AGA Rapid Review and Guideline for SARS-CoV2 Testing and Endoscopy Post-Vaccination: 2021 Update

Abstract

This guideline provides updated recommendations on the role of pre-procedure testing for SARS-CoV2 in individuals undergoing endoscopy in the post-vaccination period and replaces the prior guideline from the American Gastroenterological Association (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 healthcare 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 pre-procedure testing for SARS-CoV2, the AGA guideline panel reviewed the evidence on (1) prevalence of asymptomatic SARS-CoV2 infections in individuals undergoing endoscopy, (2) patient and HCW risk of infections that may be acquired immediately before, during, or after endoscopy, (3) effectiveness of COVID-19 vaccine in reducing risk of infections and transmission, (4) patient and HCW anxiety, (5) patient delays in care and potential impact on cancer burden, and (6) endoscopy volumes. The panel considered the certainty of the evidence, weighed the benefits and harms of routine pre-procedure testing, and considered burden, equity, and cost using the GRADE framework. Based on very low certainty evidence, the panel made a conditional recommendation against routine pre-procedure 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.

Impaired tryptophan metabolism in the gastrointestinal tract of patients with critical coronavirus disease 2019

“…The prevalence of COVID-19 has been fluctuating throughout the pandemic, and the pandemic in Japan has had a relatively low impact compared to that in other countries. Furthermore, it is recommended that colonoscopy should be avoided as much as possible in COVID-19 patients to prevent the spread of infection ( 27 ), which made it even more difficult to obtain biopsy tissue specimens.…”

Rostered routine testing for severe acute respiratory coronavirus virus 2 infection among healthcare workers: Do we detect more?

“… 2 The recent AGA update recommended against routine pre‐procedure testing for SARS‐CoV‐2 in patients undergoing endoscopy to minimize delay in care. 3 The recommendation was based on indirect studies and very low certainty evidence. However, the validity of this recommendation during the widespread community transmission of SARS‐COV‐2 variants of concern is unclear.…”

Coronavirus Disease Transmission Prevented in an Endoscopy Unit with Universal Protective Measures and No Systematic Preprocedural Testing

“…In a recent update, the American Gastroenterological Association retracted this recommendation. However, their update continued to recommend preprocedural testing in some settings, but at the discretion of individual endoscopy centers [ 12 ]. Other scientific societies have not changed until now their recommendation of universal preprocedural SARS-CoV-2 PCR testing and, in a recent update, ESGE still recommends that all patients presenting for GI endoscopy be required to provide either: a negative viral test performed within 48 h before their scheduled GI endoscopy or documentation of full COVID-19 vaccination status or recovery from COVID-19 infection within the past 6 months [ 13 ].…”