Post written by Andrew J. Gawron, MD, PhD, from the National Gastroenterology and Hepatology Program, Office of Specialty Care Services, Department of Veterans Affairs, Washington, DC, USA, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA, and the Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah, USA.

The focus of this study was to describe the outcomes of pre-endoscopy coronavirus disease 2019 (COVID-19) symptom and exposure screening and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) nucleic acid amplification testing (NAAT) across the national Veterans Affairs (VA) healthcare system and the relationship of these practices to the resumption of endoscopy service.

The COVID-19 pandemic has had a historic and profound impact on medical care. Elective medical procedures, such as endoscopy, were completely halted at the pandemic’s onset. There was significant effort in developing guidance and practices for the safe resumption of endoscopy to protect staff and patients. These practices included implementation of preprocedure screening and testing for COVID-19. We felt it was important to describe the implementation of screening and testing practices, including testing performance characteristics, across a large healthcare system. 

In our analysis of more than 300,000 completed and canceled endoscopy procedures, the results show the rapid use of preprocedure COVID-19 screening and testing to safely resume endoscopy services across the VA healthcare system. Overall, 1.8% of those tested had a positive NAAT result, including 1.3% who screened negative.

In patients with positive screening results for symptoms or exposures, 15.0% had a positive NAAT result. However, screening alone would have missed 65.4% of individuals found to have a SARS-CoV-2 infection. 

There was a weak correlation between monthly testing and monthly endoscopy volume by site across the VA healthcare system. These data should be evaluated in the context of the various waves of the pandemic and the type of procedure performed (eg, aerosol-generating). Numerous questions and potential areas of future study remain as we enter the endemic phase of the pandemic. These include unintended consequences related to pretesting requirements before receiving endoscopy care. For example, postponement of an endoscopy may lead to poor patient outcomes, such as delayed cancer diagnosis.

This report illustrates adaptations to clinical care made within a large learning healthcare system that has sought to continually generate and apply evidence and innovation to provide high-quality care during the COVID-19 pandemic.

Graphical Abstract

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