Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, USA.
Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA.
Dig Endosc. 2020 Jul;32(5):715-722. doi: 10.1111/den.13693. Epub 2020 Jun 3.
A new coronavirus emerged in December 2019 in Wuhan city of China, named as the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and the disease was called coronavirus disease-2019 (COVID-19). The infection due to this virus spread exponentially throughout China and then spread across >205 nations, including the United States (US). Gastrointestinal (GI) endoscopies are routinely performed in the US and globally. Previous reports of isolated infection outbreaks were reported with endoscopes acting as potential vectors. While multidrug-resistant organisms have been reported to be spread by endoscopes, few cases of viruses such as hepatitis B and C are noted in the literature. COVID-19 is predominately spread by droplet transmission, although recent evidence has showed that shedding in feces and feco-oral transmission could also be possible. It is unclear if COVID-19 could be transmitted by endoscopes, but it could theoretically happen due to contact with mucous membranes and body fluids. GI endoscopies involve close contact with oral and colonic contents exposing endoscopy staff to respiratory and oropharyngeal secretions. This can increase the risk of contamination and contribute to virus transmission. Given these risks, all major GI societies have called for rescheduling elective non-urgent procedures and perform only emergent or urgent procedures based on the clinical need. Furthermore, pre-screening of all individuals prior to endoscopy is recommended. This article focuses on the risk of COVID-19 transmission by GI shedding, the potential role of endoscopes as a vector of this novel virus, including transmission during endoscopies, and prevention strategies including deferral of elective non-urgent endoscopy procedures.
一种新型冠状病毒于 2019 年 12 月在中国武汉市出现，被命名为严重急性呼吸综合征冠状病毒-2（SARS-CoV-2），该病被称为 2019 年冠状病毒病（COVID-19）。由于这种病毒的感染在中国呈指数级传播，随后传播到包括美国（美国）在内的超过 205 个国家。在美国和全球范围内，常规进行胃肠（GI）内镜检查。以前有报道称，孤立的感染爆发与充当潜在载体的内窥镜有关。虽然多药耐药生物体已被报道通过内窥镜传播，但在文献中很少有乙型肝炎和丙型肝炎等病毒的病例。COVID-19 主要通过飞沫传播传播，但最近的证据表明，粪便中的脱落物和粪口传播也可能是可能的。目前尚不清楚 COVID-19 是否可以通过内窥镜传播，但由于与粘膜和体液接触，理论上可能会发生这种情况。GI 内窥镜检查涉及与口腔和结肠内容物的密切接触，使内窥镜工作人员接触到呼吸道和口咽分泌物。这会增加污染的风险并有助于病毒传播。鉴于这些风险，所有主要的 GI 协会都呼吁重新安排非紧急的选择性程序，并仅根据临床需要进行紧急或紧急程序。此外，建议在进行内窥镜检查之前对所有个体进行预筛查。本文重点介绍 GI 脱落物传播 COVID-19 的风险，内窥镜作为这种新型病毒传播媒介的潜在作用，包括内窥镜检查期间的传播，以及包括推迟非紧急选择性内窥镜检查程序在内的预防策略。
