In response to the COVID-19 pandemic, a number of North American gastroenterology institutions have implemented changes to clinical practice, according to a report published in Gastroenterology.
Various digestive manifestations are common to patients with COVID-19. It is well established that gastroenterologists are at increased of intraprocedural exposure. This has led to institutions providing gastroenterology and endoscopy services to make changes to their practice, both directly and in response to professional society recommendations.
In this report, researchers evaluated the nature and extent of adaptations to clinical practice in response to the COVID-19 pandemic. They conducted a web-based survey of gastroenterologists at 62 US and 11 Canadian centers (with 1 respondent per center), between March 21 and April 17, 2020. The survey consisted of 42 items, and was stratified into 6 categories: institutional demographics; changes in clinical practice; changes in endoscopy practice; changes in training; peri-procedure screening for COVID-19; and changes in personal protective equipment (PPE) practices.
In total, 73 individuals responded on behalf of their institutions, 63 of which were teaching institutions. The survey revealed that endoscopy volume was ≤10% of normal in 65% of centers and a total of 97% of centers had deferred screening colonoscopy. Moreover, 68% of centers did not have plans on how to address the growing procedural backlog. All but 3 (4%) had implemented virtual clinic visits, and 47% performed more than 75% of clinic visits via telemedicine. Most programs modified coverage schedules for attending physicians and endoscopy training for fellows. For instance, gastroenterology fellows performed inpatient consults in person for 75% of training programs, while outpatient encounters were carried out virtually in 62% of programs. The majority of endoscopy practices (86%), screened patients for symptoms and exposures upon arrival. Expanded PPE use (beyond standard gown, gloves and googles) were used for all procedures in 86% of facilities. N95 mask use was reported by 59% of facilities, while N95 reuse was reported by 76% of facilities.
The authors recommend further high-quality research to better inform optimal PPE usage and guidance for the re-expansion of post-COVID clinical and endoscopic services.
Forbes N, Smith ZL, Spitzer RL, Keswani RN, Wani SB, Elmunzer J. Changes in gastroenterology and endoscopy practices in response to the COVID-19 pandemic: Results from a North American survey [published online May 3, 2020]. Gastroenterology. doi: 10.1053/j.gastro.2020.04.071