Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2020; 26(43): 6880-6890
Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6880
Barriers for resuming endoscopy service in the context of COVID-19 pandemic: A multicenter survey from Egypt
Omar Elshaarawy, Sameh Aldesoky Lashen, Nahed A Makhlouf, Doaa Abdeltawab, Mariam Salah Zaghloul, Rasha M Ahmed, Hayam Fathy, Shimaa Afifi, Muhammad Abdel-Gawad, Eman Abdelsameea, Sherief Abd-Elsalam, Salem Youssef Mohamed, Mohammed Tag-Adeen, Mina Tharwat, Ahmed Alzamzamy, Ahmed Nasr Bekhit, Alshaimaa M Eid, Abeer Awad, Mohammad Aamr, Waleed A Abd El Dayem, Mohamed-Naguib Wifi, Mohamed Alboraie
Omar Elshaarawy, Eman Abdelsameea, Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Egypt
Omar Elshaarawy, Department of Internal Medicine and Center of Alcohol Research and Liver Diseases, Salem Medical Center, Heidelberg University, Heidelberg 69121, Germany
Sameh Aldesoky Lashen, Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria 21521, Egypt
Nahed A Makhlouf, Doaa Abdeltawab, Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Mariam Salah Zaghloul, Department of Hepatology, Gastroentrology and Infectious Diseases, Kafrelsheikh University, Faculty of Medicine, Kafrelsheikh 33565, Egypt
Rasha M Ahmed, Hayam Fathy, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Shimaa Afifi, National Hepatology and Tropical Medicine Research Institute, Cairo 11638, Egypt
Muhammad Abdel-Gawad, Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Assiut 71524, Egypt
Sherief Abd-Elsalam, Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
Salem Youssef Mohamed, Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
Mohammed Tag-Adeen, Department of Internal Medicine, Gastroenterology Unit, Qena Faculty of Medicine, South Valley University, Qena 83523, Egypt
Mina Tharwat, Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Aswan University, Aswan 81528, Egypt
Ahmed Alzamzamy, Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo 11771, Egypt
Ahmed Nasr Bekhit, Department of Tropical Medicine, Zagazig General Hospital, Zagazig 42511, Egypt
Alshaimaa M Eid, Department of Hepatology and Gastroenterology and Infectious Disease, Faculty of Medicine, AlAzhar University, Cairo 11562, Egypt
Abeer Awad, Mohamed-Naguib Wifi, Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11759, Egypt
Mohammad Aamr, Department of Hepatology and Gastroentorolgy, Shebin Elkom Teaching Hospital, Shebine Elkom 3521, Egypt
Waleed A Abd El Dayem, Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
Mohamed Alboraie, Department of Internal Medicine, Al-Azhar University, Cairo 11651, Egypt
Author contributions: Elshaarawy O is guarantor of the article; Elshaarawy O and Alboraie M contributed the study conception and design; Elshaarwy O, Lasheen SA and Alboraie M provided methodology; Lasheen SA contributed formal analysis and investigation; all authors wrote original draft preparation, reviewed and edited the manuscript; Elshaarawy O and Alboraie M contributed supervision; all authors approved the final version of the manuscript.
Institutional review board statement: The study was approved by the Institutional Review Board of the National Liver Institute, Menoufia University, Egypt (NLI IRB 00003413) in June 2020, protocol number 00203/2020.
Informed consent statement: It is survey no consent was needed from patients.
Conflict-of-interest statement: Nothing to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed Alboraie, MD, MRCP, MSc, Lecturer, Department of Internal Medicine, Al-Azhar University, ElMokhayam El Daem St., Nasr City, Cairo 11651, Egypt. alboraie@azhar.edu.eg
Received: October 14, 2020
Peer-review started: October 14, 2020
First decision: November 3, 2020
Revised: November 3, 2020
Accepted: November 9, 2020
Article in press: November 9, 2020
Published online: November 21, 2020
ARTICLE HIGHLIGHTS
Research background

An outbreak of coronavirus disease 2019 (COVID-19) has hit the world and disturbed the whole healthcare system, including endoscopic practices which are a very risky procedures in terms of exposure to infection.

Research motivation

Smooth resumption of routine endoscopic service has to be guaranteed as well as decreasing the burden of exposing patients and endoscopy staff to infection during endoscopic procedures. Many strategies have to be implemented in endoscopy units, however, these strategies face many barriers as shortage of personal protective equipment, working staff and post procedure tracing of infection and follow-up of patients.

Research objectives

This survey study was designed to evaluate the feasibility and the difficulty of resumption of routine endoscopic service in the context of COVID-19 pandemic.

Research methods

We conducted a survey study that included 20 questions to be answered by the head of endoscopy units in 113 units from all over Egypt.

Research results

One hundred and thirteen centers participated in the study from all over Egypt. Due to halting the routine endoscopic services during the pandemic, the waiting lists were doubled in most of the centers. Third of the centers experienced significant shortage of endoscopy staff. The lack of dedicated endoscopy rooms for infected patients and the staff shortage were the main barriers to resume routine services smoothly. 

Research conclusions

We recommend increasing working hours and dividing endoscopy staff into teams to overcome the shortage of endoscopy staff. Also, follow up of patients for two weeks after endoscopic procedures to detect any possible transmission of infection in endoscopy centers as this strategy may help in tracing the source of nosocomial transmission.

Research perspectives

For smooth resumption of endoscopic service between two waves of the current pandemic, several strategies have to be applied in a uniform manner in all endoscopy units. Our study showed how different centers acted differently during this pandemic in terms of their plan to safely getting routine endoscopy service on track. Future studies should propose modalities to guarantee uniform application of determined strategies that overcome the current barriers.