Review

. 2020 Jun;5(6):598-606.

doi: 10.1016/S2468-1253(20)30119-9. Epub 2020 Apr 16.

Endoscopy in inflammatory bowel diseases during the COVID-19 pandemic and post-pandemic period

Marietta Iacucci¹, Rosanna Cannatelli², Nunzia Labarile³, Ren Mao⁴, Remo Panaccione⁵, Silvio Danese⁶, Gursimran S Kochhar⁷, Subrata Ghosh⁸, Bo Shen⁹

Affiliations

¹ Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Department of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada.
² Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Department of Gastroenterology, Spedali Civili of Brescia, Italy.
³ Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Italy.
⁴ Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, OH, USA.
⁵ Department of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada.
⁶ IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
⁷ Department of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA.
⁸ Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Department of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada. Electronic address: ghoshs@bham.ac.uk.
⁹ Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA.

PMID: 32305075
PMCID: PMC7162648
DOI: 10.1016/S2468-1253(20)30119-9

Review

Endoscopy in inflammatory bowel diseases during the COVID-19 pandemic and post-pandemic period

Marietta Iacucci et al. Lancet Gastroenterol Hepatol. 2020 Jun.

. 2020 Jun;5(6):598-606.

doi: 10.1016/S2468-1253(20)30119-9. Epub 2020 Apr 16.

Authors

Marietta Iacucci¹, Rosanna Cannatelli², Nunzia Labarile³, Ren Mao⁴, Remo Panaccione⁵, Silvio Danese⁶, Gursimran S Kochhar⁷, Subrata Ghosh⁸, Bo Shen⁹

Affiliations

¹ Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Department of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada.
² Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Department of Gastroenterology, Spedali Civili of Brescia, Italy.
³ Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Italy.
⁴ Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, OH, USA.
⁵ Department of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada.
⁶ IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
⁷ Department of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA.
⁸ Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Department of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada. Electronic address: ghoshs@bham.ac.uk.
⁹ Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA.

PMID: 32305075
PMCID: PMC7162648
DOI: 10.1016/S2468-1253(20)30119-9

Erratum in

Correction to Lancet Gastroenterol Hepatol 2020; 5: 598-606.
[No authors listed] [No authors listed] Lancet Gastroenterol Hepatol. 2021 Mar;6(3):e2. doi: 10.1016/S2468-1253(21)00027-3. Lancet Gastroenterol Hepatol. 2021. PMID: 33581764 Free PMC article. No abstract available.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is changing the management of many chronic diseases, including that of patients with inflammatory bowel diseases (IBD). In particular, the performance of routine endoscopy is temporarily suspended, and only emergency endoscopy is allowed in many countries where severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread. We highlight different scenarios in which endoscopy should still be performed urgently in patients with IBD, as well as recommendations regarding the use of personal protective equipment. We suggest a pathway for performing safe endoscopy and discuss the potential risks of postponing endoscopy in IBD. Finally, we propose a post-pandemic plan for access to endoscopy.

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Figures

**Figure 1**
Proposed flowchart for suspected new diagnosis of IBD IBD=inflammatory bowel disease. COVID-19=coronavirus disease 2019. IBS=irritable bowel syndrome. *Mild defined as no complications, C-reactive protein not elevated or mildly elevated, haemoglobin >110 g/L, partial Mayo score 2–4 (for ulcerative colitis), Harvey Bradshaw Index 5–7 (for Crohn's disease).

**Figure 2**
Proposed flowchart for severe acute flare-up of ulcerative colitis CMV=cytomegalovirus. COVID-19=coronavirus disease 2019.

**Figure 3**
Proposed flowchart for sub-acute obstruction in patients with IBD COVID-19=coronavirus disease 2019. IBD=inflammatory bowel disease.

**Figure 4**
Proposed flowchart for cholangitis and jaundice in patients with IBD and PSC COVID-19=coronavirus disease 2019. ERCP=endoscopic retrograde cholangiopancreatography. IBD=inflammatory bowel disease. MRCP=magnetic resonance cholangiopancreatography. PSC=primary sclerosing cholangitis.

**Figure 5**
Proposed flowchart for endoscopy in patients with IBD during the COVID-19 pandemic CMV=cytomegalovirus. COVID-19=coronavirus disease 2019. CRP=C-reactive protein. IBD=inflammatory bowel disease. PPE=personal protective equipment.

See this image and copyright information in PMC

Comment in

Resumption of daily services in a gastroenterology department in Guangzhou, China, in the wake of COVID-19.
Han J, Zhu L, Wang Y, Zeng Z, Zhang S. Han J, et al. Lancet Gastroenterol Hepatol. 2020 Jul;5(7):645-646. doi: 10.1016/S2468-1253(20)30133-3. Epub 2020 May 4. Lancet Gastroenterol Hepatol. 2020. PMID: 32380008 Free PMC article. No abstract available.
Emotional state should not be used to differentiate IBD from IBS - Authors' reply.
Iacucci M, Cannatelli R, Labarile N, Ghosh S. Iacucci M, et al. Lancet Gastroenterol Hepatol. 2020 Aug;5(8):723-724. doi: 10.1016/S2468-1253(20)30199-0. Lancet Gastroenterol Hepatol. 2020. PMID: 32673606 Free PMC article. No abstract available.
Emotional state should not be used to differentiate IBD from IBS.
Ruddy J, Taft T, Siau K, Bollipo S. Ruddy J, et al. Lancet Gastroenterol Hepatol. 2020 Aug;5(8):723. doi: 10.1016/S2468-1253(20)30198-9. Lancet Gastroenterol Hepatol. 2020. PMID: 32673607 Free PMC article. No abstract available.

References

1. WHO WHO Director-General's opening remarks at the media briefing on COVID-19. 11 March 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-re...
1. WHO Coronavirus disease 2019 (COVID-19) situation report–72. https://www.who.int/docs/default-source/coronaviruse/situation-reports/2...
1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. - PMC - PubMed
1. Song Y, Liu P, Shi XL, et al. SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19. Gut. 2020 doi: 10.1136/gutjnl-2020-320891. published online March 5. - DOI - PubMed
1. Wong SH, Lui RN, Sung JJ. Covid-19 and the digestive system. J Gastroenterol Hepatol. 2020 doi: 10.1111/jgh.15047. published online March 25. - DOI - PubMed

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Endoscopy in inflammatory bowel diseases during the COVID-19 pandemic and post-pandemic period

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Endoscopy in inflammatory bowel diseases during the COVID-19 pandemic and post-pandemic period

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