Triage of General Gastrointestinal Endoscopic Procedures During the COVID-19 Pandemic: Results from a National Delphi Consensus Panel

Feuerstein, Assistant Professor of Medicine Joseph D.; Bilal, Mohammad; Berzin, Tyler M.; Calderwood, Audrey H.; Guturu, Praveen; Juncadella, Anna C.; Ketwaroo, Gyanprakash; Mishkin, Daniel S.; Perdue, David G.; Sekhon, Sandeep; Sengupta, Neil; Singh, Shailendra; Pleskow, Douglas K.; Sawhney, Mandeep S.

INTRODUCTION: As the COVID-19 pandemic moves into the post-peak period, the focus has now shifted to resuming endoscopy services to meet the needs of patients who were deferred. By using a modified Delphi process, we sought to develop a structured framework to provide guidance regarding procedure indications and procedure time intervals. METHODS: A national panel of 14 expert gastroenterologists from throughout the US used a modified Delphi process, to achieve consensus regarding: i) common indications for general endoscopy, ii) critical patient-important outcomes for endoscopy, iii) defining time-sensitive intervals, iv) assigning time-sensitive intervals to procedure indications. Two anonymous rounds of voting were allowed before attempts at consensus were abandoned. RESULTS: Expert panel reached consensus that procedures should be allocated to one of three timing categories: (1) time-sensitive emergent = scheduled within 1 week, (2) time-sensitive urgent = scheduled within 1 to 8 weeks, (3) non-time sensitive = defer to > 8 weeks and reassess timing then. The panel identified 62 common general endoscopy indications (33 for EGD, 21 for colonoscopy, 5 for sigmoidoscopy). Consensus was reached on patient-important outcomes for each procedure indication, and consensus regarding timing of the procedure indication was achieved for 74% of indications. Panelists also identified adequate personal-protective-equipment, rapid point-of-care testing, and staff training as critical pre-conditions before endoscopy services could be resumed. CONCLUSIONS: We used the validated Delphi methodology, while prioritized patient-important outcomes, to provide consensus recommendations regarding triaging a comprehensive list of general endoscopic procedures.