guidelines of pandemic endoscopy

1. GUIDELINES OF PANDEMIC
ENDOSCOPY
DR.MASFIQUE AHMED BHUIYAN
MBBS(DMC) FCPS(SURGERY)
LAPARO-ENDOSCOPIC SURGEON
DEPARTMENT OF SURGERY
DHAKA MEDICAL COLLEGE & HOSPITAL.

14. Classification of pandemic endoscopy

15. HOW IT SPREAD
• Air droplets
• Faecal transmission?
(Virus may be present in GI secretions . Viral
RNA detectable in stools )

16. HOW IT SPREAD
Asymptomatic spread
Incubation period ~5 days (range 0-14)
Viral shedding greatest when symptoms begins

17. COMMON SYMPTOM
• Cough
• Fever
• Fatigue
• Sore throat
• Nausea and/ or
• Diarrhoea
• Loss of smell

18. STOP
• all elective
• non-essential endoscopic procedures as soon
as possible.

19. DO
• Only life saving endoscopy
• Acute GI Bleeding
• Acute oesophageal obstruction by food bollus
or foreign body.
• pinhole stricture/cancer where stenting is
considered essential.

20. DO
• Acute cholangitis/jaundice secondary to
malignant/benign biliary obstruction
• • Acute biliary pancreatitis and/or cholangitis
with stone and jaundice
• Infected pancreatic collections/WON

21. DO
• PEG/NJ tube
• obstruction needing urgent
decompression/stenting

22. • Restricting numbers of staff in rooms
• Assessing stocks of consumables and devices
daily
• Regular screening of staff
• Psycological support prevent burn out

23. RESTRICT
• Patient attendent
• Patient must wear mask
• Social distance maintain

24. The release states recommendations will
be applied by individual facilities based on
local conditions and will be affected by
guidance from federal, state and local
authorities. The guidance includes:

25. Elective endoscopic procedures may resume
when the rate of new COVID-19 cases
substantially decreases in the relevant
geographic area for at least 14 days. This
decision should consider federal, state and
local recommendations, availability of local
health care system resources, and ability to
offer a safe environment for staff and patients.
Prioritize scheduled endoscopies by level of
urgency, based on patient considerations and a
physician’s professional judgement.

26. All patients should receive PCR-based testing
for active COVID-19 infection wherever
possible. Testing should be performed within
48 hours of the procedure. If pre-procedure
COVID-19 testing cannot be conducted,
patients should keep a daily temperature log
for 10 days before the procedure and be
administered a symptom questionnaire and
temperature check on the day of procedure.

27. Endoscopy staff should be screened daily with
temperature check and surveyed for COVID-19
exposure and symptoms. Policies should be
implemented to facilitate social distancing for
patients, visitors and staff. Policies may include
mask use by all center personnel, appropriate
spacing, restrict accompanying visitors,
required masks for patients and visitors,
staggered procedure start times, individual
workstations for staff, organization of workflow
patterns and job descriptions to minimize
cross-contamination.

28. Disinfection, Handling, and
Endoscope Storage
in covid era

29. disinfection
standard manual cleaning followed
by high-level disinfection (HLD)
should be effective at eradicating
SARS-CoV-2

30. Endotech management in
reprocessing
Reduce edostaff
Avoid novice

31. Precleaning of endosuite
Interval time of procedure 30
minutes

33. essential. 2. Deferment of elective endoscopies
should be considered until further notice
during the COVID-19 outbreak. 3. Urgent
endoscopies should be performed by
strategically assigned staff to minimise
concomitant exposure. 4. Resource
reallocation for staff and medical equipment is
recommended to prepare for a surge in
healthcare demand. 5. Regular monitoring of
supply and use of personal protective
equipment (PPE) is necessary to adjust
endoscopy service and uphold morale of staff.
6. Healthcare workers should practise standard
infection control for endoscopy. 7. Healthcare
workers should receive adequate training on
gowning and removal of PPE. 8. Extra
precaution is recommended during
colonoscopies as prolonged faecal shedding of
SARS-CoV-2 can occur. 9. Endoscopies should
be performed in a negative pressure room
when available with strict isolation precautions
in suspected or confirmed cases of COVID-19.
10. Disinfection policy for endoscopy rooms
and reprocessing of instruments should be
enhanced. 11. Stepwise resumption of elective

35. A recent study showed that there is prolonged
presence of SARS-Cov-2 viral RNA in faecal
samples for up to 47 days after onset of the
first symptoms.35 As endoscopes are often
affected by gut flora, this could pose a risk to
endoscopists, nursing staff and other
endoscopy staff and could also be a vector for
potentia transmission to other patients.36 37
Therefore, it is important for staff performing
colonoscopies to aware of this potential risk,
and colonoscopy should be considered a high-
risk procedure and careful decontamination
procedures vigilantly performed

36. Flow chart to prescreen and triage patients for endoscopy during COVID-19 outbreak.
Philip Wai Yan Chiu et al. Gut 2020;69:991-996
Copyright © BMJ Publishing Group Ltd & British Society of Gastroenterology. All rights reserved.

46. Adjust with covid situation

48. Practice donn of doff