Abstract
Novel coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing public-health pandemic worldwide. Although SARS-CoV-2 has been known to spread primarily through respiratory droplets, recent evidence also supports fecal/oral as an additional route of transmission, raising concerns over gastrointestinal (GI) transmission of the infection. Herein, we, as the front-line Chinese GI surgeons, would like to share our experience and lessons in the combat against COVID-19. It is essential to create science-based, rational, and practical strategies during the outbreak of COVID-19. Here, we provide multi-institutional consensus on minimizing disease transmission while continuing to provide care from all aspects for patients in GI surgery, including outpatient clinics, inpatient units, gastrointestinal endoscopy centers, and adjustments in perioperative care. Our experiences and recommendations are worth sharing and may help to establish specific infection-control and outcome measures.
Highlights
The novel coronavirus disease-2019 (COVID-19) pandemic is caused by an enveloped, single-stranded RNA virus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]
The ongoing COVID-19 pandemic continues to be a major issue with the increasing number of confirmed cases and disease-related fatalities worldwide
COVID-19-positive patients with GI bleeding with hemodynamic stability should undergo conservative treatments first, including angioembolization, before endoscopic treatment due to the high risk of endoscopy being an aerosol-generating procedure
Summary
The novel coronavirus disease-2019 (COVID-19) pandemic is caused by an enveloped, single-stranded RNA virus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]. COVID-19-positive patients with GI bleeding with hemodynamic stability should undergo conservative treatments first, including angioembolization, before endoscopic treatment due to the high risk of endoscopy being an aerosol-generating procedure The requirement for such procedures should be riskassessed and deferred or delayed if possible. For all surgical personnel involved in GI surgery for confirmed/ high-risk COVID-19 patients or for PUIs for COVID-19, we recommend the following protective measures (Figure 1). Caution needs to be taken when performing GI anastomosis in confirmed or high-risk COVID-19 patients in the emergency setting, because of both the high risk of complications (e.g. anastomotic leaks, intra-abdominal collections) and the subsequent consumption of healthcare resources following an anastomotic leak, whereas, in low-risk patients, protective diversion needs to be avoided, according to the surgeon’s best judgment, to minimize the risk of pathogen exposure when changing stoma appliances afterwards. The therapy should be switched to combination treatment after the pandemic is under control
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