The prevention of nosocomial SARS-CoV2 transmission in endoscopy: a systematic review of recommendations within gastroenterology to identify best practice

  1. John Ong
  2. Gail Brenda Cross
  3. Yock Young Dan

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Abstract

Endoscopy generates aerosol droplets and fomites, thereby increasing the risk of SARS-CoV2 transmission to healthcare workers and uninfected patients within endoscopy departments. Despite the sharp rise in the incidence of COVID-19, authoritative recommendations to limit the spread of SARS-CoV2 within gastrointestinal endoscopy units are lacking. Therefore, with the primary aim of identifying best practice and scrutinizing its supporting evidence, we conducted a systematic review of literature for articles published between 1 January 2002 and 15 March 2020 in five databases relating to both the current SARS-CoV2 and the previous SARS-CoV outbreaks. Official websites for gastroenterology and endoscopy societies in the 15 most affected countries were also searched. Unfortunately, a paucity of high quality data and heterogeneity of recommendations between countries was observed. Interestingly, not all countries advocated the postponement of non-urgent or elective procedures. Recommendations for patient screening and personal protective equipment were commonly featured in all recommendations but specifics varied. Only 32% (9/28) of all gastroenterology and endoscopy societies issued guidance on endoscopy in the COVID-19 pandemic. In conclusion, stronger evidence to inform current practice and robust guidelines are urgently needed to prevent the transmission of SARS-CoV2 in gastrointestinal endoscopy departments worldwide.

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  1. ScreenIT

    SciScore for 10.1101/2020.03.17.20037564: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategy and article selection: A systematic search (Fig.1) using the terms “Severe Acute Respiratory Syndrome”, “SARS”, “SARS-CoV”, “SAR-CoV2”, “COVID-19” and “coronavirus”, in combination with, “endoscopy”, “gastroscopy”, “oesophago-gastro-duodenoscopy”, “esophago-gastro-duodenoscopy”, “sigmoidoscopy”, “colonoscopy”, “ERCP”, “endoscopic retrograde cholangiopancreatography”, and “enteroscopy” were performed in five database (PubMed, Scopus, Cochrane, bioRxiv, and medRxiv) for articles published from 1 January 2002 to 15 March 2020.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Cochrane
    suggested: (Cochrane Library, RRID:SCR_013000)
    bioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Given the limitations of question-based screening methods, patient follow-up post-procedure becomes extremely important at detecting “false negatives” that slipped through current processes. Identification of any infected patient post-procedure who was within the window of the viral incubation at the time of endoscopy would have significant implications; undetected transmission to HCWs and other patients in the department must then be investigated. A robust contact screening program is then necessary to contain the spread of COVID-19 among exposed staff and patient contacts. Only 1 guideline identified in this review advised on post-procedure follow-up at Day 7 and Day 14 by telephone. We believe this should be a common feature in all future guidance on COVID-19. As screening methods improve and detection kits become more readily available, biological and radiological screening methods that are advocated by Chinese guidelines may become more efficient at disease detection although would be costly. If COVID-19 becomes a protracted pandemic, one possible solution to help restore normal work flow in endoscopy could be serial screening e.g. 2 throat swabs for viral RNA 2 weeks apart before listing for endoscopy. The oro-faecal transmission of SARS-CoV2 remains debatable although the virus has been isolated in gastric, duodenal and rectal biopsies with viral RNA detectable in half of all COVID-19 patients.[20] Interestingly, in those that have detectable SARS-CoV2 RNA detectable i...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.03.17.20037564v1 on medRxiv