Interventional gastroenterology

GESA guide for triage on endoscopy procedures and COVID-19: what stays or goes

GESA has provided members with advice on the triage of endoscopic procedures during the COVID-19 pandemic.

The GESA statement supports clinicians in making appropriate decisions to proceed with or defer endoscopic procedures but noting that many situations require a case-by-case assessment.

The list of procedures covers gastroscopy, oesophageal motility and pH studies, colonoscopy, enteroscopy, ERCP, EUS and capsule endoscopy.

GESA vice president Professor Ben Devereaux told the limbic the motivation for the document was two-fold.

“One is we want to limit the number of people coming to hospitals and having endoscopic procedures and being potentially exposed to the virus. We want to play our part in that social distancing,” he said.

“Secondly, we want to play a key role in limiting the use of PPE because at endoscopy we perform a lot of procedures on a lot of patients around the country so we have the potential to use a lot of PPE. Given the shortages and the supply issues we don’t want to restrict the use and availability for more front line services.”

He said their guidance supports the federal government ban on procedures other than Category 1 and urgent Category 2.

“It’s interesting when you look at guidelines from other societies around the world, there is quite a degree of consistency amongst them. I think everyone around the world is on the same page.”

“When It comes to specifics we are particularly concerned about upper GI procedures because of the risk of an aerosol.”

“With respect to the positive FOBT, it’s been a focus of ours for years to encourage everyone with a positive test to be scoped within 2 months but we just feel at this time they are cases that can be deferred for several months and, we feel, reasonably safely.”

“But I was keen that practitioners were able to assess each case on its merits because some cases might raise particular red flags necessitating a procedure in the current environment.”

The advice was that colonoscopy should proceed in cases of colorectal bleeding unlikely to be haemorrhoids, acute colonic obstruction, and probable new diagnoses or flares of IBD where the findings would direct management.

Elective or semi-elective procedures which could be deferred included positive FOBT in patients ≥50 years and with a high quality colonoscopy within the previous 4 years, routine 1,3 and 5 year polyp or IBD surveillance, and assessment of probable IBS or other functional GI disorders.

The trickier case-by-case decisions were around positive FOBTs in ≥50 years and without high quality colonoscopy within 4 years, iron deficiency with or without anaemia where no other cause likely on clinical assessment, surveillance for confirmed or suspected inherited colorectal cancer syndrome including serrated polyposis, investigation of abnormal imaging e.g. ileal/colonic wall thickening on CT Abdomen, and more.

Professor Devereaux said GESA was continuing to monitor the situation on a daily basis and would send out further advice to endoscopy units and endoscopists around the country.

GESA has published a suite of statements related to practice during COVID-19.

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