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Gastroenterology Groups Map a Return to Elective Endoscopy

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In contrast, the ACG decision tree calls for N95 or elastomeric masks in areas of high prevalence even with a negative test and a negative symptom screen. And it calls for a hospital procedure with an N95 or elastomeric mask in patients with either a positive symptom screen or a positive test.

In addition to masks, the AGA and DHPA guidelines recommend use of other PPE, such as water-resistant gowns, shoe covers, scrubs, double-gloving, and surgical head coverings.

They recommend daily screening of endoscopy center staff with temperature checks and surveys of COVID-19 symptoms and exposure.

Moreover, they call for social distancing of patients, visitors, and staff, and high-level disinfection of endoscopes. They recommend against endotracheal intubation of patients undergoing elective upper endoscopy.

The number of states allowing elective procedures is changing by the day, Berggreen said. In Arizona, where he practices, Gov. Doug Ducey removed all restrictions on elective procedures starting May 1. But other states, where caseloads have been higher, including New York and Massachusetts, have yet to follow suit.

“We are still in kind of a holding pattern,” Richard Hodin, MD, chief of gastrointestinal surgery at Massachusetts General Hospital in Boston, told Medscape Medical News. Currently his facility is only doing procedures when a patient’s life is in danger.

The availability of testing also ranges widely from one practice to another. New York University, where Pochapin is director of gastroenterology, is able to do its own tests. Berggreen’s practice, Arizona Digestive Health in Phoenix, has assigned staff to swab patients in its parking lot and then send the samples to a lab by courier for analysis. 

Berggreen said his practice has been essentially closed for the past month. In May, he expects his team will do about 30% of its normal volume. They will not start with purely elective procedures, such as following up on a polyp, but with semi-urgent cases, said Berggreen.

“Elective procedures can still be delayed a little bit longer,” he said. “But we’re trying to take care of our patients that are not purely elective: somebody with abdominal pain that you think is very likely a stomach ulcer, somebody with rectal bleeding or persistent diarrhea that’s really impacting their life and you’re thinking this could be an inflammatory condition of the colon.”

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