ESGE and ESGENA Position Statement on gastrointestinal endoscopy and COVID-19: An update on guidance during the post-lockdown phase and selected results from a membership survey

INTRODUCTION

In response to the prolonged lockdown period and implemented measures of social distancing/personal hygiene, most European countries are now (June 2020) experiencing a suppression of the COVID-19 viral pandemic [1]. This post-outbreak sustained (i. e., > 14 days) viral deceleration is being referred to as the “post-lockdown” phase of the COVID-19 pandemic. Sadly, at its height, the COVID-19 pandemic led to innumerable deaths throughout Europe, including many frontline health care professionals (HCPs) fighting the virus [2]. Therefore, we must remain vigilant in protecting HCPs, including our endoscopy unit personnel, by continuing to follow personal protective equipment (PPE) recommendations [3].

It must be stressed however, that the observed deceleration of the viral outbreak is not equivalent to the disappearance of COVID-19 transmission, as a large reservoir of the virus remains present in most European countries [4]. This generates the risk of future COVID-19 outbreaks as the protocols of infection control are gradually relaxed, as multiple viral outbreak clusters in various countries are now showing. Therefore, strategies aiming to triage, separate, and track gastrointestinal (GI) endoscopy patients, as outlined in our original Position Statement, re-main highly relevant and necessary in this new post-lockdown phase of the pandemic [3]. An additional new tool, potentially available for GI endoscopy units to further assist in patient care, is pre-endoscopy viral testing to more accurately triage patients and/or health care personnel through the identification of COVID-19 viral RNA using nasopharyngeal swabbing [5].

The prolonged lockdown period across Europe resulted in the cancellation of elective GI endoscopies as only emergent/urgent endoscopies were performed [6]. As GI endoscopy is largely used for screening, early diagnosis, and treatment of digestive tract cancers, there is a growing concern about a possible mid- or long-term increase in the GI cancer burden because of the many elective GI endoscopy procedures that were can-celled [7]. Competition for endoscopy slots between those can-celled endoscopy procedures and those procedures previously scheduled is now occurring and needs to be addressed. We must do this by striking a careful balance between the ongoing need to maintain infection prevention and control (IPC) protocols within the endoscopy unit and the need to increase endoscopy procedure capacity. Despite there being an excessive backlog of endoscopy cases, there remains no consensus on the best way to efficiently yet safely re-open access for elective endoscopy procedures. Moreover, the status of COVID-19 in Europe is neither uniform nor generalizable across the continent since some regions of Europe may not yet be in the “post-lockdown” phase of the pandemic.

The aim of this present Position Statement is to provide up-dated evidence-based guidance on endoscopy practice for the post-lockdown phase of the COVID-19 pandemic. Moreover, in this updated Position Statement, guidance is given on IPC in the post-lockdown period, on the emerging role of COVID-19 viral testing, and on issues related to returning to full endoscopy capacity. Unless otherwise stated, all the guidance statements from the original Position Statement of the European Society for Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) remain valid and applicable in the post-lockdown phase [3]. Last, to better understand how the COVID-19 pandemic was impacting endoscopy units in Europe, ESGE and ESGENA surveyed their members on the status of their endoscopy practice as related to the COVID-19 pandemic. Thus, in addition to the updated guidance recommendations offered within this Position Statement, we also report selected results from our member survey.