Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2021; 13(9): 416-425
Published online Sep 16, 2021. doi: 10.4253/wjge.v13.i9.416
COVID-19 in the endoscopy unit: How likely is transmission of infection? Results from an international, multicenter study
Ioannis S Papanikolaou, Georgios Tziatzios, Alexandros Chatzidakis, Antonio Facciorusso, Stefano Francesco Crinò, Paraskevas Gkolfakis, Gjorgi Deriban, Mario Tadic, Goran Hauser, Antonios Vezakis, Ivan Jovanovic, Nicola Muscatiello, Anna Meneghetti, Konstantinos Miltiadou, Kalina Stardelova, Alojzije Lacković, Maria-Zoi Bourou, Srdjan Djuranovic, Konstantinos Triantafyllou
Ioannis S Papanikolaou, Georgios Tziatzios, Alexandros Chatzidakis, Konstantinos Miltiadou, Konstantinos Triantafyllou, Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
Antonio Facciorusso, Nicola Muscatiello, Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy
Stefano Francesco Crinò, Anna Meneghetti, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy
Paraskevas Gkolfakis, Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels 1070, Belgium
Paraskevas Gkolfakis, Department of Medical Oncology, Institut Jules Bordet, Brussels 1000, Belgium
Gjorgi Deriban, Kalina Stardelova, University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia
Mario Tadic, Department of Gastroenterology, Dubrava University Hospital Zagreb, Zagreb 10040, Croatia
Goran Hauser, Alojzije Lacković, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
Antonios Vezakis, Maria-Zoi Bourou, 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
Ivan Jovanovic, Srdjan Djuranovic, Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia
Author contributions: Papanikolaou IS designed the study, was involved with data collection, and drafted the manuscript; Tziatzios G, Chatzidakis A, Facciorusso A, Francesco Crinò S, Gkolfakis P, Deriban G, Tadic M, Hauser G, Vezakis A, Jovanovic I, Muscatiello N, Meneghetti A, Miltiadou K, Stardelova K, Lacković A, Bourou MZ, Djuranovic S were involved with data collection, and drafted the manuscript; Triantafyllou K participated in design of the study, and drafted the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: The protocol of this study was reviewed and approved by the local institutional review board (BΠΠΚ EBΔ 320/10-6-20). The study was conducted in accord with the ethical principles of the Declaration of Helsinki and in compliance with good clinical practice.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
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: Paraskevas Gkolfakis, MD, Research Associate, Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Rue de Lennik 808, Brussels 1070, Belgium. pgkolfakis@med.uoa.gr
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: April 18, 2021
Revised: April 27, 2021
Accepted: July 21, 2021
Article in press: July 21, 2021
Published online: September 16, 2021
Research background

The coronavirus disease 2019 (COVID-19) outbreak significantly affected endoscopic practice, as gastrointestinal endoscopy is considered as a risky procedure for transmission of infection. The ESGE and ESGENA published a position statement for endoscopy during the COVID-19 pandemic regarding the safety of endoscopies for patients and the personnel of endoscopy units (PEU). However, the incidence and outcome of infection among patients undergoing endoscopy and PEU remains to be determined.

Research motivation

Currently, there is insufficient data regarding the incidence and outcomes of COVID-19 infection among patients undergoing endoscopy and in PEU.

Research objectives

We aimed to evaluate the impact of endoscopic procedures on the risk of transmission to patients and PEU in a European multicenter study, using telephone contact as a tool as suggested by the ESGE and ESGENA.

Research methods

Patients undergoing endoscopy in nine endoscopy departments across six European countries during the period of the first European lockdown for COVID-19 (March-May 2020) were included. Participants were stratified as low- or high-risk for potential COVID-19 infection according to the ESGE/ESGENA joint statement were contacted 7 d and 14 d later to assess COVID-19 infection status. PEU were questioned regarding COVID-19 symptoms and/or infection by questionnaire. Information on hospitalizations, ICU-admissions, and COVID-19-related deaths were collected. The number of weekly endoscopies during the lockdown period was also recorded.

Research results

A total of 1267 endoscopies were performed in 1222 individuals; 87 (7%) were excluded following initial positive PCR testing. The remaining 1135 individuals were at low risk or PCR negative for COVID-19 before endoscopy, and of 254 (22.4%) who were tested post endoscopy, eight were eventually found positive, resulting in an infection rate of 0.7% (95%CI: 0.2-0.12). The majority, (6/8, 75%) had undergone esophagogastroduodenoscopy. Data were available for 163 PEU, and 5 (3%; 95%CI: 0.4-5.7) tested positive during the study period. In 4 of the 5, or 2% of the total, the infection was deemed relevant to their work environment. A decrease of 68.7% (95%CI: 64.8-72.7) in the number of endoscopies was recorded.

Research conclusions

This study showed that COVID-19 transmission in endoscopic units was highly unlikely during a lockdown setting, provided endoscopies were restricted to emergency cases and PPM were implemented.

Research perspectives

More robust data are definitely warranted to identify various clinical factors that contribute to an increased risk of endoscopy-related COVID-19 infection.