Triage guidance for upper gastrointestinal physiology investigations during restoration of services during the COVID-19 pandemic

The COVID-19 pandemic has adversely affected capacity across the board; for gastrointestinal (GI) medicine it has had a direct impact on endoscopy and GI physiology testing. Upper GI physiology investigations are elective investigations, aimed at determining causes of symptoms in patients in whom structural causes have been excluded. These tests include oesophageal manometry and 24 hour ambulatory reflux monitoring, the results of which are subsequently used to guide patient management. International recommendations are available to address and help guide departments through some of the challenges posed by the pandemic. The Association of Gastrointestinal Physiologists (AGIP) council published guidelines regarding GI physiology service provision during the COVID-19 pandemic in May 2020. This guidance detailed necessary requirements for personal protective equipment (PPE) as well as highlighting the need to consider workflow changes. These changes may arise both as a result of increased time needed for physiology procedures, and as a result of new pressures on endoscopy services as a whole. The guidance also highlighted the requirement for local multidisciplinary team discussions to prioritise cases on the basis of urgency and local therapeutic availability.

The following article provides a framework for triaging patients referred into upper GI physiology services using standardised decision making based on clinical need. These triaging guidelines were initially compiled by the authors and subsequently subject to review and approval by the AGIP council, an elective group comprising representatives from the Gastroenterology, Surgery, Physiology and the Healthcare Science workforces.

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