COVID-19 and Pediatric Gastroenterology.

Pediatric gastroenterologists took on a variety of challenges during the coronavirus disease 2019 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically decreased numbers of in-person visits, adopting telehealth technologies, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the impact of the pandemic on trainee education, clinical experience, research, and job searches.

COVID-19 and liver disease: An update. / Actualización en COVID-19 y enfermedad hepática.

The SARS-CoV-2 pandemic has proven to be a serious challenge for the Spanish healthcare system. The impact of the virus on the liver is not well known, but in patients with chronic liver disease, mostly in advanced stages, it can critically compromise survival and trigger decompensation. Treatment in this subpopulation is complex due to the potential hepatotoxicity of some of the medicinal products used. Moreover, the pandemic has also negatively impacted patients with liver disease who have not contracted COVID-19, since the reallocation of human and material resources to the care of patients with the virus has resulted in a decrease in the treatment, diagnosis and follow-up of patients with liver disease, which will surely have negative consequences in the near future. Efficient reorganization of hepatology units is a priority to minimise the impact of the pandemic on a population as vulnerable as liver disease patients.

Effect of COVID-19 pandemic on workflows and infection prevention strategies of endoscopy units in Hungary: a cross-sectional survey.

BACKGROUND: Health care professionals in endoscopic labs have an elevated risk for COVID-19 infection, therefore, we aimed to determine the effect of current pandemic on the workflow and infection prevention and control strategies of endoscopy units in real-life setting. METHODS: All members of Hungarian Society of Gastroenterology were invited between 7 and 17 April 2020 to participate in this cross-section survey study and to complete an online, anonymous questionnaire. RESULTS: Total of 120 endoscopists from 83 institutes were enrolled of which 35.83% worked in regions with high cumulative incidence of COVID-19. Only 33.33% of them had undergone training about infection prevention in their workplace. 95.83% of endoscopists regularly used risk stratification of patients for infection prior endoscopy. While indications of examinations in low risk patients varied widely, in high-risk or positive patients endoscopy was limited to gastrointestinal bleeding (95.00%), removal of foreign body from esophagus (87.50%), management of obstructive jaundice (72.50%) and biliary pancreatitis (67.50%). Appropriate amount of personal protective equipment was available in 60.85% of endoscopy units. In high-risk or positive patients, surgical mask, filtering facepiece mask, protective eyewear and two pairs of gloves were applied in 30.83%, 76.67%, 90.00% and 87.50% of cases, respectively. Personal protective equipment fully complied with European guideline only in 67.50% of cases. CONCLUSIONS: Survey found large variability in indications of endoscopy and relative weak compliance to national and international practical recommendations in terms of protective equipment. This could be improved by adequate training about infection prevention.

Telehealth in Pediatric Gastroenterology Can Be a Sustainable Long-Term Option: A Single-Center Experience.

None: Telehealth has been a well-established system of care delivery at Kaiser Permanente Northwest Pediatric Gastroenterology since before the COVID-19 era, where 54% of our completed pediatric gastroenterology encounters in the past year were virtual visits. Although it was previously limited in its use across the majority of health care in the US, telehealth is now a widely accepted system in the face of the COVID-19 pandemic. However, this unprecedented rapid expansion of telehealth within both new and established telehealth systems is not without challenges or quality concerns. In this report, we present our single-center experience from the past year where virtual care was already an integral part of our clinical practice in pediatric gastroenterology and review satisfaction data and quality measures from the COVID-19 era where our existing telehealth system expanded to nearly exclusive virtual care.

Coronavirus disease-2019: implications for the gastroenterologist.

PURPOSE OF REVIEW: The COVID-19 pandemic has impacted the practicing gastroenterologist in several ways. Although majority of COVID-19 patients present with respiratory symptoms, gastrointestinal symptoms are also seen. COVID-19 has also disrupted gastrointestinal endoscopy services in numerous ways. There are also concerns regarding the impact of these changes on gastrointestinal cancer screening and management of chronic gastrointestinal diseases. The purpose of this review is to provide an overview of the implications of COVID-19 for the practicing gastroenterologist. RECENT FINDINGS: COVID-19 patients can have gastrointestinal symptoms including diarrhea, nausea and vomiting, abdominal pain and anorexia. Separate from the management of COVID-19 patients, there has been a reduction in endoscopy volume worldwide. This has also resulted in reduction/cessation of in-person clinic visits and an increasing use of telemedicine services. In addition, patients with certain chronic diseases like chronic liver disease or inflammatory bowel disease may have worse outcomes during the COVID-19 pandemic. SUMMARY: Gastroenterologists need to rapidly adapt to the challenges being faced and need to make both systems and practice-based changes to the endoscopy unit and outpatient clinic practices. Gastroenterologists should stay up-to-date with the rapidly evolving literature regarding gastrointestinal symptoms in COVID-19 patients as well as its impact on chronic gastrointestinal illnesses.

Massive impact of coronavirus disease 2019 pandemic on gastroenterology and hepatology departments and doctors in Spain.

BACKGROUND AND AIM: Significant human and material resources have been diverted to coronavirus disease 2019 (COVID-19). Healthcare workers are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We assess the impact of the COVID-19 pandemic on gastroenterology and hepatology departments and specialists in Spain. METHODS: This study involves a nationwide survey addressing the impact of COVID-19 on resources, procedures, and physicians of gastroenterology and hepatology departments in 81 hospitals representative of the Spanish National Health Service. RESULTS: Overall, 41.8% of hospital beds and 40.7% of gastroenterology and hepatology beds were allocated to COVID-19 patient care, as well as 24.8% of gastroenterologists and 58.3% of residents. Outpatient visits, abdominal ultrasounds, and endoscopies were reduced by 81.8-91.9%. Nine large university hospitals had 75% and 89% reductions in therapeutic endoscopies and hepatocellular carcinoma surgery, respectively, with cancelation of elective liver transplant and transjugular intrahepatic portosystemic shunt. Prevalence of infected physicians was 10.6% and was dependent on regional population incidence (r = 0.74, P = 0.001), with 11% hospitalized and one physician dying. Up to 63.4% of physicians may have been infected before or shortly after Spain entered lockdown, 57% of them having recently performed endoscopies. Adequate protection was acknowledged in > 80% hospitals, but only 2.9% performed regular SARS-CoV-2 testing. CONCLUSIONS: The impact of the COVID-19 pandemic on healthcare delivery has been massive. A wave of gastroenterology-related complications is expected because of resource diversion. Gastroenterologists have a high prevalence of infection, although they may have been infected during a first phase of lower awareness and protection. Regular SARS-CoV-2 screening, adequate protection, and quick reorganization of healthcare resources are still needed.

Management of paediatric IBD after the peak of COVID-19 pandemic in Italy: A position paper on behalf of the SIGENP IBD working group.

Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2, spreading in Italy during the first months of 2020, abruptly changed the way of practicing medicine in this country. As a consequence of the lockdown, the diagnostic and therapeutic management of paediatric chronic conditions, such as inflammatory bowel disease (IBD) has been affected. During the peak of COVID-19 pandemic, elective visits, endoscopies and infusions have been postponed, with potential clinical and psychological impact on disease course and a high likelihood of increasing waiting lists. While slowly moving back towards normality, clinicians need to recognize the best ways to care for patients with IBD, carefully avoiding risk factors for new potential epidemic outbreaks. In this uncertain scenario until the development and spread of COVID-19 vaccine, it is necessary to continue to operate with caution. Hereby we provide useful indications for a safer and gradual restarting of routine clinical activities after COVID-19 peak in Italy.

International Organization for the Study of Inflammatory Bowel Disease: Global Strategies for Telemedicine and Inflammatory Bowel Diseases.

Before the onset of the COVID-19 pandemic, the majority of care for inflammatory bowel disease patients was provided in-person. The practice of gastroenterology care has since rapidly transformed, with telemedicine emerging as an essential tool to provide medical care to patients while maintaining social distancing and conserving personal protective equipment. This article provides insight into past and current practices among inflammatory bowel disease specialists and shares regulatory, financial and practical considerations for incorporating telemedicine into clinical practice. Continued government and other payer support for telemedicine and ongoing innovation to provide remote objective patient data will help to sustain the use of telemedicine long after the current pandemic subsides.

Insights from a global snapshot of the change in elective colorectal practice due to the COVID-19 pandemic.

BACKGROUND: There is a need to understand the impact of COVID-19 on colorectal cancer care globally and determine drivers of variation. OBJECTIVE: To evaluate COVID-19 impact on colorectal cancer services globally and identify predictors for behaviour change. DESIGN: An online survey of colorectal cancer service change globally in May and June 2020. PARTICIPANTS: Attending or consultant surgeons involved in the care of patients with colorectal cancer. MAIN OUTCOME MEASURES: Changes in the delivery of diagnostics (diagnostic endoscopy), imaging for staging, therapeutics and surgical technique in the management of colorectal cancer. Predictors of change included increased hospital bed stress, critical care bed stress, mortality and world region. RESULTS: 191 responses were included from surgeons in 159 centers across 46 countries, demonstrating widespread service reduction with global variation. Diagnostic endoscopy was reduced in 93% of responses, even with low hospital stress and mortality; whilst rising critical care bed stress triggered complete cessation (p = 0.02). Availability of CT and MRI fell by 40-41%, with MRI significantly reduced with high hospital stress. Neoadjuvant therapy use in rectal cancer changed in 48% of responses, where centers which had ceased surgery increased its use (62 vs 30%, p = 0.04) as did those with extended delays to surgery (p<0.001). High hospital and critical care bed stresses were associated with surgeons forming more stomas (p<0.04), using more experienced operators (p<0.003) and decreased laparoscopy use (critical care bed stress only, p<0.001). Patients were also more actively prioritized for resection, with increased importance of co-morbidities and ICU need. CONCLUSIONS: The COVID-19 pandemic was associated with severe restrictions in the availability of colorectal cancer services on a global scale, with significant variation in behaviours which cannot be fully accounted for by hospital burden or mortality.

Patient's perspective on the implementation of measures to contain the SARS-CoV-2 pandemic in a Portuguese Gastroenterology Department.

BACKGROUND AND AIMS: As the COVID-19 pandemic emerged, departments had to adapt their activities, jeopardizing patient's best interests. Our aim is to evaluate the patient's perspective to the implementation of SARS-CoV-2 measures in a gastroenterology department in a Portuguese Hospital. METHODS: A survey with 13 questions was created and available to patients with at least one gastroenterology appointment at our center in the year 2019. RESULTS: Nine hundred seventy-three patients completed the survey, 51.6% (n = 502) females, and 82.6% (n = 804) with less than 65 years of age. 50.7% of 962 patients were not working. 49.5% had an appointment for monitoring a suspected or established inflammatory bowel disease (IBD). 76.8% and 69.6% subjects agreed in postponing endoscopic and non-endoscopic procedures, respectively. 93.6%, 94.3% and 95.7% patients declared to be worried about the postponing of endoscopic procedures, non-endoscopic procedures and medical visits, respectively. 88.8% supported remote consultations and 77.3% were satisfied with this type of appointment, independently of the age group (P = 0.66). 80.9% of IBD patients treated with immunosuppression or biologics were concerned about a severe infection by COVID-19. CONCLUSION: A great part of our respondents belong to IBD appointments. The majority of our patients agreed in postponing procedures, although they feel concerned. Almost all patients supported remote consultations and most patients found them positive.

Current and future implications of COVID-19 on gastroenterology training and clinical practice.

The novel coronavirus disease 2019 (COVID-19) pandemic has affected almost every country on the globe, affecting 185 countries with more than 2.6 million cases and 182,000 deaths as of April 22, 2020. The United States (US) has seen an exponential surge in the COVID-19 patients and has become the epicentre with more than 845,000 confirmed cases and 46,000 deaths. The governments and healthcare providers all over the world are racing with time to reduce the rate of increase in active cases by social distancing to flatten the curve of this pandemic. Practicing gastroenterologists are facing multiple challenges in the safe practice of medicine because of patient's inability to visit physicians' offices, endoscopy centers and the threat of potential virus spread through gastrointestinal secretions by endoscopies in emergent cases. The gastroenterological associations from Europe and North America have made position statements to guide gastroenterologists to navigate through the clinical practice during the COVID-19 pandemic. Gastroenterology fellows are on the frontlines during the COVID-19 pandemic, experiencing personal, physical and economic stresses. They had to balance the programmatic changes to meet the demands of the patient care with the additional pressure to meet training requirements. Given the imperatives for social and physical distancing, training programmes have to implement innovative educational methods to substitute traditional teaching. Healthcare organisations must synchronise institutional workforce needs with trainee safety, education and well-being. In this perspective, we have discussed the challenges that can be anticipated and implementing strategies to support fellows during the times of the COVID-19 pandemic.

Establishment of a system for control of cross-infection and workflow in endoscopy center during the pandemic of coronavirus disease 2019. / 2019å† çŠ¶ç— æ¯’ç— ç–«æƒ æœŸé—´æ¶ˆåŒ–å† é•œä¸­å¿ƒè¯Šç–—æµç¨‹å’Œé˜²æŽ§ä½“ç³»çš„å»ºç«‹åŠåº”ç”¨.

OBJECTIVES: To establish a system for control of cross-infection and workflow for preventing severe acute respiratory syndrome coronavirus 2 spread and ensuring the safety of medical staffs and patients in endoscopy center during the pandemic of the coronavirus disease 2019 (COVID-19). METHODS: Based on the national publication of relevant documents and relevant guidance of Digestive Endoscopy Branch of Chinese Medical Association, we explored and optimized the workflow, staff protection and sterilization of endoscope in digestive endoscopy center during the pandemic of the COVID-19. RESULTS: The prevention system of cross-infection and workflow in endoscopy during the pandemic of the COVID-19 were developed. The optimized workflow in endoscopy was conducted in 106 patients with necessary endoscopy from the Department of Gastroenterology, Third Xiangya Hospital, Central South University between January 24, 2020 and February 26, 2020, and no case of cross-infection was presented among the medical staffs, patients and family members. CONCLUSIONS: Measures on control of cross-infection and workflow in digestive endoscopy center during the pandemic of the COVID-19 are effective, which are beneficial to preventing cross-infection in hospital and provide a scientific guidance for the general work in the digestive endoscopy centers during the pandemic of the COVID-19.

Practical management of inflammatory bowel disease patients during the COVID-19 pandemic: expert commentary from the Gastroenterological Society of Australia Inflammatory Bowel Disease faculty.

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has emerged as a public health emergency and challenged healthcare systems globally. In a minority of patients, SARS-CoV-2 manifests with a severe acute respiratory illness and currently there is insufficient data regarding the virulence of COVID-19 in inflammatory bowel disease patients taking immunosuppressive therapy. This review aims to summarise the current literature and provide guidance on the management of inflammatory bowel disease patients in the context of the COVID-19 pandemic in the Australasian setting.

COVID-19 and gastroenterology: clinical insights and recommendations for gastroenterology care providers.

While the COVID-19 pandemic evolves, we are beginning to understand the role the gastrointestinal tract plays in the disease and the impact of the infection on the care of patients with gastrointestinal (GI) and liver diseases. We review the data and understanding around the virus related to the digestive tract, impact of the pandemic on delivery of GI services and daily gastroenterology clinical practice, and the effects on patients with pre-existing GI diseases.

Reorganisation of faecal microbiota transplant services during the COVID-19 pandemic.

The COVID-19 pandemic has led to an exponential increase in SARS-CoV-2 infections and associated deaths, and represents a significant challenge to healthcare professionals and facilities. Individual countries have taken several prevention and containment actions to control the spread of infection, including measures to guarantee safety of both healthcare professionals and patients who are at increased risk of infection from COVID-19. Faecal microbiota transplantation (FMT) has a well-established role in the treatment of Clostridioides difficile infection. In the time of the pandemic, FMT centres and stool banks are required to adopt a workflow that continues to ensure reliable patient access to FMT while maintaining safety and quality of procedures. In this position paper, based on the best available evidence, worldwide FMT experts provide guidance on issues relating to the impact of COVID-19 on FMT, including patient selection, donor recruitment and selection, stool manufacturing, FMT procedures, patient follow-up and research activities.