Recommendations for GI endoscopy and clinic practices:
Strongly consider rescheduling elective non-urgent endoscopic procedures. Some non-urgent procedures are higher priority and may need to be performed (examples include cancer evaluations, prosthetic removals, evaluation of significant symptoms). Classification of procedures into non-urgent/postpone and non-urgent/perform may be useful. Of note, the Surgeon General on 3/14/20 advised hospitals to postpone all elective surgeries5
Pre-screen all patients for high risk exposure or symptoms. Patients should be asked about history of fever or respiratory symptoms, family members or close contacts with similar symptoms, any contact with a confirmed case of COVID-19, and recent travel to a high-risk area. Avoid bringing patients (or their escorts) into the medical facility who are over age 65 or have one of the CDC recognized risks listed above.
Make sure appropriate personal protective equipment (PPE) is available and worn by all membersof the endoscopy team: gloves, mask, eye shield/goggles, face shields, and gown 6 (we recommend reviewing the in-press that just appeared in GIE and there may be others that we will keep our members appraised of).
Check body temperature of the patient upon arrival at endoscopy unit or clinic.
Keep all patients at an appropriate distance from each other (6 feet is recommended) throughout the entire time in the endoscopy unit.
Conservation of PPE is critical.Only essential personnel should be present in cases. Consider extended use or reuse of surgical masks and eye protection in accordance with hospital policies.
For COVID-19 positive patients, or those awaiting test results, isolation precautions should be taken with procedures performed in negative pressure rooms.
Consider phone follow-up at 7 and 14 days to ask about new diagnosis, or development of symptoms, of COVID-19.
Centers should strategically assign available personnel. It is important to minimizing concomitant exposure of those with similar or unique skill sets. Non-physician practitioners and fellows that cannot participate in cases may be helpful screening and triaging patients, or performing virtual visits.
For elective office visits, consider offering elective office visits remotely, via telemedicine if possible, in order to decrease the office density of patients, and provide needed care to patients who are less willing or unable to travel
It is important to address our collective staff needs and institute policies that protect our workforce
Patients on immunosuppressive drugs for IBD and autoimmune hepatitis should continue taking their medications. The risk of disease flare outweighs the chance of contracting coronavirus. These patients should also follow CDC guidelines for at-risk groups by avoiding crowds and limiting travel.
