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BSG Guidance on recommencing GI Endoscopy in the deceleration & early recovery phases of the COVID-19 pandemic

Updated on: 03 Jun 2020   First published on 30 Apr 2020

Executive Summary

Early in the COVID-19 epidemic, the BSG advised a pause in endoscopic services (6 weeks) for all but emergency and essential procedures. This pause was to protect patients and the workforce and permit time to plan service reconfiguration. Five weeks after the initiation of this pause, the following guidance is being issued to guide the safest possible restart of service.

Restoration of service: Guiding principles

  • The guidance is issued based on consensus opinion and review of the available evidence. Some data is not yet available; some data is inconclusive: in this guidance, therefore, the safety and wellbeing of patients and staff is taken as paramount
  • Delayed diagnosis, particularly of malignancy, carries the risk of serious unintended harm: this document proposes a route to the safe re-establishment of service up to 75% of the previous norm
  • It will not be possible to restore full endoscopy services immediately. Ongoing senior clinical triage remains an essential part of the restoration of service and good clinical practice
  • A safer ‘COVID-minimised endoscopy’ environment needs to be established
  • Endoscopy is part of a bigger national picture, in which supplies of personal protective equipment (PPE) are not unlimited and have to be shared across all NHS and community services

3 main caveats apply:

  • The reintroduction of services must be planned and phased
  • Different scenarios will apply at different stages of the epidemic; the benefit of screening will change as the prevalence of COVID-19 decreases in the population
  • This interim advice will be subject to change as new evidence becomes available

The most urgent changes required are:

  • The restoration of endoscopy rooms and redeployment of specialist staff to their endoscopy units
  • Extra time and space for procedures, because of increased infection control and cleaning procedures
  • The need to pre-screen patients to identify those less likely to have the infection
  • The need for “COVID-minimised” facilities, where strict patient flows separate potentially COVID-19 positive patients from those who are unlikely to have the infection
  • The need for secure supplies of PPE

In this document, the BSG has updated all its detailed advice issued previously relating to individual indications and procedures and will continue to keep this under review. We believe that the UK Government and the Devolved Administrations should be encouraged to work with and through specialist professional groups and the Royal Colleges to co-ordinate best service provision guidance across specialty practice.


Ian Penman, BSG VP Endoscopy

Cathryn Edwards, BSG President

Alastair McKinlay, BSG President Elect

 


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