Charlie Walsh1, Fadi Hawa, MD2, Avi Dobrusin, MD3, Mark Gladshteyn, BS4, Jill Duda, PA-C, RD4, Mark Velarde, PA-C4, Kristin Minnema, PA-C4, John Walsh, MD4, Naresh Gunaratnam, MD4; 1Davidson College, Ypsilanti, MI; 2St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI; 3Washington University, St. Louis, MO; 4Huron Gastroenterology Associates, Ypsilanti, MI
Introduction: The Novel Coronavirus 2019 (COVID-19) pandemic has limited endoscopic utilization causing significant health and economic losses. Accordingly, gastroenterology (GI) societies recommended COVID-19 testing to screen all patients undergoing endoscopic procedures which resulted in a relatively increased access to such interventions. Nonetheless, this approach can be limited by the cost and availability of testing. We evaluated the feasibility and yield of this approach in detecting patients with COVID-19 at our community-based GI practice which is located in an area with a low COVID-19 prevalence of < 1%. Methods: This is a clinical, non-interventional, observation-based quality initiative of patients scheduled for endoscopic procedures at our community-based GI practice from May 11th to June 4th, 2020. All patients underwent symptoms screening, followed by polymerase chain reaction (PCR)-based testing. Based on the testing result, a decision whether to proceed with endoscopic procedure or not was made. After the procedure, providers were followed closely to early detect any concerning symptoms. Results: A total of 285 patients were scheduled for endoscopic procedures during that time period, 270 were tested for COVID-19. Table 1 details patient baseline characteristics. None of the patients had a positive test result, with only one individual appearing symptomatic but later testing negative. The remaining 15 patients did not undergo their scheduled endoscopic procedure as they did not undergo the required COVID-19 testing prior to their procedure (Figure 1). None of the providers developed COVID-19 related symptoms after the endoscopic procedures. Discussion: Over a 1-month period, we observed a 0% positive test rate for COVID-19 at our GI practice. The results suggest that the current testing protocol may not be cost effective or add much to the safety of patients and providers in low prevalence areas. The most commonly used PCR test can have up to 48 hours turn-around time, which could potentially delay patient care and the overall efficiency of the practice. Therefore, preserving PCR testing to patients with high index of suspicion at GI practices with similar positive test rates as ours, may be a reasonable option in order to improve access to endoscopic procedures. Larger scale, multi-center studies are needed to corroborate these findings. In the interim, strict use of personal protective equipment during endoscopic procedures should continue to be strongly emphasized.
Table 1. Baseline Patient Characteristics
Figure 1. Patient Testing Results
Disclosures: Charlie Walsh indicated no relevant financial relationships. Fadi Hawa indicated no relevant financial relationships. Avi Dobrusin indicated no relevant financial relationships. Mark Gladshteyn indicated no relevant financial relationships. Jill Duda indicated no relevant financial relationships. Mark Velarde indicated no relevant financial relationships. Kristin Minnema indicated no relevant financial relationships. John Walsh indicated no relevant financial relationships. Naresh Gunaratnam: Lean Medical Technologies LCC – Other Financial or Material Support, Co-founder and Chief Medical Officer. Nestle Health Services – Speaker's Bureau.