Mitigating the Impact of COVID-19 on Gastrointestinal Services: Strategies From India

Background with viruses – the concept of microbiology and virology
Practitioners working in Tamil Nadu, India, once a COVID-19 hotspot, shared their experience with managing gastrointestinal services at the peak of the pandemic.

A cautious approach, with meticulous screening and infection control measures, is essential to mitigating the impact of the COVID-19 pandemic on gastrointestinal services without jeopardizing the health of health-care workers. These findings are based on research published in Gastroenterology & Hepatology.

Between April and September 2020, the state of Tamil Nadu in India became a COVID-19 hotspot. Infection rates peaked in July 2020. After lockdown, the Kovai Medical Center and Hospital (KMCH), in Coimbatore, Tamil Nadu, restarted gastrointestinal services on April 15, 2020.

They began by implementing the Asian Pacific Society for Digestive Endoscopy COVID-19 guidance for screening, along with appropriate levels of personal protective equipment for the entire department. An endoscopy was performed only if essential. Appointments for older patients and those in shielding were provided only if necessary or during an emergency. Endoscopy suites and outpatient rooms were ventilated with air from the outside to reduce indoor airborne transmission of COVID-19.   

From April 1 to September 30, 2020, researchers analyzed outcomes from the KMCH and compared these with data from the same period in 2019. Patients were contacted by telephone 2 weeks following endoscopy and after any contact with inpatient gastrointestinal services during July 2020. The investigators used a telephone questionnaire to inquire about any COVID-19 symptoms. From April to September 2020, data on symptoms among health-care workers within the gastrointestinal services department were collected weekly.

Researchers found that the number of endoscopies done in 2020 was 23.7% lower than in 2019 (1427 vs 1871 endoscopies).

With the exception of oesophagogastroduodenoscopies and sigmoidoscopies, the proportion of all other endoscopy procedures increased in 2020 compared with 2019.

The proportion of endoscopies that resulted in a diagnosis of malignancy or inflammatory bowel disease increased significantly in 2020 compared with 2019, and fewer endoscopies found no abnormalities.   

The therapeutic endoscopy volume increased significantly in 2020 compared with 2019.

Inpatient volume was 14.4% lower in 2020 compared with 2019 (681 vs 796 patients), but the percentage volume of work was determined to be similar across all diagnoses, except for increased upper gastrointestinal bleeds in 2020.

Mortality was higher in 2020 compared with 2019. However, this difference was not considered statistically significant.

Among the 195 patients who completed telephone follow-up after endoscopy in July 2020, only 1 (0.5%) reported developing COVID-19 symptoms after visiting the hospital in July 2020, 13 days following endoscopy.

According to investigators, no inpatients or health-care workers developed COVID-19 symptoms.

This study is not without limitations. Patients and staff were not screened for SARS-CoV-2 with reverse transcription polymerase chain reaction testing.  

The study authors concluded, “Our findings seem to justify our mitigation strategies to ensure the continuation of gastrointestinal services.” They added, “Transmission dynamics are different between India and western countries, and our strategy might well be applicable to countries with a pandemic profile similar to that of India.”


Ramakrishnan A, Somasundaram A, Srinivasan N, et al. Management of gastrointestinal services in Tamil Nadu, India, during COVID-19. Lancet Gastroenterol Hepatol. Published online June 2, 2021. doi: 10.1016/S2468-1253(21)00193-X