Table 3.
Included Studies Reporting on Infections After Endoscopy
| First author, design, and dates | Preprocedure testing | PPE, masks | Patient infections (data source) | HCW infections (data source) | Total endoscopic cases. n |
|---|---|---|---|---|---|
| Hayee (prospective cohort)14 12/14/2020 to 12/31/2020 after emergence of UK variant |
Universal symptom screeninga and preprocedure testing | BSG guidanceb | 3 (post-endoscopy symptom screening d7 and d14 and testing as indicated) |
0 (reporting by local endoscopy centers) |
2440 |
| Hayee (prospective cohort)15 4/30/2020 to 6/30/2020 |
Universal symptom screeninga Some endoscopy units with PCR testing (n = 2611) |
BSG guidanceb | 0 (post-endoscopy symptom screening d7 and d14) |
0 (reporting by local endoscopy centers) |
6208 |
| Huang (retrospective cohort)21 2/1/2020 to 3/31/2020 |
Universal symptom screeninga PCR testing if symptom screening positive |
N95 or medical surgical masks | 0 (post-endoscopy follow-up) |
0/33 (symptom screening, temperature monitoring, PCR testing) |
1808 |
| D’Ovidio24 (retrospective cohort) 3/9/2020 to 5/4/2020 |
Universal symptom screeninga | NR | 0 (post-endoscopy follow-up) |
0 (PCR and serologic testing) |
60 |
| Pena-Rey (retrospective cohort)20 3/13/2020 to 5/11/2020 |
Universal symptom screeninga | NR | 0 NR |
0 “No cases associated with endoscopy” unclear if this included HCWs NR |
3310 |
| Repici (retrospective cohort)22 1/27/2020 to 3/13/2020 |
Screening/triage protocols evolved during this time | Active rationing of N95s; mix of N95s and surgical masks | 1 (post-endoscopy follow-up at 2 wk) |
42/968c (HCW survey) |
802 |
| Jagannath (retrospective cohort)23 4/2/2020 to 5/31/2020 |
Universal symptom screeninga PCR testing if symptom screening positive |
N95s | 6c | 4/74 (0.26%/100 endoscopies) | 1549 |
| Casper (retrospective cohort)10 3/23/2020 to 5/10/2020 |
Universal symptom screeninga PCR testing |
BSG guidanceb | 0 (NR) |
0 (weekly testing of HCWs) |
313 |
BSG, British Society of Gastroenterology; NR, not reported.
Universal symptom screening includes both patient’s symptoms as well as screening for high-risk exposures (travel/sick contacts).
BSG guidance recommends the following: if COVID negative: surgical masks for all cases; if COVID status unknown but symptom screening negative: N95 for upper endoscopy and surgical masks for lower endoscopy.
Of note, all 6 cases in Jagannath et al23 occurred within 48 h after endoscopy (unlikely that endoscopy was the source). Also, it is unclear whether the 42 HCW cases in this study were related to endoscopy or other exposures (contact tracing was not done) and the majority of the cases, 85.7%, were recorded before implementation of stringent preventive measures, including PPE.