Bilal Mohammad, Simons Malorie, Rahman Asad Ur, Smith Zachary L, Umar Shifa, Cohen Jonah, Sawhney Mandeep S, Berzin Tyler M, Pleskow Douglas K
Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States.
Division of Gastroenterology & Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States.
Endosc Int Open. 2020 May;8(5):E693-E698. doi: 10.1055/a-1153-9014. Epub 2020 Apr 17.
There is a consensus among gastroenterology organizations that elective endoscopic procedures should be deferred during the COVID-19 pandemic. While the decision to perform urgent procedures and to defer entirely elective procedures is mostly evident, there is a wide "middle ground" of time-sensitive but not technically urgent or emergent endoscopic interventions. We aimed to survey gastroenterologists worldwide using Twitter to help elucidate these definitions using commonly encountered clinical scenarios during the COVID-19 pandemic. A 16-question survey was designed by the authors to include common clinical scenarios that do not have clear guidelines regarding the timing or urgency of endoscopic evaluation. This survey was posted on Twitter. The survey remained open to polling for 48 hours. During this time, multiple gastroenterologists and fellows with prominent social media presence were tagged to disseminate the survey. The initial tweet had 38,795 impressions with a total of 2855 engagements. There was significant variation in responses from gastroenterologists regarding timing of endoscopy in these semi-urgent scenarios. There were only three of 16 scenarios for which more than 70 % of gastroenterologists agreed on procedure-timing For example, significant variation was noted in regard to timing of upper endoscopy in patients with melena, with 44.5 % of respondents believing that everyone with melena should undergo endoscopic evaluation at this time. Similarly, about 35 % of respondents thought that endoscopic retrograde cholangiopancreatography should only be performed in patients with choledocholithiasis with abdominal pain or jaundice. Our analysis shows that there is currently lack of consensus among gastroenterologists in regards to timing of semi-urgent or non-life-threatening procedures during the COVID-19 pandemic. These results support the need for the ongoing development of societal guidance for these "semi-urgent" scenarios to help gastroenterologists in making difficult triage decisions.
胃肠病学组织之间已达成共识，即在新冠疫情期间应推迟择期内镜检查程序。虽然进行紧急手术和完全推迟择期手术的决定大多很明确，但存在大量时间敏感但技术上并非紧急或急症的内镜干预措施，处于这一“中间地带”。我们旨在通过推特对全球胃肠病学家进行调查，以利用新冠疫情期间常见的临床场景来帮助阐明这些定义。作者设计了一项包含16个问题的调查，纳入了在内镜评估的时机或紧迫性方面没有明确指南的常见临床场景。该调查发布在推特上。调查持续开放投票48小时。在此期间，多名在社交媒体上颇具影响力的胃肠病学家和研究员被标记以传播该调查。最初的推文有38795次展示，共有2855次互动。胃肠病学家对这些半紧急情况下内镜检查时机的回答存在显著差异。16个场景中只有3个场景，超过70%的胃肠病学家在手术时机上达成了一致。例如，对于黑便患者进行上消化道内镜检查的时机存在显著差异，44.5%的受访者认为每个黑便患者此时都应接受内镜评估。同样，约35%的受访者认为，内镜逆行胰胆管造影术仅应在患有胆总管结石且伴有腹痛或黄疸的患者中进行。我们的分析表明，在新冠疫情期间，胃肠病学家对于半紧急或非危及生命的手术时机目前缺乏共识。这些结果支持了需要持续制定针对这些“半紧急”情况的社会指导方针，以帮助胃肠病学家做出艰难的分诊决策。
