Casper M, Reichert M C, Rissland J, Smola S, Lammert F, Krawczyk M
Department of Medicine II - Gastroenterology, Hepatology and Endocrinology, Saarland University Medical Center, Saarland University, Kirrberger Straße 100, 66421, Homburg, Germany.
Institute of Virology, Saarland University Medical Center, Saarland University, Homburg, Germany.
Eur J Med Res. 2022 Mar 18;27(1):41. doi: 10.1186/s40001-022-00672-5.
In response to the COVID-19 pandemic, endoscopic societies initially recommended reduction of endoscopic procedures. In particular non-urgent endoscopies should be postponed. However, this might lead to unnecessary delay in diagnosing gastrointestinal conditions.
Retrospectively we analysed the gastrointestinal endoscopies performed at the Central Endoscopy Unit of Saarland University Medical Center during seven weeks from 23 March to 10 May 2020 and present our real-world single-centre experience with an individualized rtPCR-based pre-endoscopy SARS-CoV-2 testing strategy. We also present our experience with this strategy in 2021.
Altogether 359 gastrointestinal endoscopies were performed in the initial period. The testing strategy enabled us to conservatively handle endoscopy programme reduction (44% reduction as compared 2019) during the first wave of the COVID-19 pandemic. The results of COVID-19 rtPCR from nasopharyngeal swabs were available in 89% of patients prior to endoscopies. Apart from six patients with known COVID-19, all other tested patients were negative. The frequencies of endoscopic therapies and clinically significant findings did not differ between patients with or without SARS-CoV-2 tests. In 2021 we were able to unrestrictedly perform all requested endoscopic procedures (> 5000 procedures) by applying the rtPCR-based pre-endoscopy SARS-CoV-2 testing strategy, regardless of next waves of COVID-19. Only two out-patients (1893 out-patient procedures) were tested positive in the year 2021.
A structured pre-endoscopy SARS-CoV-2 testing strategy is feasible in the clinical routine of an endoscopy unit. rtPCR-based pre-endoscopy SARS-CoV-2 testing safely allowed unrestricted continuation of endoscopic procedures even in the presence of high incidence rates of COVID-19. Given the low frequency of positive tests, the absolute effect of pre-endoscopy testing on viral transmission may be low when FFP-2 masks are regularly used.
为应对新冠疫情，内镜学会最初建议减少内镜检查程序。特别是非紧急内镜检查应推迟。然而，这可能会导致胃肠道疾病诊断的不必要延迟。
我们回顾性分析了2020年3月23日至5月10日这七周内在萨尔兰大学医学中心中央内镜科进行的胃肠道内镜检查，并展示了我们基于实时荧光定量聚合酶链反应（rtPCR）的个体化内镜检查前新冠病毒检测策略的单中心实际经验。我们还介绍了2021年我们使用该策略的经验。
在初始阶段共进行了359例胃肠道内镜检查。该检测策略使我们能够在新冠疫情第一波期间保守地减少内镜检查程序（与2019年相比减少44%）。89%的患者在内镜检查前获得了鼻咽拭子新冠病毒rtPCR检测结果。除了6例已知感染新冠病毒的患者外，所有其他检测患者均为阴性。接受或未接受新冠病毒检测的患者在内镜治疗频率和具有临床意义的发现方面没有差异。2021年，通过应用基于rtPCR的内镜检查前新冠病毒检测策略，无论新冠疫情的后续浪潮如何，我们都能够不受限制地进行所有要求的内镜检查程序（超过5000例程序）。2021年只有两名门诊患者（1893例门诊程序）检测呈阳性。
结构化的内镜检查前新冠病毒检测策略在内镜科的临床常规中是可行的。基于rtPCR的内镜检查前新冠病毒检测即使在新冠病毒高发病率的情况下也能安全地允许内镜检查程序不受限制地继续进行。鉴于阳性检测频率较低，当定期使用FFP-2口罩时，内镜检查前检测对病毒传播的绝对影响可能较低。
