Covid-19 in Endoscopy: How Likely is Trasnmission of Infection? Results from an International, Multicenter Study

Aims COVID-19 has significantly affected endoscopic practice, as GI-endoscopy is considered a risky procedure fortransmission of infection towards personnel of endoscopy units (PEU) and patients. ESGE recommended reduction of non-emergency endoscopies, personal protection measures (PPM) and post-endoscopy calls to patients, to check their COVID-19 status. This study aimed to assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020). Methods Demographic data, patients' COVID-19 status before and after endoscopy, clinical data for those developingCOVID-19, implementation of PPM, number and type of overall endoscopies, as well as information for possible COVID-19infection of patients and PEU were retrospectively recorded. Results 1267 endoscopies (EGDs:46 %, colonoscopies/rectosigmoidoscopies:35 %, ERCPs:14 %, EUS:4 %) were performedin 1222 patients (mean age:63.4 y.o., males:59 %, inpatients:44 %) in 9 centers (6 countries). Pre-endoscopic testing forCOVID-19 was available for 326 (26.7 %) patients;87(7 %) tested positive. 7-14 days after endoscopy, 1204 patients werecontacted by telephone. Among 1135 pre-endoscopically COVID-19 negative patients 254 were tested post-endoscopy and8 were found positive (0.6 % of the total), with 6, 1 and 1 cases turning positive after EGD, colonoscopy and EUS,respectively. Of these, 4 were considered “obviously” irrelevant to endoscopy, but for the other 4 (3 post-EGD and 1 post-colonoscopy) the route of transmission remained obscure. Appropriate PPM were implemented and adhered to in allcenters;moreover, a significant reduction in the number of endoscopies was noted in all centers after March 2020. Finally,data regarding 163 PEU was recorded;5 (3 %) tested positive during the study period. In 4 of them (2 % of the total), theinfection was considered to be associated to their work environment. Conclusions COVID-19 transmission in endoscopic units is highly unlikely in a lockdown setting, provided endoscopies arereduced to emergency cases and appropriate PPM are implemented and followed.