Huron Gastroenterology Associates Ann Arbor, MI, United States
Charlie X. Walsh, 1, Jordan Montagano, BSc2, Ann Saliares, DO3, Fadi Hawa, MD4, Naresh Gunaratnam, MD2 1Huron Gastroenterology Associates, Ann Arbor, MI; 2Huron Gastroenterology, Ypsilanti, MI; 3Trinity Health-Michigan, Ypsilanti, MI; 4St. Joseph Mercy Ann Arbor, Macomb, MI
Introduction: The novel coronavirus 2019 (COVID-19) pandemic has limited endoscopic utilization causing significant health and economic burdens. Gastroenterology (GI) societies recommended COVID-19 testing of all patients undergoing endoscopy. The American Gastroenterological Association (AGA) later provided an updated guidance on implementing pre-testing strategy based on an estimated asymptomatic prevalence within a certain state or county. Most recently, the AGA recommended stopping pre-endoscopy COVID-19 testing due to little benefit of routine testing and very low rates of infection among patients and staff. We compared the difference between the true and estimated asymptomatic prevalence of COVID-19 in patients undergoing endoscopy at our community-based GI practice.
Methods: This is a clinical, observation-based quality initiative of patients scheduled for endoscopic procedures at our community-based GI practice from May-December, 2020. All patients underwent symptom screening, followed by polymerase chain reaction (PCR) testing. True COVID-19 asymptomatic prevalence at our practice was calculated (total number of asymptomatic PCR-positive cases divided by the total number of scheduled procedures). Estimated asymptomatic prevalence was determined based on the AGA calculation (number of new cases in the past 2 weeks within the practice’s county multiplied by 10 and then divided by the county’s population). Asymptomatic prevalence was reported as low (< 0.5%), intermediate (0.5-2%), or high ( >2%).
Results: A total of 11,542 endoscopic procedures were performed between May-December, 2020. Based on the true asymptomatic prevalence, our practice remained a low-prevalence area in May-October, intermediate in November, and high in December. Estimated asymptomatic prevalence based on the AGA calculation placed our practice in a low-prevalence area in May-June, intermediate in July-September and high in October-December. None of the providers developed COVID-19 after the procedures.
Discussion: There is a clear discrepancy between our practice’s true COVID-19 asymptomatic prevalence which was lower than the estimated asymptomatic prevalence using the AGA calculation. That, in combination with the low patient-provider infection rate and the potential delays in care and patient burdens associated with pre-endoscopy testing affirms the latest AGA guidance that COVID-19 testing prior to endoscopy is no longer needed to perform endoscopy safely.
Figure: Figure 1: Panel A: True Asymptomatic Prevalence for the Practice by Month Panel B: Estimated Asymptomatic Prevalence for the Practice’s County by Month
Charlie Walsh indicated no relevant financial relationships.
Jordan Montagano indicated no relevant financial relationships.
Ann Saliares indicated no relevant financial relationships.
Fadi Hawa indicated no relevant financial relationships.
Naresh Gunaratnam indicated no relevant financial relationships.
Charlie X. Walsh, 1, Jordan Montagano, BSc2, Ann Saliares, DO3, Fadi Hawa, MD4, Naresh Gunaratnam, MD2. P1456 - SARS-CoV2 Testing Prior to Endoscopy: Discrepancy Between Estimated and True Asymptomatic Prevalence Rates in a Community-Based Gastroenterology Practice, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.