S553 Reevaluating the Need for Pre-Endoscopic COVID-19 Testing: A Single Center Retrospective Study

Abstract

Introduction: On May 21st, the American Gastroenterological Association (AGA) updated its July 2020 Covid-19 testing guidelines, recommending against routine pre-endoscopic procedure Covid-19 testing. Prior, the community standard of care was to perform pre-endoscopy Covid-19 testing because endoscopic procedures posed a level-1 Covid-19 exposure risk to healthcare providers (HCPs). Pre-endoscopy Covid-19 testing unnecessarily consumes healthcare resources, since asymptomatic infection rates are low and the majority of HCPs are vaccinated against Covid-19. Here, we present the pre-endoscopy Covid-19 testing data from a New Jersey urban community gastroenterology clinic to evaluate the AGA recommendation. Methods: Retrospective analysis of all pre-endoscopy Covid-19 tests was performed. Between 5/20/2020 and 6/18/2021, pre-endoscopy Covid-19 testing was performed on 1097 patients. Patients were first administered a standard Covid-19 symptom screening questionnaire one week prior to endoscopy. Next, the HCP performed a nasopharyngeal specimen (NP) collection within 4 days of the endoscopic procedure, following the CDC clinical guidelines. Same day Covid-19 testing was performed on the NP specimen using the Thermo Fisher TaqMan 2019-nCoV Assay Kit v1, TaqMan 2019-nCoV Control Kit v1Test, TaqPath Covid-19 Combo Kit, or Panther Fusion® SARS-CoV-2 Assay Kit by real-time (RT) PCR. When the NP specimen was insufficient (ie. equivocal PCR amplification, missing specimen, contamination), pre-endoscopy Covid-19 testing protocol was repeated. Results: 0 study participants reported Covid-19 symptoms through the symptom screening questionnaire. Of the 1097 pre-endoscopy Covid-19 tests performed, Covid-19 was detected in 21 samples and was not detected in the remaining 1076 samples. An infection positivity rate of 1.91% was observed. The range of study participant age was 18 to 88. The median age was 54, and the mean age was 52.1. 55% of study participants were female. The race distribution was as follows: 42% White, 23% Hispanic, 18% Asian, 10% Black, 7% other. Conclusion: Study results support the AGA’s recommendation, demonstrating that pre-endoscopic procedure Covid-19 testing is unnecessary due to low asymptomatic infection rates. However, emergent Covid-19 variants may pose new risks to HCPs and vaccinated individuals. The GI community must continue to monitor infection rates, and reevaluate Covid-19 testing guidelines as needed.