Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2020; 12(5): 197-202
Published online May 27, 2020. doi: 10.4240/wjgs.v12.i5.197
COVID-19 outbreak and endoscopy: Considerations in patients encountered in a foregut surgery practice
Tanya Olszewski, Andrew D Grubic, Shahin Ayazi, Blair A Jobe
Tanya Olszewski, Andrew D Grubic, Shahin Ayazi, Blair A Jobe, Esophageal and Lung Institute, Department of Surgery, Allegheny Health Network, Pittsburgh, PA 15224, United States
Author contributions: All author contributed to this work; Olszewski T, Grubic AD, Ayazi S, Jobe BA had concept of the study and designed it; Olszewski T and Grubic AD reviewed the literature; Olszewski T, Grubic AD and Ayazi S drafted the manuscript; Ayazi S and Jobe BA provided critical revision.
Conflict-of-interest statement: The authors declare no conflict of interests.
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: Shahin Ayazi, MD, Foregut Surgeon, Esophageal and Lung Institute, Department of Surgery, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA 15224, United States. shahin.ayazi@ahn.org
Received: April 2, 2020
Peer-review started: April 2, 2020
First decision: April 19, 2020
Revised: April 23, 2020
Accepted: May 19, 2020
Article in press: May 19, 2020
Published online: May 27, 2020
Processing time: 54 Days and 10 Hours

Severe acute respiratory syndrome coronavirus has become a critical challenge to global health. Since the arrival of coronavirus disease 2019 in the United States, several government agencies and professional societies have issued guidelines to healthcare systems and medical providers. Endoscopy is a substantial portion of the practice of many general surgeons in the United States. With upper endoscopy, manipulation of the upper aerodigestive tract can turn the droplets to an aerosolized form and increase the likelihood of transmission and therefore is considered a high-risk procedure. In this article we review some aspects of the coronavirus disease 2019 outbreak that are relevant to practice of surgical endoscopy. The emphasis of this communication is on the mode of transmission, previous experiences during other coronavirus outbreaks and society guidelines. We then highlight the changes that we have made to our practice to incorporate these factors to improve the safety of patients, health care providers, and community as a whole.

Keywords: SARS-CoV-2, COVID-19, Endoscopy, Pandemic, Best practice, Personal protection equipment

Core tip: The coronavirus disease 2019 symptoms include fever and cough although patients may have a wide variety of symptoms or may be asymptomatic. Patients can transmit the disease via respiratory droplets, aerosol generating procedures including endoscopy, fecal-oral route and surface contact. Our practice guidelines: (1) Reschedule elective cases, follow tiered approach to determine urgency of cases; (2) Prescreen patients day-before procedures over the phone, perform day-of rapid testing if available; (3) Consider all patients asymptomatic carriers despite testing results; (4) Biosafety level 3 for endoscopy with minimal staff present; and (5) Biosafety level 2 for handling specimens, endoscope and for cleaning procedure room afterward.