What constitutes urgent endoscopy? A social media snapshot of gastroenterologists’ views during the COVID-19 pandemic
Background and study aims There is a consensus among gastroenterology organizations that elective endoscopic procedures should be deferred during the COVID-19 pandemic. While the decision to perform urgent procedures and to defer entirely elective procedures is mostly evident, there is a wide “middle ground” of time-sensitive but not technically urgent or emergent endoscopic interventions. We aimed to survey gastroenterologists worldwide using Twitter to help elucidate these definitions using commonly encountered clinical scenarios during the COVID-19 pandemic.
Methods A 16-question survey was designed by the authors to include common clinical scenarios that do not have clear guidelines regarding the timing or urgency of endoscopic evaluation. This survey was posted on Twitter. The survey remained open to polling for 48 hours. During this time, multiple gastroenterologists and fellows with prominent social media presence were tagged to disseminate the survey.
Results The initial tweet had 38,795 impressions with a total of 2855 engagements. There was significant variation in responses from gastroenterologists regarding timing of endoscopy in these semi-urgent scenarios. There were only three of 16 scenarios for which more than 70 % of gastroenterologists agreed on procedure-timing. For example, significant variation was noted in regard to timing of upper endoscopy in patients with melena, with 44.5 % of respondents believing that everyone with melena should undergo endoscopic evaluation at this time. Similarly, about 35 % of respondents thought that endoscopic retrograde cholangiopancreatography should only be performed in patients with choledocholithiasis with abdominal pain or jaundice.
Conclusion Our analysis shows that there is currently lack of consensus among gastroenterologists in regards to timing of semi-urgent or non-life-threatening procedures during the COVID-19 pandemic. These results support the need for the ongoing development of societal guidance for these “semi-urgent” scenarios to help gastroenterologists in making difficult triage decisions.
Received: 02 April 2020
Accepted: 03 April 2020
17 April 2020 (online)
© 2020. Owner and Copyright ©
© Georg Thieme Verlag KG
Stuttgart · New York
- 1 World Health Organization. Coronavirus disease (COVID-2019) situation report - 63. Available at (Accessed March 24, 2020): https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200323-sitrep-63-covid-19.pdf?sfvrsn=b617302d_2
- 2 Li R, Pei S, Chen B. et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science 2020; DOI: 10.1126/science.abb3221. [Epub ahead of print]
- 3 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; DOI: 10.1001/jama.2020.1585. [Epub ahead of print]
- 4 Soetikno R, Teoh AY, Kaltenbach T. et al. Considerations in performing endoscopy during the COVID19 pandemic. Gastrointestinal Endoscopy 2020; DOI: 10.1016/j.gie.2020.03.3758. [Epub ahead of print]
- 5 Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020; DOI: 10.1053/j.gastro.2020.02.054. [Epub ahead of print]
- 6 Repici A, Maselli R, Colombo M. et al. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointest Endosc 2020; DOI: 10.1016/j.gie.2020.03.019. [Epub ahead of print]
- 7 Adler DG, Leighton JA, Davila RE. et al. ASGE guideline: The role of endoscopy in acute non-variceal upper-GI hemorrhage. Gastrointest Endosc 2004; 60: 497-504
- 8 Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. BMJ 2019; 364: 1536
- 9 Iqbal U, Khara HS, Hu Y. et al. Emergent versus urgent ERCP in acute cholangitis: a systematic review and meta-analysis. Gastrointest Endosc 2020; 91: 753-760 e4
- 10 Draganov PV, Wang AY, Othman MO. et al. AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States. Clin Gastroenterol Hepatol 2019; 17: 16-25.e1
- 11 Joint GI Society. Message on COVID-19. Available at (Accessed March 24, 2020): https://gi.org/2020/03/15/joint-gi-society-message-on-covid-19/