Mahadev Srihari, Aroniadis Olga C, Barraza Luis H, Agarunov Emil, Smith Michael S, Goodman Adam J, Benias Petros C, Buscaglia Jonathan M, Gross Seth A, Kasmin Franklin, Cohen Jonathan, Carr-Locke David L, Greenwald David, Mendelsohn Robin, Sethi Amrita, Gonda Tamas A
NYP-Weill Cornell Medicine, New York, New York, United States.
Stony Brook University Hospital, Stony Brook, NY.
Endosc Int Open. 2020 Dec;8(12):E1865-E1871. doi: 10.1055/a-1264-7599. Epub 2020 Nov 27.
The coronavirus disease 2019 (COVID-19), and measures taken to mitigate its impact, have profoundly affected the clinical care of gastroenterology patients and the work of endoscopy units. We aimed to describe the clinical care delivered by gastroenterologists and the type of procedures performed during the early to peak period of the pandemic. Endoscopy leaders in the New York region were invited to participate in an electronic survey describing operations and clinical service. Surveys were distributed on April 7, 2020 and responses were collected over the following week. A follow-up survey was distributed on April 20, 2020. Participants were asked to report procedure volumes and patient characteristics, as well protocols for staffing and testing for COVID-19. Eleven large academic endoscopy units in the New York City region responded to the survey, representing every major hospital system. COVID patients occupied an average of 54.5 % (18 - 84 %) of hospital beds at the time of survey completion, with 14.5 % (2 %-23 %) of COVID patients requiring intensive care. Endoscopy procedure volume and the number of physicians performing procedures declined by 90 % (66 %-98 %) and 84.5 % (50 %-97 %) respectively following introduction of restricted practice. During this period the most common procedures were EGDs (7.9/unit/week; 88 % for bleeding; the remainder for foreign body and feeding tube placement); ERCPs (5/unit/week; for cholangitis in 67 % and obstructive jaundice in 20 %); Colonoscopies (4/unit/week for bleeding in 77 % or colitis in 23 %) and least common were EUS (3/unit/week for tumor biopsies). Of the sites, 44 % performed pre-procedure COVID testing and the proportion of COVID-positive patients undergoing procedures was 4.6 % in the first 2 weeks and up to 19.6 % in the subsequent 2 weeks. The majority of COVID-positive patients undergoing procedures underwent EGD (30.6 % COVID +) and ERCP (10.2 % COVID +). COVID-19 has profoundly impacted the operation of endoscopy units in the New York region. Our data show the impact of a restricted emergency practice on endoscopy volumes and the proportion of expected COVID positive cases during the peak time of the pandemic.
2019年冠状病毒病（COVID-19）及其相关缓解措施，对胃肠病患者的临床护理和内镜科室的工作产生了深远影响。我们旨在描述胃肠病学家提供的临床护理以及疫情早期至高峰期所进行的手术类型。纽约地区的内镜科室负责人受邀参与一项描述手术操作和临床服务的电子调查。调查于2020年4月7日分发，并在接下来的一周收集回复。2020年4月20日进行了后续调查。参与者被要求报告手术量、患者特征，以及COVID-19的人员配备和检测方案。纽约市地区的11个大型学术内镜科室回复了调查，代表了每个主要医院系统。在调查完成时，COVID患者平均占用医院床位的54.5%（18%-84%），其中14.5%（2%-23%）的COVID患者需要重症监护。实施限制措施后，内镜手术量和进行手术的医生数量分别下降了90%（66%-98%）和84.5%（50%-97%）。在此期间，最常见的手术是上消化道内镜检查（EGD）（每周每个科室7.9例；88%用于止血，其余用于异物取出和放置饲管）；内镜逆行胰胆管造影（ERCP）（每周每个科室5例；67%用于胆管炎，20%用于梗阻性黄疸）；结肠镜检查（每周每个科室4例，77%用于止血，23%用于结肠炎），最不常见的是超声内镜（EUS）（每周每个科室3例用于肿瘤活检）。在这些科室中，44%进行术前COVID检测，COVID阳性患者接受手术的比例在最初2周为4.6%，在随后2周高达19.6%。接受手术的COVID阳性患者中，大多数接受了EGD（COVID阳性率30.6%）和ERCP（COVID阳性率10.2%）。COVID-19对纽约地区内镜科室的运营产生了深远影响。我们的数据显示了在疫情高峰期，限制紧急手术对内镜手术量以及预期COVID阳性病例比例的影响。
