Background and Aims
Methods
Results
Conclusions
Abbreviations:
cIFR (corrected infection fatality rate), COVID-19 (novel coronavirus disease 2019), PPE (personal protective equipment), PCR (polymerase chain reaction), SARS-CoV-2 (severe acute respiratory syndrome–coronavirus 2), USD (U.S. dollars)Methods
Source | Cases | Procedure type | Indication | |
---|---|---|---|---|
Baseline Procedures without COVID-19 | Retrospective review 3/4/2019–3/10/2019 | Tested .0% (0) PCR positive .0% (0) Performed 100.0% (361) | Colonoscopy 44.0% EGD 41.6% EUS 6.9% FlexSig 3.9% ERCP/others 3.6% | Urgent 7.5% Semiurgent 10.5% Elective 82.0% |
Fist week with COVID-19 Day 1 (3/30/2020) Hospital: 10 inpatients, 1 death Duval County: 169 confirmed, 4 deaths 27 Florida Department of Health. 2019 novel coronavirus response (COVID-19) Florida Department of Health. 2020. https://floridahealthcovid19.gov/ Date accessed: April 1, 2020 Day 7 (4/5/2020) Hospital: 6 inpatients, 4 recovered, 1 death Duval County: 401 confirmed, 9 deaths 27 Florida Department of Health. 2019 novel coronavirus response (COVID-19) Florida Department of Health. 2020. https://floridahealthcovid19.gov/ Date accessed: April 1, 2020 | Retrospective review 3/30/2020–4/5/2020 | Tested 100.0% (49) PCR positive .0% (0) Performed 100.0% (49) | Colonoscopy 20.4% EGD 42.9% EUS 14.3% FlexSig 8.2% ERCP/others 14.3% | Urgent 30.6% Semiurgent 65.3% Elective 4.1% |
Strategy 1 Test urgent cases. Scope without waiting for result. Postpone semiurgent and elective cases. | Modeling with current prevalence | Tested 8.0% PCR positive .4% (false positive .4%) Performed 8.0% | Colonoscopy 25.0% EGD 46.0% FlexSig 11.0% EUS .0% ERCP 18.0% | Urgent 100% Semiurgent .0% Elective .0% |
Strategy 2 Test urgent and semiurgent cases. Scope urgent regardless of result. Scope semiurgent cases with negative result. | Modeling with current prevalence | Tested 20.0% PCR positive 1.0% (false positive 1.0%) Performed 19.4% | Colonoscopy 36.3% EGD 43.6% FlexSig 6.7% EUS 4.1% ERCP 9.3% | Urgent 41.2% Semiurgent 58.8% Elective .0% |
Strategy 3 Test all patients. Scope urgent regardless of result. Scope semiurgent and elective with negative result. | Modeling with current prevalence | Tested 100.0% PCR positive 5.1% (false positive 5.0%) Performed 95.3% | Colonoscopy 42.0% EGD 42.4% FlexSig 4.5% EUS 6.3% ERCP 4.7% | Urgent 8.0% Semiurgent 12.0% Elective 80.0% |
U.S. Food and Drug Administration, 2020.
Description | Estimate | Range | Reference |
---|---|---|---|
Clinical probabilities | |||
Corrected infection fatality rate | .6% | .2-1.3% | 10 , 28 |
Percentage of emergency/urgency cases | 8.0% | 4.0-12.0% | Retrospective review |
Percentage of semiurgent cases | 12.0% | 8.0-16.0% | |
Percentage of elective cases | 80.0% | 72.0-88.0% | |
Sensitivity and specificity in vitro † Authors’ calculation. Real-time PCR using Cobas severe acute respiratory syndrome–coronavirus 2 test.3 Reported sensitivity of 95% when there were at least 689.3 copies/mL.6 In a small cohort of symptomatic admitted patients viral load at admission was ∼150,000 copies/mL.23 Emergency use authorization by U.S. Food and Drug Administration. | 95.0% 98.6% | 92.5-97.5% 96.1-99.9% | 5 , 6 |
Sensitivity and specificity in vivo compared with CT | 70.6% 97.8% | 68.1-73.1% 95.7-99.9% | 7 |
Sensitivity and specificity used in model | 82.5% 95.0% | 77.5-87.5% 90.0-99.9% | |
Current prevalence in Duval County | 122 per 100,000 | 56-365 per 100,000 | Supplementary Material A |
True positive | .0010 | .0001-.0019 | 5 , 6 |
False positive | .0499 | .0489-.0509 | 5 , 6 |
True negative | .9488 | .9088-.9888 | 5 , 6 |
False negative | 213 × 10-6 | 165-261 × 10-6 | 5 , 6 |
5% Infected population | |||
True positive | .0413 | .0361-.0465 | 5 , 6 |
False positive | .0475 | .0417-.0533 | 5 , 6 |
True negative | .9025 | .8625-.9425 | 5 , 6 |
False negative | .0088 | .0078-.0098 | 5 , 6 |
10% Infected population | |||
True positive | .0825 | .0721-.0926 | 5 , 6 |
False positive | .0450 | .0394-.0506 | 5 , 6 |
True negative | .8550 | .8150-.8950 | 5 , 6 |
False negative | .0175 | .0153-.0197 | 5 , 6 |
Costs (U.S. dollars) | |||
Basic PPE | 4 | 2-6 | 8 |
High-risk PPE | 20 | 10-30 | 8 |
PCR testing | 100 | 75-125 | |
Room decontamination | 5 | 3-7 | |
Anesthesia | 98 | 74-122 | 11 Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health & Human Services Colonoscopy-related costs, Medicare fee-for-service beneficiaries who received a screening or diagnostic colonoscopy, 2015. https://aspe.hhs.gov/system/files/pdf/255906/DHNAdditionalInfor.pdf Date accessed: March 31, 2020 |
Colonoscopy (with biopsy/polypectomy) | 1004 | 754-1,254 | 11 , Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health & Human Services Colonoscopy-related costs, Medicare fee-for-service beneficiaries who received a screening or diagnostic colonoscopy, 2015. https://aspe.hhs.gov/system/files/pdf/255906/DHNAdditionalInfor.pdf Date accessed: March 31, 2020 12 , Center for Medicare & Medicaid Services. Physician fee schedule search, 2020. Available at: https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx. Accessed March 20, 2020. 13 Centers for Medicare & Medicaid Services (CMS) CY 2020 Medicare reimbursement rates for common GI procedures (national average). https://files.constantcontact.com/11178001701/2705f148-23e7-4a4d-afe0-40de940c50cd.pdf Date accessed: March 31, 2020 |
EGD (diagnostic, no biopsy) | 786 | 590-982 | 12 , Center for Medicare & Medicaid Services. Physician fee schedule search, 2020. Available at: https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx. Accessed March 20, 2020. 13 Centers for Medicare & Medicaid Services (CMS) CY 2020 Medicare reimbursement rates for common GI procedures (national average). https://files.constantcontact.com/11178001701/2705f148-23e7-4a4d-afe0-40de940c50cd.pdf Date accessed: March 31, 2020 |
Flexible sigmoidoscopy (diagnostic, no biopsy) | 764 | 572-956 | 12 , Center for Medicare & Medicaid Services. Physician fee schedule search, 2020. Available at: https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx. Accessed March 20, 2020. 13 Centers for Medicare & Medicaid Services (CMS) CY 2020 Medicare reimbursement rates for common GI procedures (national average). https://files.constantcontact.com/11178001701/2705f148-23e7-4a4d-afe0-40de940c50cd.pdf Date accessed: March 31, 2020 |
EUS (diagnostic, no FNA) | 1100 | 824-1370 | 12 , Center for Medicare & Medicaid Services. Physician fee schedule search, 2020. Available at: https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx. Accessed March 20, 2020. 13 Centers for Medicare & Medicaid Services (CMS) CY 2020 Medicare reimbursement rates for common GI procedures (national average). https://files.constantcontact.com/11178001701/2705f148-23e7-4a4d-afe0-40de940c50cd.pdf Date accessed: March 31, 2020 |
ERCP | 2999 | 2249-3749 | 12 , Center for Medicare & Medicaid Services. Physician fee schedule search, 2020. Available at: https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx. Accessed March 20, 2020. 13 Centers for Medicare & Medicaid Services (CMS) CY 2020 Medicare reimbursement rates for common GI procedures (national average). https://files.constantcontact.com/11178001701/2705f148-23e7-4a4d-afe0-40de940c50cd.pdf Date accessed: March 31, 2020 |
Extras (average evaluation, pathology, labs, radiology, and management) | 215 | 161-269 | 11 , Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health & Human Services Colonoscopy-related costs, Medicare fee-for-service beneficiaries who received a screening or diagnostic colonoscopy, 2015. https://aspe.hhs.gov/system/files/pdf/255906/DHNAdditionalInfor.pdf Date accessed: March 31, 2020 12 Center for Medicare & Medicaid Services. Physician fee schedule search, 2020. Available at: https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx. Accessed March 20, 2020. |
- •Strategy 1: Patients requiring an emergent/urgent endoscopy (within 24 hours) are tested. Endoscopy is performed regardless of result. High-risk personal protective equipment (PPE) and decontamination after procedure is used for each emergent/urgent endoscopy.8All other procedures (semiurgent and elective) are postponed.
- •Strategy 2: Patients requiring emergent/urgent and semiurgent procedures are tested within 48 hours before the planned endoscopic procedure. All emergent/urgent cases are completed regardless of PCR result using high-risk PPE. Semiurgent cases with a negative result proceed to endoscopy using low-risk PPE. Semiurgent cases with a positive result are postponed. All elective procedures are postponed.
- •Strategy 3: PCR test is performed on all patients within 48 hours. All emergent/urgent cases are completed regardless of PCR result using high-risk PPE. Semiurgent and elective cases with a negative result proceed to endoscopy using low-risk PPE. Semiurgent and elective cases with a positive result are postponed.

Outcomes
Clinical probabilities and other inputs
Colonoscopy-related costs, Medicare fee-for-service beneficiaries who received a screening or diagnostic colonoscopy, 2015.
Center for Medicare & Medicaid Services. Physician fee schedule search, 2020. Available at: https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx. Accessed March 20, 2020.
CY 2020 Medicare reimbursement rates for common GI procedures (national average).
Sensitivity analysis and statistical considerations
- •We performed a second-order Monte Carlo simulation with 1000 computer iterations of our model.15By using tracker variables, the number of endoscopies performed was compared among the 3 strategies. Sensitivity analysis was done with Bayes revision.
- •Threshold analysis was performed to determine clinical limits under which all cases are performed with adequate PPE (ie, no false-negative cases).
- •Tornado diagrams were created to compare the weight of different variables (PCR testing performance, costs of anesthesia, and endoscopic procedures, etc) into the final estimates of our model.
- •Using published reports, we estimated the number of needed colonoscopies, EGDs, flexible sigmoidoscopies, ERCPs, and EUSs in United States for 1 week in 2020, assuming COVID-19 had not developed.16,17,18We projected the effects of the 3 strategies in resuming endoscopic procedures toward that goal (Supplementary Table 5, available online at www.giejournal.org).iData Research
An astounding 19 million colonoscopies are performed annually in The United States. iData Research, 2018.https://idataresearch.com/an-astounding-19-million-colonoscopies-are-performed-annually-in-the-united-states/Date accessed: March 31, 2020
Discontinuation of isolation for persons with COVID-19 not in healthcare settings (interim guidance). 2020.
Results
No. of patients tested (%) | Added costs per week (U.S. dollars) | No. of endoscopies performed (%) | Endoscopy return per week (U.S. dollars) | Δ Return – intervention (U.S. dollars) | True positive | False positive | False negative | Staff infected | |
---|---|---|---|---|---|---|---|---|---|
Current prevalence (122 per 100,000 cases) | |||||||||
Strategy 1 | 29 (8.0) | 3610 | 29 (8.0) | 44,764 | 41,604 | 0 | 1 | 0 | 0 |
Strategy 2 | 72 (20.0) | 7942 | 70 (19.4) | 97,831 | 89,889 | 0 | 4 | 0 | 0 |
Strategy 3 | 361 (100.0) | 37,905 | 344 (95.3) | 453,055 | 415,150 | 0 | 18 | 0 | 0 |
5% Prevalence | |||||||||
Strategy 1 | 29 (8.0) | 3610 | 29 (8.0) | 44,764 | 41,604 | 1 | 1 | 0 | 0 |
Strategy 2 | 72 (20.0) | 7942 | 68 (18.9) | 96,026 | 88,084 | 3 | 3 | 1 | 1-2 |
Strategy 3 | 361 (100.0) | 37,905 | 303 (83.9) | 436,810 | 398,905 | 15 | 17 | 3 | 4-10 |
10% Prevalence | |||||||||
Strategy 1 | 29 (8.0) | 3610 | 29 (8.0) | 44,764 | 41,604 | 2 | 1 | 1 | 1-2 |
Strategy 2 | 72 (20.0) | 7942 | 66 (18.4) | 93,860 | 85,918 | 6 | 3 | 1 | 2-4 |
Strategy 3 | 361 (100.0) | 37,905 | 290 (80.3) | 420,204 | 382,299 | 30 | 16 | 6 | 9-22 |
Sensitivity analysis

Strategy 1 | Strategy 2 | Strategy 3 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Endoscopy needs in U.S. per week | Added cost (U.S. dollars) | Return (U.S. dollars) | Infected staff (range) | Added cost (U.S. dollars) | Return (U.S. dollars) | Infected staff (range) | Added cost (U.S. dollars) | Return (U.S. dollars) | Infected staff (range) | |
Colonoscopy | 373,997 (373,128 374,867) | 3,739,972 (3,731,277 3,748,667) | 46,375,655 (46,267,840 46,483,469) | 16 (10-22) | 8,227,939 (8,208,810 8,247,067) | 101,353,245 (101,117,619 101,588,871) | 40 (24-56) | 39,269,707 (39,178,413 39,361,002) | 469,366,504 (468,275,320 470,457,687) | 199 (119-279) |
EGD | 213,054 (206,562 219,546) | 2,130,542 (2,065,621 2,195,463) | 26,418,722 (25,613,698 27,223,745) | 9 (5-13) | 4,687,193 (4,544,366 4,830,019) | 57,737,690 (55,978,324 59,497,055) | 23 (13-33) | 22,370,692 (21,689,019 23,052,365) | 267,383,029 (259,235,414 275,530,644) | 113 (66-164) |
Flexible sigmoidoscopy | 10,678 (10,654 10,703) | 106,784 (106,535 107,032) | 1,324,117 (1,321,039 1,327,196) | 0 (0-1) | 234,924 (234,378 235,470) | 2,893,837 (2,887,109 2,900,565) | 1 (1-2) | 1,121,228 (1,118,622 1,123,835) | 13,401,348 (13,370,193 13,432,504) | 6 (3-8) |
EUS | 7,386 (6,675 8,096) | 73,856 (66,752 80,961) | 915,817 (827,721 1,003,913) | 0 (0-0) | 162,484 (146,854 178,114) | 2,001,503 (1,808,971 2,194,036) | 1 (0-1) | 775,490 (700,893 850,088) | 9,268,954 (8,377,336 10,160,572) | 4 (2-6) |
ERCP | 5,895 (5,769 6,022) | 58,953 (57,688 60,219) | 731,019 (715,326 746,713) | 0 (0-0) | 129,697 (126,913 132,481) | 1,597,631 (1,563,334 1,631,929) | 1 (0-1) | 619,008 (605,720 632,297) | 7,398,625 (7,239,794 7,557,455) | 3 (2-4) |
Total | 611,011 (602,787 619,234) | 6,110,107 (6,027,873 6,192,342) | 75,765,330 (74,745,625 76,785,035) | 26 (15-37) | 13,442,236 (13,261,321 13,623,151) | 165,583,906 (163,355,357 167,812,455) | 65 (39-92) | 64,156,126 (63,292,666 65,019,586) | 766,818,459 (756,498,056 777,138,862) | 325 (193-462) |
Discussion
- Fink S.
The New York Times.
Strengths and limitations
- Galvin G.
The great unknown: how many health care workers have coronavirus? U.S. News & World Report, 2020.
Implications and future directions
- Gottlieb S.
American Enterprise Institute, 2020.
Phase | Status | Population strategy | Endoscopy interventions |
---|---|---|---|
1: Slow the spread, ie, “flattening the curve” | Community transmission progresses rapidly in each state. Increasing infections and deaths. | Social distancing for all (closing schools, restaurants, malls, gyms, etc). Quarantines, gatherings, and travel bans. Transition to work from home. Public to wear masks. Scale up health infrastructure to safely manage the outbreak and take care of the sick. | Transfer endoscopy staff to first response line. Endoscopy rooms and ventilators used for COVID-19 patients. Treat all cases as potential positive. Restrict endoscopy to emergent and urgent indications. PPE and room decontamination based on risk stratification. 8 |
2: Reopening state by state | Able to test and isolate all COVID-19 suspected cases. Reduction in new cases for 14 days. Sufficient critical care capacity. | Resume schools and business Social distancing for high-risk populations (adults >60 years old, underlying health conditions). Comprehensive surveillance systems. | PCR testing (strategy 2 or 3) according to local resources and disease prevalence. Rooms and teams conditioned to scope COVID-19 patients. Telemedicine and online appointments. PPE and room decontamination based on risk stratification. 8 |
3: Establish immune protection and lift physical distancing | Safe and effective tools to mitigate or cure COVID-19: vaccines or medical treatments become available. | Therapeutics to rescue patients with severe disease. Provide prophylaxis (vaccination) to those exposed. Lift all distancing measures. | Resume all endoscopy cases and normal workflow. Resume face to face appointments. |
4: Prepare for next pandemic | Successful control of the pandemic. | Investment in research and development initiatives. Expansion of public health and healthcare infrastructure and workforce. | Epidemic vigilance. Select rapid response teams in case demand is needed. Design protocols for future pandemics. |
- Gottlieb S.
American Enterprise Institute, 2020.
Conclusion
Acknowledgment
Supplementary Material A: Calculations for Novel Coronavirus Disease 2019 Prevalence in Duval County (Florida, USA) as of April 2, 2020 Afternoon
Crude prevalence
Prevalence based on fatality rate
U.S. Food and Drug Administration, 2020.
Supplementary Material B: Additional Cost Calculations
Emergency cases
Semiurgent and elective cases

Timing | Indications |
---|---|
Emergent, <8 h Urgent, 8-24 h | EGD: upper GI bleeding Food bolus impaction Colon/FlexSig: lower GI bleeding hemodynamically unstable Acute intestinal obstruction ERCP: cholangitis, acute biliary leak. EUS: none DBE: none |
Semiurgent, 24 h to 7 wk | EGD: gastric cancer diagnosis Acute-onset dysphagia Colon/FlexSig: lower GI bleeding hemodynamically stable Partial intestinal obstruction New-onset bloody diarrhea with negative cultures Ulcerative colitis flare Crohn’s disease flare ERCP: choledocholithiasis w/o cholangitis Biliary pancreatitis w/o cholangitis EUS: concerns for pancreatic cancer or cholangiocarcinoma (mass seen) DBE: small-bowel bleeding |
Elective, ≥8 wk (56 days) Also semiurgent indication in setting of epidemic | EGD: ampullary adenoma Isolated weight loss GERD/heartburn Dyspepsia/noncardiac chest pain Established dysphagia Barrett’s (regardless of dysplasia) Esophageal varices evaluation or follow-up banding Iron-deficiency anemia Endoscopic submucosal dissection for early gastric cancer PEG tube placement Colon/FlexSig: possible FIT or fecal FIT-DNA test Chronic diarrhea Colorectal cancer screening Colon EMR Ulcerative colitis with dysplasia ERCP: biliary stent replacement Pancreatic stent removal EUS: concerns for submucosal mass (GIST, leyomioma, lipoma) Double duct sign without a discrete mass Concerns for neuroendocrine tumor Celiac plexus block Pancreatic cyst evaluation DBE: small-bowel tumor |
Confirmed severe acute respiratory syndrome–coronavirus 2 positive | Corrected infection fatality rate Diamond Princess ship | Corrected infection fatality rate China |
---|---|---|
Prevalence per 100,000 residents | ||
28 | 56 (20-192) | 122 (56-365) |
Number needed to test | ||
3534 | 1779 (520-4926) | 821 (274-1779) |
Hospital outpatient department costs | Ambulatory surgery center Costs | |
---|---|---|
Basic PPE | 4 | 4 |
High-risk PPE | 20 | 20 |
Polymerase chain reaction testing | 100 | 100 |
Room decontamination | 5 | 5 |
Anesthesia | 98 | 98 |
Colonoscopy (with biopsy/polypectomy) | 1004 | 507 |
EGD (diagnostic, no biopsy) | 786 | 397 |
Flexible sigmoidoscopy (diagnostic, no biopsy) | 764 | 386 |
EUS (diagnostic, no FNA) | 1100 | 663 |
ERCP | 2999 | 1306 |
Extras (average evaluation, pathology, labs, radiology, and management) | 215 | 215 |
Low risk | Intermediate risk | High risk |
---|---|---|
Endoscopy personnel | ||
Surgical mask | Upper GI endoscopy → consider as high risk | N95 mask |
Hairnet | Hairnet | |
Goggles | Lower GI endoscopy → consider as low risk | Goggles and/or face shield |
Single-use gown | Long-sleeved water resistant gown | |
Gloves | Two pairs of gloves | |
Patient | ||
Surgical mask | Surgical mask | |
Gloves | ||
Decontamination endoscopy rooms | ||
Standard disinfection at the end of procedure day | At the end of each procedure |
2013 Medicare cases | Percent of cases | 2017 Estimated U.S. cases | Distribution adapted from Medicare beneficiaries | 2020 Projected annual cases (average of lower and higher estimate) | Lower estimate using annual population growth (see below) | Upper estimate using annual procedure growth (see below) | One week 2020 projected cases (annual/52.1) | Lower estimate | Upper estimate | |
---|---|---|---|---|---|---|---|---|---|---|
Colonoscopy | 10,964,034 | 61.90 | 19,000,000 | .6190040 | 19,501,337 | 19,456,000 | 19,546,673 | 373,997 | 373,128 | 374,867 |
EGD | 6,069,647 | 34.27 | 10,518,327 | .3426782 | 11,109,285 | 10,770,767 | 11,447,804 | 213,054 | 206,562 | 219,546 |
Flexible sigmoidoscopy | 313,045 | 1.77 | 542,488 | .0176738 | 556,802 | 555,508 | 558,096 | 10,678 | 10,654 | 10,703 |
EUS | 196,144 | 1.11 | 339,906 | .0110738 | 385,108 | 348,063 | 422,154 | 7,386 | 6,675 | 8,096 |
ERCP | 169,510 | .96 | 293,750 | .0095701 | 307,400 | 300,800 | 313,999 | 5,895 | 5,769 | 6,022 |
Total | 17,712,380 | 100.00 | 30,694,471 | 1.0000000 | 31,859,932 | 31,431,138 | 32,288,726 | 611,011 | 602,787 | 619,234 |
Volume increase based on U.S. annual population growth | Volume increase based on Medicare annual procedure reports | |||||||||
Estimated increase 2017-2020 | 2009 | 2010 | Difference | Estimate increase 2017-2020 | ||||||
1.024 | Colonoscopy/flexible sigmoidoscopy | 3,330,829 | 3,336,136 | .0015908 | 1.004772 | |||||
EGD | 2,833,863 | 2,895,999 | .0214558 | 1.064367 | ||||||
ERCP | 284,391 | 288,715 | .0149767 | 1.04493 | ||||||
EUS | 59,604 | 64,274 | .0726577 | 1.217973 |
Comments
- • All endoscopes and reusable accessories should be disinfected according to standard guidelines.
- • Endoscopies of intermediate-/high-risk patients should preferably be performed in a negative pressure room. Delay the next procedure with 30 minutes to allow airborne particles to vanish. If no negative pressure room is available, the room should be kept empty for at least 1 hour.
- • Discourage reuse.
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Article info
Publication history
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: J. E. Corral: Travel, food, and beverage compensation from Abbvie, Intercept Pharmaceuticals, Janssen Scientific, Boston Scientific, and Cook Medical. M. B. Wallace: Consultant for Virgo Inc, Cosmo/Aries Pharmaceuticals, Anx Robotica, Covidien, GI Supply, Endokey, Endostart, Boston Scientific, and Microtek; research grant recipient from Fujifilm, Boston Scientific, Olympus, Medtronic, Ninepoint Medical, and Cosmo/Aries Pharmaceuticals; stockholder in Virgo Inc; food and beverage compensation from Synergy Pharmaceuticals, Boston Scientific, and Cook Medical. All other authors disclosed no financial relationships.
If you would like to chat with an author of this article, you may contact Dr Wallace at [email protected]
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- COVID-19 testing before every endoscopy: Is India ready for prime time?Gastrointestinal EndoscopyVol. 92Issue 3
- PreviewThe first case of SARS-CoV-2 infection in India was reported on January 30, 2020, from Kerala.1 The disease since then has increased manifold to reach figures of over 45,000 infections across the country, making a significant impact on healthcare with drastic changes in clinical practice. Multiple society guidelines have been published since the outbreak of the virus, with a major focus on screening and precautions for patients undergoing endoscopy. Continuing hospital services in a smooth and effective manner while taking care of patients’ and caregivers’ safety remains a priority.
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