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Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 36-38

Gastrointestinal motility services during COVID pandemic: The past and the present


1 Department of Gastroenterology, Arihant Hospital and Research Centre, Indore, Madhya Pradesh, India
2 Arihant Hospital and Research Centre, Indore, Madhya Pradesh, India

Date of Submission21-May-2021
Date of Decision07-Aug-2021
Date of Acceptance12-Oct-2021
Date of Web Publication01-Jan-2022

Correspondence Address:
Mayank Jain
Department of Gastroenterology, Arihant Hospital and Research Centre, Indore, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ghep.ghep_25_21

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  Abstract 


Coronavirus disease pandemic has affected the delivery of gastrointestinal endoscopy and physiology services. We highlight our experience where we maintained strict adherence to locally developed protocols based on patient demographics. This was helpful in restricting risk of disease transmission to health-care workers and keeping the cost of procedures under check.

Keywords: Coronavirus, gastroenterology, manometry, physiology


How to cite this article:
Jain M, Agrawal V. Gastrointestinal motility services during COVID pandemic: The past and the present. Gastroenterol Hepatol Endosc Pract 2022;2:36-8

How to cite this URL:
Jain M, Agrawal V. Gastrointestinal motility services during COVID pandemic: The past and the present. Gastroenterol Hepatol Endosc Pract [serial online] 2022 [cited 2022 Aug 16];2:36-8. Available from: http://www.ghepjournal.com/text.asp?2022/2/1/36/334696



Coronavirus disease (COVID-19) pandemic has had a direct impact on endoscopy and gastrointestinal (GI) physiology testing. Various guidelines from national[1] and international bodies have guided practitioners through the challenges posed by the pandemic.[2],[3] GI motility testing is usually elective and nonurgent. However, given the high prevalence and the impact of these conditions on the quality of life of the patients, it is mandatory to restore these services as early as possible. It is well known that there is an increased risk for viral spread through droplets when motility probes pass through the nose or mouth[4] and fecal shedding of the coronavirus too has been documented.[5] Careful attitude of well-trained and well-informed medical staff is of paramount importance while performing motility testing in this situation.

India is a resource-poor country. During the pandemic, there has been significant reallocation of hospital resources and medical professionals are facing challenges in running routine diagnostic services. We share our experience regarding the impact of the pandemic on GI physiology testing at our center. Based on the patient population, we cater to and their economic constraints, we modified our approach to GI motility testing. To minimize the risk of virus transmission to the medical staff, we followed stringent infection control policies, which have been elaborated on later. The impact of the pandemic on GI physiology testing has been assessed on the following aspects-caseload, indication for testing, protective measures taken, and cost of testing.

We retrospectively analyzed our database and accessed the data of patients referred to our unit between June 2019 and March 2021. We divided the study period into two equal time zones of 10 months each time zone 1 (June 2019-March 2020) and time zone 2 (June 2020 to March 2021). We have a two-member team in our unit-one doctor and one technician. We do procedures for 3 days in a week at an average of 2 procedures per day. We have maintained the same frequency of procedures even during the pandemic. Daily reporting of symptoms and monitoring of vitals was done for both the members by trained nursing staff. No quarantine was done.

The following activities were included in the analysis-esophageal manometry, anorectal manometry. and catheter-based pH testing. Our center stopped all motility testing for 72 days from March 24, 2020, to June 04, 2020. Motility testing was restarted for selected patients after this period. Initially, we started testing for patients with dysphagia to reduce the risk of nutritional and symptomatic compromise. Later, we included patients with long standing, troublesome reflux symptoms who were planned for surgical intervention and those who had symptom recurrence after treatment of major motility disorders. To date, we have avoided esophageal manometry for patients with atypical reflux symptoms, rumination, supragastric belching, and other functional GI problems. For anorectal manometry, we included patients with long-standing symptoms and those planned for surgical interventions. Twenty-four pH testing was done for cases planned for surgical intervention.

We also evaluated the protective measures and screening methods adopted and continued during time zone 2. We avoided the use of cotton bed sheets and started using plastic disposable sheets. Before the procedure, symptoms and charting of temperature and saturation were made mandatory. We triaged our patients into low-risk group (no fever/cough/history of contact and travel to high-risk area/stay in containment areas) and high-risk group (with one or more above risk factors).[6] Testing was mandatory for all patients in high-risk group. In low-risk cases, testing was only done if they were planned for admission or surgical intervention. For all cases, the doctor and technician involved used gloves, hairnet, face shield, filtering facepiece 2 (FFP-2), and other protective equipment using proper donning and doffing protocols. Diligent hand washing was practiced before and after the procedure. On entry, the hands of the patients were sanitized using alcohol-based hand rub and washed, clean gowns were provided. Disinfection of the equipment was done as per the manufacturer's instructions after every procedure. A recent consensus statement has highlighted that the use of current disinfectants such as glutaraldehyde and reprocessing protocols are adequate. The reprocessing work should preferably be done by experienced staff with documented competency. No changes were made in our disinfection and reprocessing practices.[6]

A total of 195 procedures were done during the study period-105 in time zone 1 and 90 in time zone 2. There was a reduction of 14.3% in overall procedures between time zone 1 and 2 [Figure 1]. Symptom screening and monitoring of vitals were done for all patients. However, screening tests such as radiological investigations and molecular diagnostics were done in few patients based on patient risk profile and logistic or economic constraints [Table 1]. Protective measures were followed by the staff members in more than 80% of cases with the use of gloves, FFP-2 mask, and face shields in 100% of cases [Table 1]. The use of personal protective equipment with or without a water-resistant gown was done in all cases. These measures led to an increase in the charges of the procedure with a price hike of 40% compared to the prepandemic period. In addition, nearly one-third of patients had to pay for additional tests such as radiology and antigen/reverse transcription-polymerase chain reaction (RT-PCR) tests [Table 2].
Figure 1: Comparison of various gastrointestinal physiology tests done during the two time zones

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Table 1: Screening measures for patients and protective measures for staff in time zone 2 (postcoronavirus disease 2019)

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Table 2: Procedure and additional costs borne by patients in time zones 1 and 2

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To summarize, the number of cases at our center dropped by 14.3% in time zone 2 compared to time zone 1. This could be related to lower referral, fear of visiting hospitals, and rising medical expenditure during the pandemic. Moreover, with the adoption of protective strategies, the price of procedures went up by 20%–233% and procedures were predominantly done for patient management altering indications. Although most guidelines recommend the use of RT-PCR or rapid antigen test or radiology for high aerosol-generating procedures, we did these tests in approximately 50% of cases due to financial constraints. By following strict protocols, we were able to prevent disease transmission. Both the staff members have remained asymptomatic during the pandemic period and on the telephonic interview, none of the patients developed symptoms of the upper respiratory infection within 10 days of procedure.

The COVID-19 pandemic has affected the delivery of GI physiology services. Strict adherence to locally developed protocols based on patient demographics seems helpful in restricting risk of disease transmission and keeping the cost of procedures under check.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Philip M, Lakhtakia S, Aggarwal R, Madan K, Saraswat V, Makharia G. Joint Guidance from SGEI, ISG and INASL for gastroenterologists and gastrointestinal endoscopists on the prevention, care, and management of patients With COVID-19. J Clin Exp Hepatol 2020;10:266-70.  Back to cited text no. 1
    
2.
Lee YY, Bredenoord AJ, Gyawali CP. Recommendations for essential esophageal physiologic testing during the COVID-19 pandemic. Clin Gastroenterol Hepatol 2020;18:1906-8.  Back to cited text no. 2
    
3.
Tack J, Vanuytsel T, Serra J, Accarino A, Stanghellini V, Barbara G, et al. European Society for Neurogastroenterology and Motility recommendations for conducting gastrointestinal motility and function testing in the recovery phase of the COVID-19 pandemic. Neurogastroenterol Motil 2020;32:e13930.  Back to cited text no. 3
    
4.
Keller J, Bassotti G, Clarke J, Dinning P, Fox M, Grover M, et al. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol 2018;15:291-308.  Back to cited text no. 4
    
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Tian Y, Rong L, Nian W, He Y. Review article: Gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther 2020;51:843-51.  Back to cited text no. 5
    
6.
Siah KT, Rahman MM, Ong AM, Soh AY, Lee YY, Xiao Y, et al. The practice of gastrointestinal motility laboratory during COVID-19 pandemic: Position Statements of the Asian Neurogastroenterology and Motility Association (ANMA-GML-COVID-19 position statements). J Neurogastroenterol Motil 2020;26:299-310.  Back to cited text no. 6
    


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