Are German endoscopy units prepared for the COVID-19 pandemic? A nationwide survey
Authors: Garbe Jakob , Eisenmann Stephan , Heidemann Clara S. , Damm Marko , Krug Sebastian , Walter Steffen , Lammert Frank , Darwiche Kaid , Michl Patrick , Rosendahl Jonas 
Published: April 2020

Objective

The COVID-19 pandemic challenges health care systems worldwide. In this situation, guidelines for health care professionals in endoscopy units with increased risk of infection from inhalation of airborne droplets, conjunctival contact and faeces are urgently needed. Recently, the European Society of Gastrointestinal Endoscopy (ESGE) and the German Society for Pneumology (DGP) issued recommendations. However, real-world data on the conditions and requirements of endoscopy units to adhere to this guidance are missing.

Design

We conducted an internet-based survey among German endoscopy units from all levels of care from April 1st to 7th, 2020. The survey comprised 33 questions and was distributed electronically by the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and the DGP.

Results

In total, 656 endoscopy units completed the survey. Overall, 253 units (39%) cancelled fewer than 40% of their procedures. Of note, private practices cancelled less procedures than hospital-based units. Complete separation of high-risk and COVID-19 positive patients was achieved in only 20% of the units. Procedural measures were well adopted, with 91% of the units systematically identifying patients at risk and 85% using risk-adapted personal protective equipment (PPE). For the future, shortages in PPE (81%), staff (69%) and relevant financial losses (77%) were expected.

Conclusion

Concise definitions of non-urgent, elective interventions and endoscopic surveillance strategies are needed to better guide endoscopic activity and intervention cancellations. In the short term, a lack of PPE can constitute considerable impairment of endoscopy units’ operability and patient outcomes.

SUMMARY BOX

What is already known about this subject?

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Recent data indicate a potentially important role of the gastrointestinal tract in the spreading of COVID-19.

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Endoscopy units and their personnel are at high risk to be exposed to and to distribute COVID-19 infections.

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Several societies have formulated guidance for endoscopy units in the current situation, but their feasibility is unclear.

What are the new findings?

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Endoscopic activity seems not to be limited to urgent interventions across all units as 39% of all endoscopy units cancelled less than 40% of procedures.

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For most endoscopy units, structural conditions are insufficient to realize a complete separation of high-risk patients, which can be guaranteed by only 20% of the units.

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The willingness to adhere to the recommendations is very high, as most endoscopy units adopted their procedures accordingly. Shortage of personal protective equipment is a critical concern in many units.

How might it impact on clinical practice in the foreseeable future?

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An update of the current recommendations to refine practicable measures for the majority of endoscopic units is warranted.

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A concise definition of non-urgent or elective procedures as well as postponement strategies and intervals are of utmost importance, since current data implicate that transmission of SARS-CoV-2 via the respiratory and gastrointestinal tract may be critical for public health.