Based on a review of available evidence, we have published guidance for clinicians in Gastroenterology: AGA Institute Rapid Recommendations for Gastrointestinal Procedures During the COVID-19 Pandemic. AGA recommends increasing personal protective equipment (PPE) during all GI procedures during the coronavirus pandemic, as well as triaging procedures following a decision-making framework outlined in the recommendations document. This guidance expands upon the joint society guidance released March 31.
Join the authors in a discussion on these recommendations in AGA Community.
RECOMMENDATIONS
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MASKS
- 1. In health care workers performing upper GI procedures, regardless of COVID-19 status*, AGA recommends use of N95 (or N99 or PAPR) instead of surgical masks, as part of appropriate personal protective equipment. (Strong recommendation, moderate certainty of evidence)
- 2. In health care workers performing lower GI procedures regardless of COVID-19 status*, AGA recommends the use of N95 (or N99 or PAPR) masks instead of surgical masks as part of appropriate personal protective equipment. (Strong recommendation, low certainty of evidence)
- 3. In health care workers performing upper GI procedures, in known or presumptive COVID-19 patients, AGA recommends against the use of surgical masks only, as part of adequate personal protective equipment. (Strong recommendation, low certainty of evidence)
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LIMITED RESOURCE SETTINGS
- 4. In extreme resource-constrained settings involving health care workers performing any GI procedures, regardless of COVID-19 status*, AGA suggests extended use/re-use of N95 masks over surgical masks, as part of appropriate personal protective equipment. (Conditional recommendation, very low certainty evidence)
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GLOVES
- 5. In health care workers performing any GI procedure, regardless of COVID-19 status, AGA recommends the use of double gloves compared with single gloves as part of appropriate personal protective equipment. (Strong recommendation, moderate certainty of evidence)
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NEGATIVE PRESSURE ROOMS
- 6. In health care workers performing any GI procedures with known or presumptive COVID-19, AGA suggests the use of negative pressure rooms over regular endoscopy rooms when available. (Conditional recommendation, very low certainty of evidence)
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ENDOSCOPIC DISINFECTION
- 7. For endoscopes utilized on patients regardless of COVID-status, AGA recommends continuing standard cleaning endoscopic disinfection and reprocessing protocols. (Good practice statement)
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TRIAGE
Download the triage decision support tool and quick reference chart for social sharing - 8. All procedures should be reviewed by trained medical personnel and categorized as time-sensitive or not time-sensitive as a framework for triaging procedures. (Good practice statement)
- 9. In an open access endoscopy system where the listed indication alone may provide insufficient information to make a determination about the time-sensitive nature of the procedure, consideration should be given for the following options (i) a telephone consultation with the referring provider or (ii) a telehealth visit with the patient or (iii) a multidisciplinary team approach to facilitate decision-making for complicated patients. (Good practice statement)
- *These recommendations assume the absence of widespread reliable rapid testing for the diagnosis of COVID-19 infection or immunity