Sharing Our Experience of Operating an Endoscopy Unit in the Midst of a COVID-19 Outbreak

Han, Jimin; Kim, Eun Young

The following is about performing colonoscopy in a pa-tient who came into close contact with a confirmed case of COVID-19. A 59-years old male with hematochezia was transferred to the emergency room (ER) from other hospital. His initial COVID-19 test was negative. Colonoscopy was planned to evaluate the cause of hematochezia. The patient was transported to the endoscopy unit from ER using preplanned route designed to minimize contact with other people in the hospital. All other healthcare personnel were kept in a designated place separate from the patient and three staff members required for sigmoidoscopy. These three included one endoscopist, one nurse, and one person for scope reprocessing. All these staff members wore hair caps, foot wraps, disposable plastic gowns over long-sleeved surgical gowns, and two layers of gloves (with one over the wrist of the plastic gown), goggles, and N95 facial masks for the procedure (Fig. 1) . The exam was uneventful and the endoscopic findings were compatible with severe ulcerative colitis. After the procedure, the scope was reprocessed according to the Korean Society of Gastrointestinal Endoscopy guideline. 5, 6 The endoscopy room was cleaned including all exposed surfaces and the window of the room was kept opened for two hours. If an endoscopic procedure for a confirmed case of COVID-19 were to be done, level-D protective clothing is required for all the involved personnel. During the two weeks of self-isolation of the endoscopy unit nurses, 20 procedures of urgent endoscopic retrograde cholangiopancreatography (ERCP) were performed. In addition to standard radiation protection, all the involved healthcare personnel wore PPE as described previously. Since radiation protective goggles are already put on, facial shield was worn over the goggles and N95 or KF94 facial mask. The greatest difficulty in performing ERCP was risk stratification, as 50% of the patients who required ERCP had fever. Presence of fever automatically caused the patient to be stratified as having an intermediate 2 or high risk 3 of potential infection. Because COVID-19 test took about one day at that time, some patients had to undergo ERCP before knowing the test results. Prior to deciding to perform ERCP in a febrile patient, the endoscopist reviewed chest X-ray and arterial blood gas analysis in addition to contact history, symptoms, and body temperature. When a patient was suspected to have respiratory tract infection, they underwent a computed tomography of the chest. If there was no cause for fever besides underlying pancreatobiliary disease, ERCP was performed. As of March 21, 2020, there has been no confirmed case of COVID-19 infection among the patients who underwent ERCP.