Post written by Mohammad Bilal, MD, and Mandeep S. Sawhney, MD, MS, from the Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

In anticipation of the surge of COVID-19 cases in the United States, the Surgeon General of the United States advised hospitals to cancel all elective procedures. The 4 national gastroenterology organizations also recommended that elective procedures should be rescheduled to mitigate the spread of COVID-19 and preserve personal protective equipment. Despite these recommendations, there was ambiguity among practicing gastroenterologists regarding which endoscopic procedures should be performed during the COVID-19 pandemic and which ones could be safely deferred.

To provide more specific guidance on triaging endoscopic procedures, we utilized a modified Delphi methodology to attain expert consensus regarding procedural timing for advanced endoscopic procedures. The Delphi method is a validated and structured technique to obtain expert consensus, and it is particularly well suited for the present situation where there is limited outcomes data, and guidance for procedural timing is urgently needed. This is also important because gastrointestinal endoscopy services might vary based on variation in the surge of COVID-19 cases across different regions.

Using a modified Delphi method, we first achieved consensus on patient-important outcome for each procedural indication. Panelists prioritized consensus patient-important outcome when categorizing each indication into 1 of the following 3 procedural time-periods: (1) time-sensitive emergent (schedule within 1 week), (2) time-sensitive urgent (schedule within 1 to 8 weeks), (3) non-time sensitive (defer for >8 weeks and then reassess the timing). We were able to provide consensus recommendations regarding 40 out of 41 advanced endoscopy indications by stratifying them into 1 of 3 procedural time periods. The procedures included advanced endoscopic interventions in EGD and colonoscopy, as well as EUS, ERCP, and balloon-assisted enteroscopy.

By using a Modified Delphi method that prioritized patient-important outcomes, we developed consensus recommendations on procedural timing for common indications for advanced endoscopy. These recommendations and the structured decision framework provided by our study can inform decision-making as endoscopy services are reopened.

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