Evolution of International Pediatric Endoscopic Practice Changes During the Coronavirus Disease 2019 Pandemic

Abstract

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has drastically altered endoscopic practices. We initially reported the international impact of COVID-19 on pediatric endoscopic practice. This follow-up study aimed to assess changes 7 months following the initial survey to delineate practice change patterns as the pandemic evolved.

Methods: Pediatric gastroenterologists who responded to the initial survey were re-surveyed seven months later using Research Electronic Data Capture (REDCap). The survey recorded information on changes in pediatric endoscopic practice patterns, including COVID-19 screening and testing processes and personal protective equipment (PPE) utilization. Additionally, endoscopists' risk tolerance of COVID-19 transmission was evaluated.

Results: Seventy-five unique institutions from 21 countries completed surveys from the 145 initial responses (51.7% response rate). Procedural volumes increased at most institutions (70.7%) and most were performing previously postponed cases (90.7%). Ninety-seven percent of institutions were performing pre-endoscopy screening with 78.7% testing all patients. Many institutions (34.7%) have performed procedures on COVID-19 positive patients. There was significantly less PPE reuse (P < 0.05) and fewer institutions recommending full PPE for all endoscopies (43.2% vs 59.2%, P = 0.013). Overall, pediatric endoscopists' risk tolerance of COVID-19 transmission is low.

Conclusions: This is the first survey to highlight the evolution of pediatric endoscopic practices related to the COVID-19 pandemic, underscoring the need for ongoing pandemic-related guidance for pediatric endoscopic practice.

FIGURE 1

(A) Differences in endoscopie practices between the initial survey (April 2020) and follow-up survey (November 2020). Fewer urgent/ emergent and elective endoscopies were postponed at the time of the follow-up survey compared with the initial survey. Additionally, more fellows were allowed in endoscopies without restrictions on the follow-up survey compared with the initial survey. ∗P < 0.05. (B) Pediatric endoscopists risk threshold for performing endoscopy. Pediatric endoscopists were asked the following question: You have an asymptomatic pediatric patient undergoing elective endoscopy. Please indicate your threshold for the risk of COVID-19 that you are willing to assume as the endoscopist for this patient? Pre-endoscopy testing, whenever applicable, was negative. Assumptions are: (1) well-established tests are never 100% accurate; (2) low prevalence of asymptomatic COVID-19 patients in your area (1%). Patients are screened using CDC symptoms screening checklist. (3) On the basis of the best available evidence, the risk of COVID-19 infection is 50% if an endoscopist performs endoscopy with no PPE in a patient with COVID-19, 20% if wearing a surgical mask, and 5% if wearing N95 with face shield.