Upper gastrointestinal stenting during the SARS-CoV-2 outbreak: impact of mitigation measures and risk of contamination for patients and staff

 

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Abstract

Background and study aims The impact of COVID-19 mitigation measures on stent placement procedures has not yet been reported. The aim of this study was to assess the impact of COVID-19 mitigation measures on upper stenting during SARS-CoV-2 outbreak, as well as the use of personal protection equipment (PPE) and risk of contamination for patients and staff.

Patients and methods This was a multicenter, retrospective study of consecutive patients who underwent stent placement for upper gastrointestinal obstruction during the second half of SARS-CoV-2 outbreak period in comparison to same period one year before.

Results A total of 29 stents were placed for upper gastrointestinal obstruction during the study period, corresponding to an increase of 241 % comparing to the same period in 2019 (n = 12). No significant major differences were found between the two time periods regarding patients’ baseline characteristics, post-stenting management and number of staff involved in stent placement. Fellows’ involvement was significantly lower in 2020 compared to 2019 (21 % vs 67 %; P = 0.01). The majority of procedures were performed using FFP2 /FFP3 mask (76 %), protective eyewear (86 %), two pairs of gloves (65 %), hairnet (76 %) and full disposable gowns (90 %). One patient tested positive for SARS-CoV-2 after the procedure. None of the medical staff involved in stenting procedures developed COVID-19 14 days after procedure.

Conclusion Upper gastrointestinal stenting increased during the SARS-CoV-2 outbreak period, which could be related to yearly variation on the number of procedures or reflect a change of oncologic treatment practice during COVID times.

Publication History

Received: 21 July 2020

Accepted: 19 October 2020

Article published online:
01 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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• References

• 1 Maida M, Sferrazza S, Savarino E. et al. Italian Society of Gastroenterology (SIGE). Impact of the COVID-19 Pandemic on Gastroenterology Divisions in Italy: A National Survey. Dig Liver Dis 2020; DOI: 10.1016/j.dld.2020.05.017.
  CrossrefPubMedGoogle Scholar
• 2 New York Society for Gastrointestinal Endoscopy. New York Society for Gastrointestinal Endoscopy Guidelines for Endoscopy Units during the COVID-19 Pandemic. 2020 Available from: https://www.nysge.org//Files/NYSGE%20Guidelines%20for%20Endoscopy%20Units%20During%20the%20COVID-19%20Pandemic.pdf
  PubMedGoogle Scholar
• 3 British Society of Gastroenterology. Advice for Endoscopy Teams during COVID-19. 2020 Available from: https://www.bsg.org.uk/covid-19-advice/endoscopy-activity-and-covid-19-bsg-and-jag-guidance/
  PubMedGoogle Scholar
• 4 Irisawa A, Furuta T, Matsumoto T. et al. Gastrointestinal endoscopy in the era of the acute pandemic of COVID-19: Recommendations by Japan Gastroenterological Endoscopy Society. Digest Endosc 2020; 32: 648-650
  CrossrefPubMedGoogle Scholar
• 5 Gralnek IM, Hassan C, Beilenhoff U. et al. ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy 2020; 52: 483-490
  Article in Thieme ConnectPubMedGoogle Scholar
• 6 Chiu PWY, Ng SC, Inoue H. et al. Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements). Gut 2020; 69: 991-996
  CrossrefPubMedGoogle Scholar
• 7 Soetikno R, Teoh AY, Kaltenbach T. et al. Considerations in performing endoscopy during the COVID-19 pandemic. Gastrointest Endosc 2020; 92: 176-183
  CrossrefPubMedGoogle Scholar
• 8 European Center for Disease Prevention and Control. https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-public-health-management-contact-novel-coronavirus-cases-EU.pdf
  PubMed
• 9 Spaander MC, Baron TH, Siersema PD. et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 939-948
  Article in Thieme ConnectPubMedGoogle Scholar
• 10 Nassif T, Prat F, Meduri B. et al. Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: results of a multicenter study. Endoscopy 2003; 35: 483-489
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Peters JH, Meester TR, Stein HJ. Surgical therapy for cancer of the esophagus and cardia. In: Castell DO. The Esophagus, 2nd edn. New York: Little, Brown; 1995: 293-335
  Google Scholar
• 12 Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self expanding metal stents: experience in 36 patients. Am J Gastroenterol 2002; 97: 72-78
  CrossrefPubMedGoogle Scholar
• 13 Marasco M, Nardone OM, Maida M. et al. Impact of COVID-19 outbreak on clinical practice and training of young gastroenterologists: a European Survey. Dig Liver Dis 2020; [Epub ahead of print] DOI: 10.1016/j.dld.2020.05.023.
  CrossrefPubMedGoogle Scholar
• 14 Lui RN, Wong SH, Sanchez-Luna SA. et al. Overview of guidance for endoscopy during the coronavirus disease 2019 pandemic. J Gastroenterol Hepatol 2020; 35: 749-759
  CrossrefPubMedGoogle Scholar
• 15 Armellini E, Repici A, Alvisi C. et al. Fast Track Endoscopy Study Group. Analysis of patients attitude to undergo urgent endoscopic procedures during COVID-19 outbreak in Italy. Dig Liver Dis 2020; DOI: 10.1016/j.dld.2020.05.015.
  CrossrefPubMedGoogle Scholar
• 16 Ginès A, Fernández-Esparrach G, Pellisé M. et al. Critical importance of early introduction of prevention measures for SARS-CoV-2 infection in endoscopy units. Gastrointest Endosc 2020; DOI: 10.1016/j.gie.2020.06.023.
  CrossrefPubMedGoogle Scholar
• 17 Repici A, Aragona G, Cengia G. et al. Italian GI-COVID19 Working Group. Low risk of covid-19 transmission in GI endoscopy. Gut 2020; 69: 1925-1927 DOI: 10.1136/gutjnl-2020-321341.
  CrossrefPubMedGoogle Scholar
• 18 Repici A, Pace F, Gabbiadini R. et al. Endoscopy units and the COVID-19 Outbreak: a multi-center experience from Italy. Gastroenterology 2020; DOI: 10.1053/j.gastro.2020.04.003.
  CrossrefPubMedGoogle Scholar
• 19 European Centre for Disease Prevention and Control. Infection prevention and control and preparedness for COVID-19 in healthcare settings. 2020 https://www.ecdc.europa.eu/en/publications-data/infection-prevention-and-control-and-preparedness-covid-19-healthcare-settings
  PubMedGoogle Scholar
• 20 European Centre for Disease Prevention and Control. Guidance for wearing and removing personal protective equipment in healthcare settings for the care of patients with suspected or confirmed COVID-19. https://www.ecdc.europa.eu/en/publicationsdata/guidance-wearing-and-removing-personal-protective-equipment-healthcare-settings
  PubMedGoogle Scholar
• 21 Zhang Y, Zhang X, Liu L. et al. Suggestions for infection prevention and control in digestive endoscopy during current 2019-nCoV pneumonia outbreak in Wuhan, Hubei province, China. Endoscopy 2020; 52: 312-314
  Article in Thieme ConnectPubMedGoogle Scholar
• 22 World Health Organization. Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. https://www.who.int/publications-detail/infection-prevention-and-control-during-health-carewhen-novel-coronavirus-(ncov)-infection-is-suspected-20200125
  PubMedGoogle Scholar
• 23 Joint AGA/DHPA Guidance: Recommendations for Resumption of Elective Endoscopy During the COVID-19 Pandemic. 2020 Available from (cited 2020 May 12): https://www.dhpassociation.org/2020/04/27/aga-dhpa-resume-endoscopy-covid19/
  PubMedGoogle Scholar
• 24 Sagami R, Nishikiori H, Sato T. et al. Endoscopic Shield: barrier enclosure during the endoscopy to prevent aerosol droplets during the COVID-19 pandemic. VideoGIE 2020; DOI: 10.1016/j.vgie.2020.05.002.
  CrossrefPubMedGoogle Scholar