Gastroenterology and Digestive Endoscopy Unit, Hospital of Bolzano, Italy.
Gastroenterology and Digestive Endoscopy Unit, S. Chiara Hospital of Trento, Italy.
Acta Gastroenterol Belg. 2022 Oct-Dec;85(4):581-858. doi: 10.51821/85.4.10742.
The role of pre-procedure SARS-CoV2 testing in digestive endoscopy is still debated. AGA guidelines recommend against pre-procedure testing considering low prevalence of SARS- CoV2 infection in the general population and low incidence of infection among endoscopy units Health Care Workers (HCWs). However, no studies have compared pre-procedure testing associated to symptom screening vs. symptom screening alone in reducing the risk of infection for HCWs. Main aim of the present study is to compare the risk of infection for HCWs in different Endoscopy Units adopting different pre-endoscopy screening and operating in two nearby hospital of the same region in Northern Italy in pre-vaccination period. For outpatients in the Endoscopy Unit of Trento (Unit 1) only pre-procedure symptom screening was performed, while in the Endoscopy Unit of Bolzano (Unit 2) pre-procedure symptom screening and negative pre-procedure real-time PCR were requested. Secondary aims were to assess the impact of pre-procedure real-time PCR testing on endoscopic activity and diagnostic delay.
Retrospective data collection on a prospectively maintained database was performed, including outpatient endoscopy procedures performed between June 1st 2020 and February 28th 2021 in Unit 1 and Unit 2.
No differences in terms of infection rate in HCWs have been identified in Unit 1 and Unit 2 (9.0 vs. 19.3% P=0.2) over a nine-month period. Moreover, in the unit performing pre- procedure real-time PCR before endoscopy a significantly higher reduction in endoscopic activity has been recorded (61.9% vs. 53.4%; P<0.01). In patients with positive real-time PCR, endoscopy was performed with a mean delay of 61.7 days (range 9-294) and 22.5% of them were lost at follow-up and did not undergo any endoscopic procedure in the following 12 months.
This study supports the AGA recommendation suggesting that pre-endoscopy real-time PCR is an expensive and time-consuming procedure without proven benefits in an outpatient setting.
在消化内镜检查中，术前 SARS-CoV2 检测的作用仍存在争议。AGA 指南建议反对术前检测，因为 SARS-CoV2 感染在普通人群中的患病率较低，内镜单位医护人员（HCW）的感染发生率也较低。然而，尚无研究比较术前检测联合症状筛查与单独症状筛查在降低 HCW 感染风险方面的差异。本研究的主要目的是比较在接种疫苗前，意大利北部同一地区两家医院附近的不同内镜科室采用不同的术前筛查方式时，HCW 感染的风险。特伦托内镜科（1 号科室）仅对门诊患者进行术前症状筛查，而博尔扎诺内镜科（2 号科室）则要求进行术前症状筛查和术前实时 PCR 检测。次要目的是评估术前实时 PCR 检测对内镜活动和诊断延迟的影响。
对前瞻性维护的数据库进行回顾性数据收集，包括 2020 年 6 月 1 日至 2021 年 2 月 28 日在 1 号科室和 2 号科室进行的门诊内镜检查。
在 9 个月的时间里，1 号科室和 2 号科室的 HCW 感染率没有差异（9.0%比 19.3%，P=0.2）。此外，在进行内镜检查前进行术前实时 PCR 的科室，内镜活动的减少量显著更高（61.9%比 53.4%；P<0.01）。在实时 PCR 阳性的患者中，内镜检查的平均延迟为 61.7 天（范围 9-294 天），其中 22.5%的患者在随访时丢失，并且在接下来的 12 个月内没有进行任何内镜检查。
本研究支持 AGA 建议，即内镜前实时 PCR 是一种昂贵且耗时的检测方法，在门诊环境中没有被证实的益处。
