Plans to Reactivate Gastroenterology Practices Following the COVID-19 Pandemic: A Survey of North American Centers

Kushnir, Vladimir M.; Berzin, Tyler M.; Elmunzer, B. Joseph; Mendelsohn, Robin B.; Patel, Vaishali; Pawa, Swati; Smith, Zachary L.; Keswani, Rajesh N.

Abstract: Background and Aims Practices dramatically reduced endoscopy services due to the COVID-19 pandemic. As practices are now considering reintroduction of elective endoscopy, we conducted a survey of North American practices to identify reactivation barriers and strategies. Methods We designed and electronically distributed a web-based survey to North American gastroenterologists consisting of seven domains: institutional demographics, impact of COVID-19 on endoscopy practice, elective endoscopy resumption plans, anesthesia modifications, personal protective equipment (PPE) policies, fellowship training and telemedicine use. Responses were stratified by practice type: ambulatory surgery center (ASC) or hospital-based. Results In total, 123 practices (55% ASC-based and 45% hospital-based) responded. At the pandemic’s peak (as reported by the respondent), practices saw a 90% drop in endoscopy volume with most centers planning to resume elective endoscopy a median of 55 days after initial restrictions. Declining community prevalence of COVID-19, PPE availability, and pre-procedure SARS-CoV-2 testing availability were ranked as the three primary factors influencing reactivation timing. ASC-based practices were more likely to identify pre-procedure testing availability as a major factor limiting elective endoscopy resumption (p=0.001). Pre-procedure SARS-CoV-2 testing was planned by only 49.2% of practices overall; when testing is performed and negative, 52.9% of practices will continue to utilize N95 masks. Conclusion This survey highlights barriers and variable strategies for reactivation of elective endoscopy services following the COVID-19 pandemic. Our results suggest that more widespread access to pre-procedure SARS-CoV-2 tests with superior performance characteristics is needed to increase provider and patient comfort in proceeding with elective endoscopy.