Restarting endoscopy services in Pakistan, in the covid era: The way forward

Abstract

Background: The emergence of SARS-COVID2 has completely reshaped the way we go about our daily business. Apart from other services, this has also impacted healthcare services and the way they are delivered. As endoscopy is an Aerosol generating procedure(AGP) with high risk of transmission, multiple endoscopy societies at the peak of the pandemic published guidelines on prioritizing of endoscopy services according to the urgency, highlighting the clinical indications which could be deferred until a more comprehensive plan is put out to safely perform endoscopy procedures or the infection rates drop down. 
 Aims and Objectives: We give an example of how our unit in a low Human development Index country, worked through the peak of pandemic providing service to patients in a safe manner which can be continued forward until the pandemic runs its course. 
 Materials and Methods: This prospective study was performed at Dr. Ziauddin University Hospital, Karachi. The ethical endorsement was taken from the Ethical Review Committee. Informed consent was secured in writing from each participant.Patients were assessed by a given screening questionnaire and COVID RT PCR of every patient was checked before endoscopy procedures, only those who tested negative were included in the study. Theendoscopy consultant, endoscopy trainee, anesthetist and the endoscopy staff along with the patients were reassessed for signs & symptoms of COVID-19 via a telephonic questionnaire, 2 weeks after the procedure. 
 Results : Total 80 patients were assessed, out of which 60 were males. All the patients had negative COVID-19 PCR at the time of endoscopy. The procedures were performed under propofol sedation with full Personal protective equipment (PPE) both for the endoscopist and the staff in the room. The PPE included N95 masks, hairnet, Face visor, surgical gloves and disposable gowns. 2 weeks post procedure both the patients and the endoscopy staff were assessed via telephonic questionnaire for any signs & symptoms of COVID-19 or any positive COVID PCR since the time of endoscopy.
 Conclusion: SARS-COVID 19 pandemic is far from over. There is a dire need to restart endoscopy services in a safe and effective way. Ideally full PPE and negative pressure rooms for AGP is the way forward considering that quite a few patients are asymptomatic carriers and the dismissal rate of COVID PCR pick up rate .In low socioeconomic countries these facilities are not readily available. Hence doing a COVID PCR prior to the procedure with adequate PPE can be used as a way forward in COVID era until the pandemic is over.