COVID-19 Screening Questionnaire Effective in Identifying High Risk Patients in Endoscopic Practices

Novel coronavirus 2019 (COVID-19) screening questionnaires may be effective in identifying high risk patients, according to a study published in Gastroenterology.

The spread of COVID-19 has led to the delay or cancellation of many endoscopic procedures, and recommendations on the re-opening of endoscopic practices and facilities have been vague and variable. Researchers described their experiences resuming the practice of endoscopic procedures using a 2-step strategy comprised of patient screening followed by COVID-19 testing. This approach aimed to provide data on the risks and benefits of resuming endoscopic procedures during the COVID-19 pandemic.

In this retrospective study, all patients with emergent, urgent, and elective endoscopic procedures scheduled at a single facility in Miami-Dade County between April 13, 2020 and May 15, 2020 had mandatory COVID-19 polymerase chain reaction (PCR) testing by nasopharyngeal swab prior to any endoscopic procedure. Researchers administered outpatients a COVID-19 screening questionnaire via phone call. They performed PCR tests 72 hours prior to procedures. Sampling of PCR testing was performed at the care facility and specimens were processed either in-house or at a neighboring safety-net affiliate. Patients with negative PCR results went on to receive endoscopic procedure as planned, whereas patient with positive PCR results had procedures cancelled and rescheduled for 14 days later with a retest 72 hours before the new procedure date. Inpatients who required immediate procedures received rapid in-house tests with results typically available within 2 hours. In emergent cases, researchers performed endoscopy regardless of COVID-19 test results, with staff using maximum barrier personal protective equipment (PPE). In total, 3 assays were used during the study period: QIAstat-Dx Respiratory 2019-nCoV Panel (Qiagen;, CE-IVD kit GeneFinderTM COVID-19 Plus RealAmp Kit (OSANGHealtcare); and Xpert® Xpress SARS-CoV-2 (Cepheid). The researchers compared data to publicly available population-based test results from Miami-Dade County.

Overall, 396 PCR swabs were performed in preparation for endoscopy, with 1 patient showing a positive PCR result (positive test rate, 0.25%; 95% CI, 0.01-1.4%). The endoscopy staff did not report cases of COVID-19 or suggestive symptoms. In the same period, 14,007 (12.7%) individuals had positive test results from 110,506 patients who were tested for COVID-19 in Miami-Dade County at large. In the neighboring counties of Broward, Palm Beach, and Monroe, the percentages of positive results in catchment areas of the system were 9.1%, 9.5%, and 5.4% respectively, which would categorize the entire area as having “intermediate” prevalence.

Limitations of the study included concerns typical of a retrospective design as well as a lack of generalizability due to fact that study data came from a single facility.

Regardless of PCR testing results, the authors “recommend that all

practices adhere to social distancing, hygiene, and use full barrier PPE during every procedure to minimize transmission and maximize safety – regardless of test results. Ultimately, specific testing practices should be tailored to disease prevalence rates in distinct communities.”

Reference

Forder JJ, Goldberg D, Sussman D, Soriano F, Barkin JA, Amin S. Yield and implications of pre-procedural COVID-19 PCR testing on routine endoscopic practice [published online May 21, 2020]. Gastroenterology. doi: 10.1053/j.gastro.2020.05.062