Abstract
Background:The impact of gastrointestinal endoscopy on COVID-19 infection remains poorly investigated. We herein performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 in patients undergoing gastrointestinal endoscopy.Method:Ovid Medline, Ovid EMBASE, Ovid the Cochrane Library, and other electronic databases were searched until 30 November 2020 to identify publications with confirmed COVID-19 infection in patients undergoing gastrointestinal endoscopy. The primary outcomes were SARS-CoV-2 transmission, personal protective equipment use, rates of case fatality, complications, and procedural success.Results:A total of 18 articles involving 329 patients were included in this systematic review and meta-analysis. The overall basic reproduction rate is 0.37, while the subgroup results from Asia, Europe, and North America are 0.13, 0.44, and 0.33, respectively. The differences in personal protective equipment use between the positive transmission and non-transmission group are mainly in isolation gowns, N95 or equivalent masks, and goggles or face-shields. The rate of case fatality, complication, and procedural success are 0.17 (95% confidence interval = 0.02–0.38), 0.00 (95% confidence interval = 0.00–0.02), and 0.89 (95% confidence interval = 0.50–1.00), respectively. The fatality rate in Europe was the highest (0.23, 95% confidence interval = 0.04–0.50), which is significantly different from other continents (p = 0.034).Conclusion:The risk of SARS-CoV-2 transmission within gastrointestinal endoscopy units is considerably low if proper use of personal protective equipment is applied. Similarly, a low fatality and complication rate, as well as a high procedural success rate, indicated that a full recovery of endoscopic units should be considered.
Highlights
The outbreak of the novel coronavirus disease 2019 (COVID-19), caused by SARS-CoV2 infections, has widely spread throughout the world[1,2] and has been declared as a pandemic by the World Health Organization (WHO) in March 2020.3 So far, more than 119 million confirmed COVID-19 cases have been reported, with 2.6 million confirmed death by 17 March 2021.4COVID-19 is able to cause respiratory illness, but may lead to gastrointestinal (GI) diseases, for example, enteritis,[5,6] pancreatitis,[7] and cholangitis.[8]
Search strategy The publications that published on several electronic databases, registries, and guideline, including Ovid Medline (1950-present), Ovid EMBASE (1974- present), Ovid the Cochrane Library of Randomized Trials (1993-present), the World Health Organization International Clinical Trials Platform Search Portal (ICTRP), and ClinicalTrials.gov, were searched on 15 November 2020, using the key terms ‘2019nCoV’, ‘novel corona virus’, ‘COVID19’, ‘betacoronavirus’, ‘SARS-CoV-2’, ‘coronavirus infection’, ‘Wuhan pneumonia’, AND ‘endoscopy’, ‘gastroscopy’, ‘duodenoscopy’, ‘choledochoscopy’, ‘cholangioscopy’, ‘colonoscopy’, ‘rectoscopy’, and ‘proctoscopy’
Inclusion criteria were as follows: (1) studies reported data on COVID-19-confirmed patients; (2) these patients underwent GI endoscopy for both diagnosis and therapy; (3) had one of the following outcomes: transmission of SARSCoV-2, protective equipment (PPE) use, fatality, complications, success rate of endoscopic hemostasis; (4) the latest study was included if duplicated studies from the same population were identified; and (5) studies limited to human
Summary
The outbreak of the novel coronavirus disease 2019 (COVID-19), caused by SARS-CoV2 infections, has widely spread throughout the world[1,2] and has been declared as a pandemic by the World Health Organization (WHO) in March 2020.3 So far, more than 119 million confirmed COVID-19 cases have been reported, with 2.6 million confirmed death by 17 March 2021.4. Correspondence to: Dörte Wichmann Department of General, Visceral and Transplantation Surgery, Interdisciplinary Endoscopy Unit, University Hospital Tübingen, HoppeSeyler-Str. 3, 72076 Tübingen, Germany. Alfred Königsrainer Department of General, Visceral and Transplantation Surgery, Interdisciplinary Endoscopy Unit, University Hospital Tübingen, Tübingen, Germany. Repici and colleagues[11] declared that there is a low risk of SARS-CoV-2 transmission within GI endoscopy units with an infection rate of 4.2%. The SARS-CoV-2 transmission rates within GI endoscopy units remain unknown.[12] Another example is the management of gastrointestinal bleeding (GIB). Special emphasis will be put on disease transmission, personal protective equipment (PPE) use, rates of case fatality, complications, and procedural success in COVID-positive patients within endoscopic units. The study may provide evidence-based guidance for clinical decision-making
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