ESGE and ESGENA Position Statement on gastrointestinal endoscopy and COVID-19: Updated guidance for the era of vaccines and viral variants

Authors: Ian M. Gralnek*, Cesare Hassan*, Alanna Ebigbo, Andre Fuchs, Ulrike Beilenhoff, Giulio Antonelli, Raf Bisschops, Marianna Arvanitakis, Pradeep Bhandari, Michael Bretthauer, Michal F. Kaminski, Vicente Lorenzo-Zuniga, Enrique Rodriguez de Santiago, Peter D. Siersema, Tony C. Tham, Konstantinos Triantafyllou, Alberto Tringali, Andrei Voiosu, George Webster, Marjon de Pater, Björn Fehrke, Mario Gazic, Tatjana Gjergek, Siiri Maasen, Wendy Waagenes, Mario Dinis-Ribeiro, Helmut Messmann

*Co-first authors

Introduction

The ongoing COVID-19 pandemic has entered a new phase following the introduction and availability of highly effective vaccination therapies that have modified the epidemiology of severe disease [1–5]. Conversely, viral variants (e. g. the Delta variant) with increased transmissibility have developed and become dominant drivers of the pandemic in Europe and throughout the world. This has led to uncertainty regarding infection prevention, viral control strategies, and vaccination regimens [6]. In Europe, as of October 2021, vaccination rollout, with complete double-dose immunization status, has reached 73.5 % of the population, although with a high intercountry variability (ranging from 25 % to 95 %) [7]. In some countries, the administration of a third (“booster”) dose has been initiated for individuals considered at high risk of negative outcomes from COVID-19 [8, 9]. It must also be noted that currently, COVID-19 vaccination rollout is highly imbalanced between high- and low-income countries, with vaccinated population percentages in the latter being as low as 1 % [10]. This has prompted a flow of vaccines into these areas of the world, where strategies for endoscopy resumption and procedure scheduling should be adapted to local epidemiology and regional risk stratifications. For such affected regions of the world, please refer to World Health Organization (WHO) guidelines and guidance documents from the European Society of Gastrointestinal Endoscopy and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGE-ESGENA) and their adaptations to low-resources settings [11–15].

Despite the worldwide introduction of COVID-19 vaccinations, gastrointestinal (GI) endoscopy continues to entail a significant risk of infection and morbidity from COVID-19, for both health care professionals (HCPs) and patients. Infection prevention and control (IPC) has been shown to be dramatically effective in assuring the safety of both patients and HCPs [16, 17]. ESGE (www.esge.com) and ESGENA (www.esgena.org) continue to join forces in this updated Position Statement, to provide ongoing guidance during the pandemic to help assure the highest level of GI endoscopy care and protection against COVID-19 for both our patients and endoscopy unit personnel. This guidance is based upon the best available evidence in the current context of COVID-19 vaccines and SARS-CoV-2 viral variants.

Methods

As in our previous ESGE-ESGENA Position Statements on GI endoscopy and COVID-19 [14, 15], a PubMed/MEDLINE search was performed once again, using “severe acute respiratory distress syndrome coronavirus 2,” “COVID-19,” “endoscopy, digestive system endoscopy,” “gastrointestinal endoscopic examination, therapy,” “vaccination”, and “viral variants” as MeSH terms, between February 1, 2020 and October 15, 2021, to identify relevant publications that could inform this updated Position Statement. When applicable, recommendations by international medical bodies, such as WHO, the European Centre for Disease Prevention and Control (ECDC), and the US Centers for Disease Control and Prevention (CDC), have also been considered and adapted.