Thread by @ShaziaMSiddique

#Tweetorial on @AmerGastroAssn NEWLY released #COVID19 Rapid Review & #Guidelines in @AGA_Gastro! The most evidence-based #GI guidance on #PPE & #endoscopy #triage using #GRADE methodology @SultanShazi @SeragHashem @PDavitkov @DrJFeuerstein 1/13

https://twitter.com/AmerGastroAssn/status/1245383805269086210

Background: Healthcare workers are at ⬆️ risk for #COVID w/o adequate #PPE (20-30% of cases). In #GI, upper scopes are aerosolized-generating procedures (AGPs) & therefore even ⬆️ risk for #COVID. Lower scopes also = ⬆️ risk 2/2 some e/o AGPs w/bx + fecal oral spread. 2/13

Rec 1: Wear N95s (or better) for all upper scopes REGARDLESS of #COVID status. (Strong rec, mod quality evid). Why? Testing is inadequate & w/community spread, take universal precautions. If rapid testing for endo pts is avail, prioritize #N95s for known COVID 3/13

Rec 2: Do NOT wear surgical masks alone for upper scopes if patient has KNOWN or presumptive #COVID19 (Strong rec, low cert of evid). Why? AGPs in pts w/COVID is too high risk to risk transmission & surgical masks are insufficient w/aerosolization 4/13

Rec 3: Wear N95s (or better) for lower scopes REGARDLESS of #COVID19 status (Strong rec, low certainty of evidence). See above (Background & Rec 1) for reasoning. 5/13

Rec 4: If very resource-constrained, consider extended use (8h) or re-use (5d) of N95s for #GI scopes (Conditional rec, very low cert). Why? Data here are terrible. No direct data on viral transmission with 1+ use of N95s, or even indirect via SARS/MERS + none for AGPs! 6/13

Rec 4 more info: Limited indirect data suggest loss of fit & durability with repeated use. If you are doing this, suggest full face shield with N95s. If you have a PAPR with disposable face shields, then disinfect shields with biocidal agents between use 7/13

Rec 5: DOUBLE glove for all #GI scopes! (Strong rec, mod certainty of evid). Why? Wearing single gloves can lead to contamination of other #PPE gear like gowns and masks when doffing 8/13

Rec 6: Do scopes in #negative-pressure rooms for pts w/ KNOWN or presumptive #COVID when available (Conditional rec, very low qual evidence). For many inpts, this can be done in a neg pressure ICU room or OR. Limited data suggesting this could mitigate spread of infxn. 9/13

Rec 7: Standard #disinfecting procotols for endoscopy re-processing and cleaning are effective against #COVID19. Biocidal agents have shown efficacy here & no need to change protocols here. 10/13

Helpful & practical tips for #PPE in photo below & regarding donning & doffing of PPE from @CDCgov cdc.gov/hai/pdfs/ppe/p… 11/13

Now onto #Endoscopy #Triage during the #COVID19 pandemic: See algorithm and table below for guidance 12/13

END: so grateful to be a part of this rapid systematic review & guideline via @AmerGastroAssn leadership. Now let's RT & spread the word: #COVIDGI @KristleLynchMD @petersliang @drfolamay @SophieBalzoraMD @IssakaMD @DMGrayMD @AustinChiangMD @stevenbollipo @BilalMohammadMD 13/13