonia, Viral/transmission , Aerosols/adverse effects , COVID-19 , Coronavirus Infections/prevention & control , Endoscopy/standards , Hospital Units/organization & administration , Humans , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic
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