1Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
2Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand
3Division of Radiology, Jinnah Hospital, Lahore, Pakistan
4Division of Gastroenterology, Lahore General Hospital, Lahore, Pakistan
5Division of Digestive Diseases, Department of Internal Medicine, Emory University, Atlanta, GA, USA
6Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
7Department of Surgery, Rajavithi Hospital, Bangkok, Thailand
8Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Copyright © 2022 Korean Society of Gastrointestinal Endoscopy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of Interest: Rungsun Rerknimitr is currently serving as an associate editor in Clinical Endoscopy; however, he was not involved in the peer reviewer selection, evaluation, or decision process for this article. The authors have no potential conflicts of interest.
Funding:This research was also supported by the Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand.
Author Contributions
Conceptualization: Rungsun Rerknimitr and Parit Mekaroonkamol
Data curation: PM, Kasenee Tiankanon, Fariha Shams, Ghias Un Nabi Tayyab, Julia Massaad, Saurabh Chawla, Stanley Khoo, Siriboon Attasaranya, Nonthalee Pausawasdi, Qiang Cai, Thawee Ratanachu-ek, Pradermchai Kongkham
Formal analysis: PM, KT, Rapat Pittayanon Investigation: PM, KT, RP
Methodology: Rungsun Rerknimitr, PK, PM
Project administration: KT, PM
Resources: RR, PK
Supervision: RR
Validation: NP, TR, PK, RR
Writing-original draft: PM
Writing-review & editing: KT, RP, Wiriyaporn Ridtitid, FS, GUNT, JM, SC, SK, SA, NP, QC, TR, PK, RR
Number of respondents (n=330) | |
---|---|
Age (years) | |
Under 25 | 3 (0.9) |
25–34 | 93 (28.2) |
35–44 | 156 (47.3) |
45–54 | 57 (17.3) |
Over 55 | 21 (6.4) |
Gender | |
Male | 202 (61.2) |
Female | 128 (38.8) |
Role | |
Endoscopist | 278 (84.2) |
Endoscopy nurse | 44 (13.3) |
Technical assistant | 8 (2.5) |
Work experience | |
Fellow-in-training | 32 (9.7) |
0–5 years | 109 (33.0) |
5–10 years | 92 (27.9) |
10–15 years | 46 (13.9) |
More than 15 years | 51 (15.5) |
Institutional level of care | |
Primary care | 10 (3.0) |
Secondary care | 47 (14.2) |
Tertiary care | 273 (82.7) |
Institutional funding | |
Private practice | 58 (17.6) |
Governmental hospital | 272 (82.4) |
Case volume prior to COVID-19 pandemic per day | |
0–10 | 71 (21.5) |
11–20 | 105 (31.8) |
21–30 | 59 (17.9) |
31–40 | 28 (8.5) |
41–50 | 25 (7.6) |
More than 50 | 42 (12.7) |
Number of COVID-19 cases being treated in the hospital | |
None | 65 (19.7) |
1–10 | 107 (32.4) |
11–20 | 42 (12.7) |
21–30 | 26 (7.9) |
More than 30 | 90 (27.3) |
Region of practice | |
Southeast Asia | 180 (54.5) |
South Asia | 97 (29.4) |
North America | 38 (11.5) |
Europe | 9 (2.7) |
West Asia | 5 (1.5) |
East Asia | 1 (0.3) |
National COVID-19 prevalence | |
High prevalencea) | 150 (45.5) |
Low prevalenceb) | 180 (54.5) |
Data are presented as number (%).
COVID-19; coronavirus disease 2019.
a)Countries with high prevalence of COVID-19 during the study (Year 2020);
b)Countries with low prevalence of COVID-19 during the study (Year 2020), High prevalence countries were defined as those with “community spread” or >10,000 accumulated cases per million population.
PPE recommendation |
|||
---|---|---|---|
Agreement (“Strongly agree” and “Agree”) | Practicality (“A great deal” and “A lot”) | Applicability (“Very easy” and “Easy”) | |
Age | p=0.792 | p=0.609 | p=0.493 |
Under 25 | 100.0% | 33.3% | 66.7% |
25–34 | 92.5% | 58.1% | 54.8% |
35–44 | 94.9% | 60.3% | 61.5% |
45–54 | 96.5% | 57.9% | 57.9% |
Over 55 | 95.2% | 66.7% | 57.1% |
Gender | p=0.302 | p=0.434 | p=0.033* |
Male | 95.0% | 57.4% | 55.0% |
Female | 94.5% | 62.5% | 64.9% |
Work experience (years) | p=0.523 | p=0.140 | p=0.205 |
0–5 | 95.4% | 64.2% | 64.2% |
6–10 | 96.7% | 50.0% | 52.2% |
11–15 | 91.3% | 63.0% | 58.7% |
>15 | 96.1% | 64.7% | 60.8% |
Professional role | p=0.065 | p=0.830 | p=0.011* |
Physician | 94.2% | 59.4% | 56.5% |
Nurses | 95.5% | 59.1% | 70.5% |
Institutional level | p=0.722 | p=0.089 | p=0.295 |
Primary care | 100% | 60% | 70.0% |
Secondary care | 100% | 70.2% | 70.2% |
Tertiary care | 93.4% | 57.5% | 56.4% |
Private practice status | p=0.888 | p=0.866 | p=0.708 |
Private practice | 93.1% | 60.4% | 55.2% |
Governmental hospital | 94.9% | 59.2% | 59.5% |
Number of COVID cases in the hospital (cases/day) | p=0.039* | p=0.055 | p=0.585 |
0 | 95.4% | 60.0% | 66.2% |
1–10 | 98.1% | 51.4% | 57.0% |
11–20 | 95.2% | 54.8% | 54.8% |
21–30 | 92.3% | 65.4% | 53.8% |
>30 | 90.0% | 68.9% | 58.9% |
Endoscopic volume on COVID-19 cases (cases/month) | p=0.225 | p=0.843 | p=0.164 |
0 | 100.0% | 83.3% | 100.0% |
1–10 | 94.9% | 59.1% | 59.9% |
11–20 | 93.8% | 56.3% | 56.3% |
21–30 | 80.0% | 60.0% | 30.0% |
>30 | 100.0% | 69.2% | 53.8% |
National COVID-19 prevalence | p=0.008* | p<0.001* | p<0.001* |
Low prevalent | 96.7% | 68.3% | 72.8% |
High prevalent | 92% | 48.7% | 42.0% |
Trainee status | p=0.919 | p=0.841 | p=0.518 |
In-training | 86.6% | 53.4% | 53.3% |
Attending physician | 95.2% | 60.0% | 56.8% |
Case Selection recommendations |
|||
---|---|---|---|
Agreement (“Strongly agree” and “Agree”) | Practicality (“A great deal” and “A lot”) | Applicability (“Very easy” and “Easy”) | |
Age | p=0.604 | p=0.808 | p=0.184 |
Under 25 | 100.00% | 66.70% | 66.70% |
25–34 | 92.5% | 45.2% | 58.1% |
35–44 | 96.8% | 41.0% | 72.4% |
45–54 | 94.7% | 40.4% | 66.7% |
Over 55 | 100.0% | 47.6% | 71.4% |
Gender | p=0.421 | p=0.737 | p=0.032* |
Male | 95.1% | 72.2% | 63.4% |
Female | 96.2% | 68.8% | 73.5% |
Work experience (years) | p=0.796 | p=0.268 | p=0.659 |
0–5 | 67.9% | 75.2% | 95.4% |
6–10 | 66.3% | 66.3% | 95.7% |
11–15 | 67.4% | 73.9% | 93.5% |
>15 | 68.6% | 66.7% | 98.0% |
Professional role | p=0.305 | p=0.704 | p=0.391 |
Physician | 95.7% | 71.9% | 66.2% |
Nurses | 95.5% | 63.6% | 70.4% |
Institutional level | p=0.512 | p=0.547 | p=0.194 |
Primary care | 100% | 60.0% | 60.0% |
Secondary care | 93.6% | 76.6% | 77.7% |
Tertiary care | 95.6% | 70.3% | 75.5% |
Private practice status | p=0.561 | p=0.015* | p=0.680 |
Private practice | 96.6% | 63.8% | 62.1% |
Governmental hospital | 95.2% | 72.5% | 68.3% |
Number of COVID cases in the hospital (cases/day) | p=0.830 | p=0.214 | p=0.934 |
0 | 96.9% | 67.60% | 69.2% |
1–10 | 97.2% | 66.30% | 66.4% |
11–20 | 88.1% | 66.70% | 66.7% |
21–30 | 92.3% | 76.90% | 61.5% |
>30 | 96.7% | 78.90% | 68.9% |
Endoscopic volume on COVID-19 cases (cases/month) | p=0.002* | p=0.120 | p=0.927 |
0 | 83.3% | 100.0% | 100.0% |
1–10 | 67.5% | 95.8% | 51.5% |
11–20 | 76.6% | 92.2% | 57.8% |
21–30 | 80.0% | 100.0% | 50.0% |
>30 | 92.3% | 100.0% | 30.8% |
National COVID-19 prevalence | p=0.178 | p=0.134 | p<0.001* |
Low prevalent | 96.7% | 75.0% | 77.5% |
High prevalent | 94.0% | 66.0% | 48.5% |
Trainee status | p=0.891 | p=0.391 | p=0.737 |
In-training | 93.3% | 70.0% | 77.8% |
Attending physician | 95.9% | 62.0% | 54.7% |
Number of respondents (n=330) | |
---|---|
Age (years) | |
Under 25 | 3 (0.9) |
25–34 | 93 (28.2) |
35–44 | 156 (47.3) |
45–54 | 57 (17.3) |
Over 55 | 21 (6.4) |
Gender | |
Male | 202 (61.2) |
Female | 128 (38.8) |
Role | |
Endoscopist | 278 (84.2) |
Endoscopy nurse | 44 (13.3) |
Technical assistant | 8 (2.5) |
Work experience | |
Fellow-in-training | 32 (9.7) |
0–5 years | 109 (33.0) |
5–10 years | 92 (27.9) |
10–15 years | 46 (13.9) |
More than 15 years | 51 (15.5) |
Institutional level of care | |
Primary care | 10 (3.0) |
Secondary care | 47 (14.2) |
Tertiary care | 273 (82.7) |
Institutional funding | |
Private practice | 58 (17.6) |
Governmental hospital | 272 (82.4) |
Case volume prior to COVID-19 pandemic per day | |
0–10 | 71 (21.5) |
11–20 | 105 (31.8) |
21–30 | 59 (17.9) |
31–40 | 28 (8.5) |
41–50 | 25 (7.6) |
More than 50 | 42 (12.7) |
Number of COVID-19 cases being treated in the hospital | |
None | 65 (19.7) |
1–10 | 107 (32.4) |
11–20 | 42 (12.7) |
21–30 | 26 (7.9) |
More than 30 | 90 (27.3) |
Region of practice | |
Southeast Asia | 180 (54.5) |
South Asia | 97 (29.4) |
North America | 38 (11.5) |
Europe | 9 (2.7) |
West Asia | 5 (1.5) |
East Asia | 1 (0.3) |
National COVID-19 prevalence | |
High prevalence |
150 (45.5) |
Low prevalence |
180 (54.5) |
PPE recommendation |
|||
---|---|---|---|
Agreement (“Strongly agree” and “Agree”) | Practicality (“A great deal” and “A lot”) | Applicability (“Very easy” and “Easy”) | |
Age | p=0.792 | p=0.609 | p=0.493 |
Under 25 | 100.0% | 33.3% | 66.7% |
25–34 | 92.5% | 58.1% | 54.8% |
35–44 | 94.9% | 60.3% | 61.5% |
45–54 | 96.5% | 57.9% | 57.9% |
Over 55 | 95.2% | 66.7% | 57.1% |
Gender | p=0.302 | p=0.434 | p=0.033 |
Male | 95.0% | 57.4% | 55.0% |
Female | 94.5% | 62.5% | 64.9% |
Work experience (years) | p=0.523 | p=0.140 | p=0.205 |
0–5 | 95.4% | 64.2% | 64.2% |
6–10 | 96.7% | 50.0% | 52.2% |
11–15 | 91.3% | 63.0% | 58.7% |
>15 | 96.1% | 64.7% | 60.8% |
Professional role | p=0.065 | p=0.830 | p=0.011 |
Physician | 94.2% | 59.4% | 56.5% |
Nurses | 95.5% | 59.1% | 70.5% |
Institutional level | p=0.722 | p=0.089 | p=0.295 |
Primary care | 100% | 60% | 70.0% |
Secondary care | 100% | 70.2% | 70.2% |
Tertiary care | 93.4% | 57.5% | 56.4% |
Private practice status | p=0.888 | p=0.866 | p=0.708 |
Private practice | 93.1% | 60.4% | 55.2% |
Governmental hospital | 94.9% | 59.2% | 59.5% |
Number of COVID cases in the hospital (cases/day) | p=0.039 |
p=0.055 | p=0.585 |
0 | 95.4% | 60.0% | 66.2% |
1–10 | 98.1% | 51.4% | 57.0% |
11–20 | 95.2% | 54.8% | 54.8% |
21–30 | 92.3% | 65.4% | 53.8% |
>30 | 90.0% | 68.9% | 58.9% |
Endoscopic volume on COVID-19 cases (cases/month) | p=0.225 | p=0.843 | p=0.164 |
0 | 100.0% | 83.3% | 100.0% |
1–10 | 94.9% | 59.1% | 59.9% |
11–20 | 93.8% | 56.3% | 56.3% |
21–30 | 80.0% | 60.0% | 30.0% |
>30 | 100.0% | 69.2% | 53.8% |
National COVID-19 prevalence | p=0.008 |
p<0.001 |
p<0.001 |
Low prevalent | 96.7% | 68.3% | 72.8% |
High prevalent | 92% | 48.7% | 42.0% |
Trainee status | p=0.919 | p=0.841 | p=0.518 |
In-training | 86.6% | 53.4% | 53.3% |
Attending physician | 95.2% | 60.0% | 56.8% |
Case Selection recommendations |
|||
---|---|---|---|
Agreement (“Strongly agree” and “Agree”) | Practicality (“A great deal” and “A lot”) | Applicability (“Very easy” and “Easy”) | |
Age | p=0.604 | p=0.808 | p=0.184 |
Under 25 | 100.00% | 66.70% | 66.70% |
25–34 | 92.5% | 45.2% | 58.1% |
35–44 | 96.8% | 41.0% | 72.4% |
45–54 | 94.7% | 40.4% | 66.7% |
Over 55 | 100.0% | 47.6% | 71.4% |
Gender | p=0.421 | p=0.737 | p=0.032 |
Male | 95.1% | 72.2% | 63.4% |
Female | 96.2% | 68.8% | 73.5% |
Work experience (years) | p=0.796 | p=0.268 | p=0.659 |
0–5 | 67.9% | 75.2% | 95.4% |
6–10 | 66.3% | 66.3% | 95.7% |
11–15 | 67.4% | 73.9% | 93.5% |
>15 | 68.6% | 66.7% | 98.0% |
Professional role | p=0.305 | p=0.704 | p=0.391 |
Physician | 95.7% | 71.9% | 66.2% |
Nurses | 95.5% | 63.6% | 70.4% |
Institutional level | p=0.512 | p=0.547 | p=0.194 |
Primary care | 100% | 60.0% | 60.0% |
Secondary care | 93.6% | 76.6% | 77.7% |
Tertiary care | 95.6% | 70.3% | 75.5% |
Private practice status | p=0.561 | p=0.015 |
p=0.680 |
Private practice | 96.6% | 63.8% | 62.1% |
Governmental hospital | 95.2% | 72.5% | 68.3% |
Number of COVID cases in the hospital (cases/day) | p=0.830 | p=0.214 | p=0.934 |
0 | 96.9% | 67.60% | 69.2% |
1–10 | 97.2% | 66.30% | 66.4% |
11–20 | 88.1% | 66.70% | 66.7% |
21–30 | 92.3% | 76.90% | 61.5% |
>30 | 96.7% | 78.90% | 68.9% |
Endoscopic volume on COVID-19 cases (cases/month) | p=0.002 |
p=0.120 | p=0.927 |
0 | 83.3% | 100.0% | 100.0% |
1–10 | 67.5% | 95.8% | 51.5% |
11–20 | 76.6% | 92.2% | 57.8% |
21–30 | 80.0% | 100.0% | 50.0% |
>30 | 92.3% | 100.0% | 30.8% |
National COVID-19 prevalence | p=0.178 | p=0.134 | p<0.001 |
Low prevalent | 96.7% | 75.0% | 77.5% |
High prevalent | 94.0% | 66.0% | 48.5% |
Trainee status | p=0.891 | p=0.391 | p=0.737 |
In-training | 93.3% | 70.0% | 77.8% |
Attending physician | 95.9% | 62.0% | 54.7% |
Society | Published | Postpone non urgent procedures | Urgent procedures | Pre-endoscopy screening tool | Type of PPE recommended | Scope cleaning process |
---|---|---|---|---|---|---|
European Society of Gastrointestinal Endoscopy | 18 March 2020 | yes | -Acute GI bleeding and anemia with hemodynamic instability | Questionnaire | Double gloves, mask (FFP2/3), goggles or face shield, waterproof gown, hairnet, shoe covers | Same as pre-COVID-19 era |
-Foreign body | ||||||
-Obstruction | ||||||
-Acute cholangitis | ||||||
World Endoscopy Organization | 24 March 2020 | yes | -Upper GI bleeding, | Questionnaire | Double gloves, mask (N95/FFP2/FF3/CAPR/PAPR), goggles or face shield, waterproof gown, hairnet, shoe covers | Not mentioned |
-Foreign body | ||||||
-Obstruction | ||||||
-Acute cholangitis | ||||||
American Society for Gastrointestinal Endoscopy | 27 March 2020 | yes | -Upper GI bleeding, | Questionnaire and body temperature measurement | Gloves, mask(N95/FFP2), goggles or face shield, waterproof gown | Same as pre-COVID-19 era |
-Foreign body | ||||||
-Obstruction | ||||||
-Acute cholangitis | ||||||
-Care of cancer | ||||||
Thai Association for Gastrointestinal Endoscopy | 25 March 2020 | yes | -Acute GI bleeding | Questionnaire and body temperature measurement | Double gloves, mask (N95/FFP2/FF3/CAPR/PAPR), goggles or face shield, waterproof gown, hairnet, shoe covers | 3 additional pre-cleaning steps before standard reprocessing |
-Foreign body | ||||||
-Obstruction | ||||||
-Acute cholangitis | ||||||
-Perforation and leakage | ||||||
-Access for urgent feeding |
Data are presented as number (%). COVID-19; coronavirus disease 2019. Countries with high prevalence of COVID-19 during the study (Year 2020); Countries with low prevalence of COVID-19 during the study (Year 2020), High prevalence countries were defined as those with “community spread” or >10,000 accumulated cases per million population.
COVID-19, coronavirus disease 2019; PPE, personal protective equipment. Statistically significant.
COVID-19, coronavirus disease 2019 Statistically significant.
COVID-19, coronavirus disease 2019; GI: gastrointestinal; PPE, personal protective equipment.