S2082 Importance of Coronavirus Disease 2019 Screening Before Endoscopic Procedures

Abstract

INTRODUCTION: Asymptomatic coronavirus disease 2019 (COVID-19) is estimated to be between 15 to 40% of all cases. This needs to be distinguished from pre-symptomatic disease as patients are asymptomatic for a while, but eventually have symptoms. Since COVID-19 patients are contagious while asymptomatic, healthcare providers are at high risk of exposure. Although mass testing may prevent healthcare worker exposure, mass testing may not be possible due to insufficient healthcare resources. To illuminate the importance of COVID-19 screening, we present a 66 year-old asymptomatic male with a COVID-19 positive screen before an esophagogastroduodenoscopy (EGD). CASE DESCRIPTION/METHODS: A 66 year-old African American non-Hispanic male with a past medical history of ischemic stroke, hypertension, and hyperlipidemia, presented to the emergency department with bright red blood per rectum and melenic stool. He denied any fever, chills, night sweats, cough, dyspnea, abdominal pain, diarrhea, nausea, or vomiting. His bleeding began one week after starting apixaban for a left internal jugular vein thrombosis. Initial laboratory was significant for a microcytic anemia (11.2 g/dL). Therefore, he was admitted for further evaluation of gastrointestinal bleed. Gastroenterology was consulted and recommended proceeding with an EGD. However, recent hospital guidelines warranted COVID-19 screening in all patients undergoing a procedure. Although the patient had asymptomatic respiratory symptoms, he tested positive for COVID-19. Therefore, endoscopy was cancelled. Once serial hemoglobin was stable, he was discharged after two days of hospitalization. DISCUSSION: Healthcare workers are at high risk of COVID-19 infection. In an observational study enrolling 1,099 Chinese patients infected with COVID-19, 3.5% were healthcare workers. Gastroenterologists are at high risk of infection as some procedures create viral aerosolization. However, pre-endoscopic and nationwide screening could decrease infection rate. South Korea successfully contained COVID-19 spread through mass testing. Although such solution could be implemented in the United States, insufficient healthcare utilization of resources including limited tests and reagent supplies are potential hurdles. We present the importance of COVID-19 screening before endoscopy. Although the long-term benefits of pre-endoscopic COVID-19 screening is not well known, pre-endoscopic screening may be an effective way to limit healthcare worker exposure.