Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements)

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Abstract

Coronavirus-19 (COVID-19) caused by SARS-CoV-2 has become a global pandemic. Risk of transmission may occur during endoscopy and the goal is to prevent infection among healthcare professionals while providing essential services to patients. Asia was the first continent to have a COVID-19 outbreak, and this position statement of the Asian Pacific Society for Digestive Endoscopy shares our successful experience in maintaining safe and high-quality endoscopy practice at a time when resources are limited. Sixteen experts from key societies of digestive endoscopy in Asia were invited to develop position statements, including patient triage and risk assessment before endoscopy, resource prioritisation and allocation, regular monitoring of personal protective equipment, infection control measures, protective device training and implementation of a strategy for stepwise resumption of endoscopy services after control of the COVID-19 outbreak.

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Most cited references 29

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

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

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

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

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

Dawei Wang, Bo Hu, Fangfang Zhu … (2020)

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

Journal ID (nlm-ta): Gut

Journal ID (iso-abbrev): Gut

Journal ID (hwp): gutjnl

Journal ID (publisher-id): gut

Title: Gut

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 0017-5749

ISSN (Electronic): 1468-3288

Publication date (Print): June 2020

Publication date (Electronic): 2 April 2020

Volume: 69

Issue: 6

Pages: 991-996

Affiliations

[1 ] departmentDepartment of Surgery , The Chinese University of Hong Kong , Hong Kong, Hong Kong

[2 ] departmentDepartment of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences , The Chinese University of Hong Kong , Hong Kong, Hong Kong

[3 ] departmentDigestive Disease Center , Showa University, Northern Yokohama Hospital , Yokohama, Japan

[4 ] departmentAsian Healthcare Foundation , Asian Institute of Gastroenterology , Hyderabad, Andhra Pradesh, India

[5 ] departmentDepartment of Gastroenterology and Hepatology , General Hospital of Chinese PLA , Beijing, China

[6 ] departmentDigestive Endoscopy Center , CHA Bundang Medical Center, CHA University , Seoul, Republic of Korea

[7 ] departmentDepartment of Medicine , Yong Loo Lin School of Medicine, National University of Singapore , Singapore

[8 ] departmentSchool of Medicine , The University of Queensland , Brisbane, Queensland, Australia

[9 ] departmentDivision of Gastroenterology , Queen Elizabeth II Jubilee Hospital , Brisbane, Queensland, Australia

[10 ] departmentDepartment of Internal Medicine, College of Medicine , National Taiwan University , Taipei, Taiwan

[11 ] departmentDepartment of Medicine , Chulalongkorn University , Bangkok, Thailand

[12 ] departmentDepartment of Internal Medicine , National Taiwan University Hospital and National Taiwan University College of Medicine , Taipei, Taiwan

[13 ] Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia

[14 ] Asan Medical Center , Songpa-gu, Seoul, Republic of Korea

[15 ] departmentDepartment of Gastroenterology and Hepatology , University of Malaya , Kuala Lumpur, Malaysia

[16 ] departmentDivision of Gastroenterology and Hepatology , The Jikei University School of Medicine , Tokyo, Japan

[17 ] departmentDepartment of Endoscopy , The Jikei University School of Medicine , Tokyo, Japan

[18 ] departmentOita University , Oita, Japan

Author notes

[Correspondence to ] Professor Siew C Ng, Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong; siewchienng@ 123456cuhk.edu.hk

SK and FKLC are joint senior authors.

Author information

Philip Wai Yan Chiu http://orcid.org/0000-0001-9292-112X

Siew C Ng http://orcid.org/0000-0002-6850-4454

David G Hewett http://orcid.org/0000-0002-4529-3543

Han-Mo Chiu http://orcid.org/0000-0003-2786-8056

Francis K L Chan http://orcid.org/0000-0001-7388-2436

Article

Publisher ID: gutjnl-2020-321185

DOI: 10.1136/gutjnl-2020-321185

PMC ID: 7211066

PubMed ID: 32241897

SO-VID: e252ed78-cc67-42f0-ae4d-73c0adad486f

License:

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