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New AGA guidance on virus testing patients before endoscopy

Endoscopy centers in both low- and high-prevalence areas may not benefit from a pre-testing strategy.
Coronavirus. COVID-19. 3D Render
Coronavirus. COVID-19. 3D Render

Our new evidence-based review helps you answer the question: Should my endoscopy center test asymptomatic patients for SARS-CoV-2 prior to endoscopy?

Key guidance for gastroenterologists

Endoscopy centers in areas with an intermediate prevalence of SARS-CoV-2 infection should consider testing patients for the virus before endoscopy. Several important factors contribute to this decision including testing feasibility, personal protective equipment (PPE) availability, and risk aversion threshold of endoscopists and staff.

Endoscopy centers in both low- and high-prevalence areas may not benefit from a pre-testing strategy.

  • Rationale for low-prevalence areas: Diagnostic tests have a high proportion of false positives with significant downstream consequences, such as patient burden (quarantining and out of work for 14 days), unnecessarily delayed cases and over-utilization of testing which may already be limited in availability. Therefore, PPE availability may drive decision-making for case triage instead. If PPE is not limited, then the majority of endoscopists and staff may reasonable select to use N95/N99 respirators or PAPRs.
  • Rationale for high-prevalence areas: Highest available PPE (such as N95/N99 respirators or PAPRs) would be used universally, as available. Additionally, testing is often limited due to a high demand for a potential surge of cases.

AGA created an online tool to help endoscopy centers make decisions about their pre-endoscopy testing strategy. This tool combines local prevalence with diagnostic test performance data to calculate the proportion of true versus false positives and negatives to help endoscopy centers understand the downstream consequences of implementing a pre-procedure testing strategy. View instructions for using the online tool.

For all four evidence-based recommendations and a detailed discussion, review the full publication in Gastroenterology.

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