Elsevier

Gastrointestinal Endoscopy

Volume 93, Issue 5, May 2021, Pages 1060-1064.e1
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Outcomes of symptom screening and universal COVID-19 reverse transcriptase polymerase chain reaction testing before endoscopy in a community-based ambulatory surgery center

https://doi.org/10.1016/j.gie.2020.10.001Get rights and content

Background and Aims

Elective endoscopy resumed in our outpatient ambulatory center after instituting the preprocedure policy of a confirmed negative coronavirus disease 2019 (COVID-19) reverse transcriptase polymerase chain reaction (RT-PCR) status performed 72 hours before a scheduled procedure as mandated by the state of Illinois. In addition, all patients were required to contemporaneously complete the American Society for Gastrointestinal Endoscopy (ASGE) COVID-19 risk screening questionnaire published April 28, 2020 as outlined in the ASGE guidance document for reopening GI endoscopy during the COVID-19 pandemic. The aim of our study is to report the outcomes of 1000 patients who successfully completed the clinical aspects of the ASGE COVID-19 risk screening questionnaire and whose RT-PCR tests were valid for interpretation.

Methods

Data were retrospectively collected from patient medical records for demographics, symptom responses to the preprocedure ASGE COVID-19 risk screening questionnaire, and RT-PCR test results of patients scheduled to undergo an elective outpatient endoscopy at Rockford Gastroenterology Associates from May 22 through June 28, 2020. Descriptive statistics and standard calculation methods to determine both positive and negative predictive values were used for data analysis.

Results

Eight of 1000 patients included in the study tested positive for COVID-19. Three of 8 patients reported 1 or more symptoms on the ASGE COVID-19 risk screening questionnaire. One hundred nineteen additional patients reported symptoms on the ASGE COVID-19 risk screening questionnaire but tested negative for COVID-19. The positive and negative predictive values of the ASGE COVID-19 risk screening questionnaire were 2.46% and 99.43%, respectively.

Conclusions

The low incidence of COVID-19 infection in a community-based ambulatory surgery center is supported by a positive RT-PCR test rate of .80%. Absence of symptoms on the ASGE COVID-19 risk screening questionnaire was highly predictive of a negative RT-PCR test (99.43% negative predictive value), whereas the positive predictive value was low (2.46%) in symptomatic patients. A positive RT-PCR test was invaluable in preventing 5 asymptomatic patients from undergoing endoscopy. Similarly, 119 symptomatic patients underwent endoscopic evaluation who would have otherwise been excluded without RT-PCR testing. Symptom-based screening alone should not be the primary preprocedural assessment tool in selecting patients for undergoing endoscopy during the COVID-19 pandemic.

Abbreviations

ASGE
American Society for Gastrointestinal Endoscopy
COVID-19
coronavirus disease 2019
RGA
Rockford Gastroenterology Associates
RSQ
Risk Screening Questionnaire
RT-PCR
reverse transcriptase polymerase chain reaction

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DISCLOSURE: All authors disclosed no financial relationships.

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