Analysis of the effects of the first and second/third waves of the COVID-19 pandemic on an Interdisciplinary Endoscopy Unit in a German ‘hotspot’ area: a single-center experience

Abstract

Background: Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed a pandemic threat to global health. We are now in the fourth wave of this pandemic. As the pandemic developed, the requirements and therapeutic endoscopic procedures for SARS-CoV-2-positive patients underwent changes. Methods: Analysis of implications for an endoscopy unit during the first and second/third waves of the COVID-19 pandemic with a focus on COVID-19-related process changing. Addressed are number of SARS-CoV-2-positive patients and endoscopic examinations performed in patients who tested positive for SARS-CoV-2 during the various waves, adherence to scheduled examinations, rotation of staff to COVID-dedicated structures and, finally, impact of vaccination on infection rate among endoscopic staff. Results: During the first wave, 10 SARS-CoV-2-positive in-house patients underwent a total of 22 gastrointestinal (GI) endoscopic procedures. During the second and third waves, 59 GI endoscopies were performed in 38 patients. While in the first wave, GI bleeding was the main indication for endoscopy (82%), in the second and third waves the main indication for endoscopy was endoscopic insertion of deep feeding tubes (78%; p < 0.001). During the first wave, 5 (17%) of 29 Interdisciplinary Endoscopy Unit (IEU) staff members were moved to designated COVID wards, which was not necessary during the following waves. Lack of protective clothing was critical during the first wave, but not in the later waves. Screening tests for patients and staff were widely available after the first wave, and IEU staff was vaccinated during the second wave. Conclusion: Strategies to ensure safe endoscopies with respect to preventing transmission of SARS-CoV-2 from patients to staff were effective. Organizational adjustments allowed the routine program to continue unaffected. Indications for GI endoscopies changed over time: during the first wave, GI endoscopies were performed for life-threatening indications, whereas later supportive procedures were the main indication.

COVID-19 und gastrointestinale Endoskopie –angepasste Strategien im pandemischen Wandel

“…In Abhängigkeit vom lokalen pandemischen Infektionsgeschehen führte dies im klinischen Alltag vielerorts zu einer Reduktion aller endoskopischen Leistungen um bis zu 50 % und zu terminlichen Verschiebungen elektiver, insbesondere ambulant durchgeführter Eingriffe [ 3 ]. Daten aus der 1. und 2. pandemischen Welle in Deutschland und Polen zeigten, dass die Anzahl von Notfallendoskopien und interventionellen Endoskopien mit hoher Dringlichkeit (endoskopische retrograde Cholangiopankreatikographie, ERCP) an großen Zentren hingegen nicht reduziert wurden [ 4 , 5 ]. Insbesondere zu Beginn der Pandemie im Jahr 2019 traf dies für viele endoskopische Zentren zu.…”

“…Durch Verwendung von optimierter PPE mit KN95-/FFP2-Masken konnte in diesen Zentren eine „nosokomiale“ Transmission von infizierten Patienten auf das Personal verhindert bzw. deutlich eingegrenzt werden [ 4 , 5 , 8 , 19 ]. Der Effekt dieser protektiven Maßnahmen wurde sicherlich durch die während der 2.…”

“…Der Effekt dieser protektiven Maßnahmen wurde sicherlich durch die während der 2. Welle verfügbare Vakzinierung zusätzlich verstärkt, sodass im Verlauf der Pandemie in vielen endoskopischen Abteilung eine Anpassung der Untersuchungszahlen an den Routinebetrieb erfolgen konnte [ 5 ].…”