COVID-19 Pandemic: Which IBD Patients Need to Be Scoped-Who Gets Scoped Now, Who Can Wait, and how to Resume to Normal

Abstract

Endoscopy is an essential component in the management of inflammatory bowel disease [IBD]. There is a risk of SARS-CoV-2 transmission during endoscopic procedures. The International Organization for the study of IBD [IOIBD] has developed 11 position statements, based on an online survey, that focus on how to prioritise endoscopies in IBD patients during the COVID-19 pandemic, alternative modes for disease monitoring, and ways to triage the high number of postponed endoscopies after the pandemic. We propose to pre-screen patients for suspected or confirmed COVID-19 and test for SARS-CoV-2 before endoscopy if available. High priority endoscopies during pandemic include acute gastrointestinal bleed, acute severe ulcerative colitis, new IBD diagnosis, cholangitis in primary sclerosing cholangitis, and partial bowel obstruction. Alternative modes of monitoring using clinical symptoms, serum inflammatory markers, and faecal calprotectin should be considered during the pandemic. Prioritising access to endoscopy in the post-pandemic period should be guided by control of COVID-19 in the local community and availability of manpower and personal protective equipment. Endoscopy should be considered within 3 months after the pandemic for patients with a past history of dysplasia and endoscopic resection for dysplastic lesion. Endoscopy should be considered 3-6 months after the pandemic for assessment of postoperative recurrence or new biologic initiation. Endoscopy can be postponed until after 6 months of pandemic for routine IBD surveillance and assessment of mucosal healing.

Keywords: COVID-19; Endoscopy; inflammatory bowel disease.

Figure 1.

Has your institution decreased the number of endoscopies for IBD during the COVID-19 outbreak?

Figure 2.

Amon the indications below for endoscopy, which do you still use as an indication for endoscopy during COVID-19 outbreak?

Figure 3.

a. Do you perform research endoscopy as part of industry-sponsored clinical trials in IBD as scheduled during the COVID-19 outbreak? b. Do you perform research endoscopy in IBD for non-industry sponsored trials as scheduled during the COVID-19 outbreak?

Figure 4.

Do you perform SARS-CoV-2 viral testing for IBD patients before endoscopy?

Figure 5.

What kinds of personal protective equipments do you wear for IBD endoscopy during COVID-19?

Figure 6.

Do you perform IBD endoscopies in a negative pressure room?

Figure 7.

Which modes of monitoring will you consider during the COVID-19 outbreak?

Figure 8.

Among the indications for endoscopy listed below, which will you plan to re-schedule as priority [within 3 months]/within 36 months/ after 6 months after the COVID-19 outbreak?