key: cord-1038546-lj6f8hre
authors: Dolinger, Michael T.; Kumta, Nikhil A.; Greenwald, David A.; Dubinsky, Marla C.
title: Outcomes of universal pre-procedure COVID-19 testing prior to endoscopy in a tertiary care center in New York City
date: 2020-07-16
journal: Gastroenterology
DOI: 10.1053/j.gastro.2020.07.015
sha: 603d20b6db44d10b2c451523037297cd9d6598bb
doc_id: 1038546
cord_uid: lj6f8hre

nan

In response to the Coronavirus disease 2019 (COVID-19) pandemic, gastrointestinal professional societies initially provided guidance to delay all elective endoscopies and to perform only urgent or emergent procedures. 1 This resulted in endoscopy centers to operate at less than 25% of normal volume. 2 In early April, planning to reopen endoscopy units had begun. As almost half of coronavirus infections are transmitted by asymptomatic or pre-symptomatic individuals, gastrointestinal societies advised obtaining a negative SARS-CoV-2 molecular test for all patients within 48-72 hours prior to endoscopy to prevent viral transmission. [3] [4] Despite SARS-CoV-2 molecular testing recommendations for endoscopy centers, there is little evidence to support their effectiveness. Stanford University Medical Center reported one ambulatory SARS-CoV-2 positive test out of 694, a positive percentage of 0.14% compared to 4.34% in Santa Clara County from April 1 st to May 31st. 5 In this study, we aim to report on outcomes of universal 48-72 hour, pre-procedure SARS-CoV-2 testing over a 2 month period from May 1, 2020 to June 30, 2020 after reopening an adult and pediatric endoscopy center in New York City, the global epicenter of the pandemic, and to compare those results to the New York City and New York State SARS-CoV-2 positive percentage during that time. (Figure 1 ).

This is the first study of outcomes for universal SARS-CoV-2 testing in an ambulatory endoscopy center from New York City, the highest prevalence area of COVID-19 in the United States. This data suggest that a SARS-CoV-2 positive PCR test in an asymptomatic ambulatory endoscopy patients is a rare event, with an overall percentage positive of less than one percent.

As the SARS-CoV-2 percentage positive decreased in the local and state population from May to June, the percentage positive also decreased slightly in those undergoing endoscopy from 1.27% in May to 0.86% in June, despite almost triple the amount of patients tested in June compared to May. These findings are consistent with those from Stanford University Medical Center and Santa Clara County, a lower prevalence area than New York City, that SARS-CoV-2 positivity in asymptomatic ambulatory endoscopy patients is a rare event. 5 In our study, no children tested PCR positive prior to endoscopy. More studies are needed to determine if routine screening of asymptomatic children prior to endoscopy is necessary in areas of low prevalence to prevent viral transmission.

Endoscopy is an aerosolizing procedure. SARS-CoV-2 can be detected in the air 3 hours after aerosolization. [6] [7] The presence of SARS-CoV-2 RNA has been detected in feces of COVID-19 patients, yet live virus was never isolated from stool samples, even in samples with a high viral RNA concentration, suggesting fecal-oral transmission may be a less likely method of viral transmission. 8 

Joint Gastrointestinal Society Guidance on Endoscopic Procedures During COVID-19

Changes in Gastroenterology and Endoscopy Practices in Response to the COVID-19 Pandemic: Results from a North American Survey

Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo'

The ACG Endoscopy Resumption Task Force: Guidance on Safely Reopening Your Endoscopy Center

Implementation and Impact of Universal Pre-procedure Testing of Patients for COVID-19 Prior to Endoscopy

COVID-19 and gastrointestinal endoscopy: what should be taken into account? Digestive Endoscopy

COVID-19 and its effects on the digestive system and endoscopy practice

Virological assessment of hospitalized patients with COVID-2019

patients. Further, multi-center studies are needed as the COVID-19 pandemic continues to assess the safety of pre-procedure endoscopic protocols to prevent viral transmission.