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      ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic

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          Abstract

          We are currently living in the throes of the COVID-19 pandemic that imposes a significant stress on health care providers and facilities. Europe is severely affected with an exponential increase in incident infections and deaths. The clinical manifestations of COVID-19 can be subtle, encompassing a broad spectrum from asymptomatic mild disease to severe respiratory illness. Health care professionals in endoscopy units are at increased risk of infection from COVID-19. Infection prevention and control has been shown to be dramatically effective in assuring the safety of both health care professionals and patients. The European Society of Gastrointestinal Endoscopy ( www.esge.com ) and the European Society of Gastroenterology and Endoscopy Nurses and Associates ( www.esgena.org ) are joining forces to provide guidance during this pandemic to help assure the highest level of endoscopy care and protection against COVID-19 for both patients and endoscopy unit personnel. This guidance is based upon the best available evidence regarding assessment of risk during the current status of the pandemic and a consensus on which procedures to perform and the priorities on resumption. We appreciate the gaps in knowledge and evidence, especially on the proper strategy(ies) for the resumption of normal endoscopy practice during the upcoming phases and end of the pandemic and therefore a list of potential research questions is presented. New evidence may result in an updated statement.

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          Most cited references12

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of Coronavirus Disease 2019 in China

            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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              Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

              In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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                Author and article information

                Journal
                Endoscopy
                Endoscopy
                10.1055/s-00000012
                Endoscopy
                © Georg Thieme Verlag KG (Stuttgart · New York )
                0013-726X
                1438-8812
                June 2020
                17 April 2020
                : 52
                : 6
                : 483-490
                Affiliations
                [ 1 ]Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel & Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
                [ 2 ]Nuovo Regina Margherita Hospital, Rome, Italy
                [ 3 ]Ulm, Germany
                [ 4 ]III. Medizinische Klinik Universitätsklinikum Augsburg, Augsburg, Germany
                [ 5 ]Department of Gastroenterology, Hospital Clinic de Barcelona. Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS). Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Universitat de Barcelona, Barcelona, Spain
                [ 6 ]Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
                [ 7 ]Portsmouth Hospital NHS Trust, Gastroenterology, Portsmouth, United Kingdom
                [ 8 ]Department of Gastroenterology and Hepatology,Catholic University of Leuven (KUL), TARGID, University, Hospitals Leuven, Leuven, Belgium
                [ 9 ]Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
                [10 ]Department of Cancer Prevention and Department of Oncological Gastroenterology,The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
                [11 ]Hepatogastroenterology Unit, 2nd Department of Internal Medicine - Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
                [12 ]Department of Gastroenterology, University College London Hospitals, London, United Kingdom
                [13 ]Dartmouth Geisel School of Medicine, Hanover NH, VA Medical Center, Section of Gastroenterology, White River Junction, VT., USA
                [14 ]North West Anglia NHS Foundation Trust, Hinchingbrooke, United Kingdom
                [15 ]Inselspital, Bern, Switzerland
                [16 ]General hospital, Bjelovar, Croatia
                [17 ]University Medical Centre, Ljubljana, Slovenia
                [18 ]Tallinn Healthcare College, Tallin,Estonia
                [19 ]Hvidovre Hospital, Copenhagen, Denmark
                [20 ]Amsterdam UMC location AMC, Amsterdam, The Netherlands
                [21 ]Gastroenterology Division, Edouard Herriot Hospital Lyon, France
                [22 ]Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
                [23 ]Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
                Author notes
                Corresponding author Mario Dinis Ribeiro Instituto Português de Oncologia – Gastrenterologia Rua Dr. Bernardino de AlmediaPorto 4200-072Portugal mario@ 123456med.up.pt
                Article
                10.1055/a-1155-6229
                7295280
                32303090
                912da09e-469e-47ab-b29d-86fdcf1b8d64
                Copyright @ 2020

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