David Geffen School of Medicine at UCLA Los Angeles, CA
Bao Sean Nguyen, MD1, Cameron Hines, BS1, Midori White, BS1, Anthony Myint, MD2, Liu Yang, MD, MPH3, Lynn Connolly, MD, MSCR4, Folasade P. May, MD, PhD, MPhil3; 1David Geffen School of Medicine at UCLA, Los Angeles, CA; 2David Geffen School of Medicine, UCLA, Los Angeles, CA; 3UCLA Health, Los Angeles, CA; 4University of California Los Angeles, Santa Monica, CA
Introduction: In March 2020, hospitals temporarily halted non-urgent surgeries and procedures due to the SARS-CoV-2 (COVID-19) global pandemic. By mid-April, several gastroenterology societies published guidelines regarding safe resumption of elective endoscopy, including a recommendation for COVID-19 polymerase chain reaction testing 48 hours pre-endoscopy. We determined the prevalence of COVID-19 infection among adults presenting for routine outpatient endoscopy at a large, academic health center in order to establish whether new policies are needed to ensure patient and healthcare provider safety. Methods: We used electronic health record data to identify all patients scheduled for an outpatient endoscopic procedure (EGD, colonoscopy, flexible sigmoidoscopy, EUS, or ERCP) at any of 5 UCLA Health endoscopy units between April 13, 2020 (testing policy implementation) and May 17, 2020 who completed a COVID-19 test as part of the screening protocol. We performed a manual chart review to collect data on patient demographics and clinical factors. The primary outcome was the COVID-19 test result. We also collected data on presence of COVID-19 symptoms pre-procedure and 6-14 days post-procedure. Results: The cohort included 550 patients (Table 1). Mean age was 56.1, 49.6% were male, 57.5% were non-Hispanic white, and 99.5% had health insurance coverage. There were 0 (0%) positive, 549 (99.8%) negative, and 1 (0.2%) inconclusive COVID-19 test results. There were 112 (20.4%) patients with symptoms possibly consistent with COVID-19 at the time of testing (Figure 1A). Fifty-three (9.6%) had symptoms possibly consistent with COVID-19 6-14 days after initial testing (Figure 1B). There were 63 patients (11.5%) tested again for COVID-19 at some point after initial endoscopy; none had positive results. Of note, the estimated seroprevalence of COVID-19 antibodies in Los Angeles County was 4.65% during the study period. Discussion: In the first month of our pre-endoscopy COVID-19 testing program, no patients presenting for routine outpatient endoscopy were positive for COVID-19. There were also no positive COVID-19 results for patients who developed symptoms consistent with COVID-19 6-14 days after endoscopy. These results may reflect a selection bias as providers may be less likely to refer patients for endoscopy when there are concerns for COVID-19. Nonetheless, the results reflect a low prevalence of COVID-19 in a large patient population and increase confidence about endoscopy utilization at this time.
Table 1: Demographic, clinical characteristics of patient population and pre-endoscopy COVID-19 testing results, N=550.
Figure 1A: Number of patients with each symptom possibly consistent with COVID-19 at the time of pre-endoscopy testing (Patients with reported symptom data=535; Number of patients with symptoms, n=112)
Figure 1B. Number of patients with each symptom possibly consistent with COVID-19 at 6-14 days after COVID-19 testing (Number of patients with symptoms, n=53)
Disclosures: Bao Sean Nguyen indicated no relevant financial relationships. Cameron Hines indicated no relevant financial relationships. Midori White indicated no relevant financial relationships. Anthony Myint indicated no relevant financial relationships. Liu Yang indicated no relevant financial relationships. Lynn Connolly indicated no relevant financial relationships. Folasade May indicated no relevant financial relationships.