Endoscopy during the Covid-19 outbreak: experience and recommendations from a single center in a high-incidence scenario

Abstract

A dramatic SARS-Cov-2 outbreak is hitting Italy hard. To face the new scenario all the hospitals have been re-organised in order to reduce all the outpatient services and to devote almost all their personnel and resources to the management of Covid-19 patients. As a matter of fact, all the services have undergone a deep reorganization guided by: the necessity to reduce exams, to create an environment that helps reduce the virus spread, and to preserve the medical personnel from infection. In these days a reorganization of the endoscopic unit, sited in a high-incidence area, has been adopted, with changes to logistics, work organization and patients selection. With the present manuscript, we want to support gastroenterologists and endoscopists in the organization of a "new" endoscopy unit that responds to the "new" scenario, while remaining fully aware that resources, availability and local circumstances may extremely vary from unit to unit.

How to manage celiac disease and gluten-free diet during the COVID-19 era: proposals from a tertiary referral center in a high-incidence scenario

“…CeD activity can be monitored by means of POC tests detecting anti transglutaminase and/or anti gliadin antibodies, routinely considered as non-invasive bio-markers to monitor the CeD activity status [ 57 , 58 ]. In case of suspected CeD complications and impossibility to hospitalise the patient, endoscopic investigation of the small bowel (where usually CeD complications are localised) may be carried out via a panoramic-view endoscopic capsule with no external recording system (Capsocam System, USA) [ 59 , 60 ]. Such a capsule can be sent to the patient, ingested and resent to the gastroenterologist after expulsion in the stools, without need to travel or invasive investigations causing the emission of potentially infective droplets [ 60 ].…”

Reopening Endoscopy after the COVID-19 Outbreak: Indications from a High Incidence Scenario

“…However, for these procedures we encourage a systematic patients' screening in order to use lighter PPE which are more comfortable for daily routine use during prolonged procedures. Sequences to wear and remove PPE has been previously described [9] and protocols regarding PPE are available at the American Center for Disease Control webpage: https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf [22].…”

“…During the COVID-19 outbreak, in order to avoid the risk of viral transmission, all EUs reorganized their rooms: generally reserving one room for low-risk patients -oral route, one for low-risk patients -anal route or one room for low-risk patients according to availability, and one for high-risk and COVID-19 positive patients [9]. In the upcoming scenario another adjustment should be applied which is increasing, whenever possible, the number of rooms dedicated to low-risk patients and ideally including a room dedicated to aerosol-generating procedures, considered to be more prone to SARS-CoV-2 infection (i.e., all nasal and oral-route procedures).…”

“…As stated before [9], patients should enter the EU based on their assessed risk for SARS-CoV-2 infection. Ideally, low-risk patients should be the first procedures to carry out.…”

“…Healthcare systems and hospitals were reorganized to face and take care of patients with coronavirus disease 2019 (COVID- 19) and to contain the spreading of SARS-CoV-2 among patients and health personnel [8]. Outpatient services were reduced guaranteeing access only to urgent or undeferrable cases [9]; new strategies were adopted in endoscopy units (EU) in order to reduce the number of investigations carried out [10][11][12][13]. Indeed, endoscopy is considered a high-risk activity due to the likely exposure of personnel to patients' possibly infected body fluids [14,15].…”