Plans to Reactivate Gastroenterology Practices Following the COVID-19 Pandemic: A Survey of North American Centers

• Type of Material: Article
• Authors: Vladimir Kushnir, Washington University; Tyler M. Berzin, Harvard Medical School; B. Joseph Elmunzer, Medical University of South Carolina; Robin B. Mendelsohn, Memorial Sloan Kettering Cancer Center; Vaishali Patel, Emory University; Swati Pawa, Wake Forest University; Zachary L. Smith, Case Western Reserve University; Rajesh N. Keswani, Northwestern University
• Language: English
• Date: 2020-09-01
• Publisher: Elsevier Science Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the AGA Institute.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.cgh.2020.05.030
• Title of Journal or Parent Work: Clinical Gastroenterology and Hepatology
• Volume: 18
• Issue: 10
• Start Page: 2287
• End Page: +
• Grant/Funding Information: None declared
• Keywords: COVID-19; Endoscopy Operations; Science & Technology; Safety; Personal Protective Equipment; Gastroenterology & Hepatology; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Pathology; Health Sciences, Epidemiology; Health Sciences, Nutrition

Abstract

Background & Aims: Practices dramatically reduced endoscopy services due to the COVID-19 pandemic. Because practices now are considering reintroduction of elective endoscopy, we conducted a survey of North American practices to identify reactivation barriers and strategies. Methods: We designed and electronically distributed a web-based survey to North American gastroenterologists consisting of 7 domains: institutional demographics, impact of COVID-19 on endoscopy practice, elective endoscopy resumption plans, anesthesia modifications, personal protective equipment policies, fellowship training, and telemedicine use. Responses were stratified by practice type: ambulatory surgery center (ASC) or hospital-based. Results: In total, 123 practices (55% ASC-based and 45% hospital-based) responded. At the pandemic's peak (as reported by the respondents), practices saw a 90% decrease in endoscopy volume, with most centers planning to resume elective endoscopy a median of 55 days after initial restrictions. Declining community prevalence of COVID-19, personal protective equipment availability, and preprocedure severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing availability were ranked as the 3 primary factors influencing reactivation timing. ASC-based practices were more likely to identify preprocedure testing availability as a major factor limiting elective endoscopy resumption (P =.001). Preprocedure SARS-CoV-2 testing was planned by only 49.2% of practices overall; when testing is performed and negative, 52.9% of practices will continue to use N95 masks. Conclusions: This survey highlights barriers and variable strategies for reactivation of elective endoscopy services after the COVID-19 pandemic. Our results suggest that more widespread access to preprocedure SARS-CoV-2 tests with superior performance characteristics is needed to increase provider and patient comfort in proceeding with elective endoscopy.