Clin Endosc.  2022 Jan;55(1):49-57. 10.5946/ce.2021.191.

Impact of the COVID-19 Outbreak on Anesthesiologist Assistance for Endoscopic Procedures

• Calcara C
• Ciscato C
• Amato A
• Sinagra E
• Alvisi C
• Ardizzone S
• Anderloni A
• Gambitta P
• on behalf of the FISMAD Lombardy COVID-19 Impact on Anesthesiologist-Assisted Endoscopy Study Group

• KMID: 2525050
• DOI: http://doi.org/10.5946/ce.2021.191

Abstract

Background/Aims
The coronavirus disease 2019 (COVID-19) outbreak has modified the activities of endoscopy units worldwide. Herein, we investigated the impact of the COVID-19 outbreak on anesthesiologist assistance for endoscopic procedures in Lombardy, Italy.
Methods
A questionnaire concerning anesthesiologist assistance provided from October 26 to December 6, 2020, in comparison with the same period in 2019, was sent to endoscopic units in Lombardy.
Results
Approximately 54% (34/63) of the units responded. A reduction in the number of all endoscopies (-33.5%; 18792 in 2020 vs. 28264 in 2019) and anesthesiologist-assisted endoscopies (-15.3%; 2652 in 2020 vs. 3132 in 2019) was reported. A greater reduction in anesthesiologist assistance was observed in government community units (-29.5%) than in academic (-14%) and private community units (-4.6%). Among all units, 85% reported a reduction in anesthesiologist assistance; 65% observed a delay/cancellation of procedures; 59%, a restricted patient selection; 17%, the need to transfer some patients to other hospitals; and 32%, a related worsening of procedure quality.
Conclusion
The COVID-19 pandemic compromised the anesthesiologist assistance for endoscopic procedures in Lombardy, which worsened the procedure quality mainly in government community units. The COVID-19 “stress test” suggests a more balanced allocation of anesthesiologic resources in the future.

Keyword

Anesthesiologist assistance; COVID-19; Endoscopic quality

Reference

1. Maida M, Sferrazza S, Savarino E, et al. Impact of the COVID-19 pandemic on gastroenterology divisions in Italy: a national survey. Dig Liver Dis. 2020; 52:808–815.

2. Repici A, Pace F, Gabbiadini R, et al. Endoscopy units and the coronavirus disease 2019 outbreak: a multicenter experience from Italy. Gastroenterology. 2020; 159:363–366.e3.

3. Manes G, Repici A, Radaelli F, Bezzio C, Colombo M, Saibeni S. Planning phase two for endoscopic units in Northern Italy after the COVID-19 lockdown: an exit strategy with a lot of critical issues and a few opportunities. Dig Liver Dis. 2020; 52:823–828.

4. Boškoski I, Pecere S, Bove V, Barbaro F, Perri V, Costamagna G. Impact of SARS-CoV-2 on a high volume endoscopy center in Italy. Dig Liver Dis. 2020; 52:819–822.

5. ASA Physical Status Classification System [Internet]. Schaumburg: The American Society of Anesthesiologists;c2020 [cited 2021 Oct 22]. Available from: https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system.

6. 2019 DGR Regione Lombardia DELIBERAZIONE N° XI / 1865 Seduta del 09/07/2019. [Internet]. Regione Lombardia. [updated 2019 Jul 9; cited 2021 Jul 31]. Available from: https://www.asst-monza.it/documents/492169/0/DGR+n_XI_1865+del+2019+temoi+d%27attesa. pdf/95d2f917-8781-e793-a3df-97ba2e926c77.

7. Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) guideline-update 2021. Endoscopy. 2021; 53:300–332.

8. Birk M, Bauerfeind P, Deprez PH, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2016; 48:489–496.

9. Oakland K, Chadwick G, East JE, et al. Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology. Gut. 2019; 68:776–789.

10. de Franchis R; Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015; 63:743–752.

11. Enestvedt BK, Eisen GM, Holub J, Lieberman DA. Is the American Society of Anesthesiologists classification useful in risk stratification for endoscopic procedures? Gastrointest Endosc. 2013; 77:464–471.

12. Laffin AE, Kendale SM, Huncke TK. Severity and duration of hypoxemia during outpatient endoscopy in obese patients: a retrospective cohort study. Can J Anaesth. 2020; 67:1182–1189.

13. Elphick DA, Donnelly MT, Smith KS, Riley SA. Factors associated with abdominal discomfort during colonoscopy: a prospective analysis. Eur J Gastroenterol Hepatol. 2009; 21:1076–1082.

14. Analgo-sedazione in endoscopia digestiva [Internet]. Roma: SIAARTI;c2020 [cited 2021 Oct 22]. Available from: https://www.siaarti.it/news/338126.

15. Sidhu R, Turnbull D, Newton M, et al. Deep sedation and anaesthesia in complex gastrointestinal endoscopy: a joint position statement endorsed by the British Society of Gastroenterology (BSG), Joint Advisory Group (JAG) and Royal College of Anaesthetists (RCoA). Frontline Gastroenterol. 2019; 10:141–147.

16. ASGE Standards of Practice Committee, Early DS, Lightdale JR, et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2018; 87:327–337.

17. Manes G, Saibeni S, Pellegrini L, et al. Improvement in appropriateness and diagnostic yield of fast-track endoscopy during the COVID-19 pandemic in Northern Italy. Endoscopy. 2021; 53:162–165.

18. Salerno R, Conti CB, De Silvestri A, Campbell Davies SE, Mezzina N, Ardizzone S. The impact of covid-19 pandemic on urgent endoscopy in Italy: a nation-wide multicenter study. Scand J Gastroenterol. 2020; 55:870–876.

19. Marco AP. Anesthesiology, the tragedy of the commons, and COVID-19. Anesth Analg. 2020; 131:120–123.

20. Silva DS. Ventilators by Lottery: The least unjust form of allocation in the coronavirus disease 2019 pandemic. Chest. 2020; 158:890–891.

21. Rosenbaum L. Facing Covid-19 in Italy - ethics, logistics, and therapeutics on the epidemic’s front line. N Engl J Med. 2020; 382:1873–1875.

22. Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of covid-19. N Engl J Med. 2020; 382:2049–2055.

23. Hyder AA. Allocating medical resources in the time of covid-19. N Engl J Med. 2020; 382:e79.

24. Liddell K, Martin S, Palmer S. Allocating medical resources in the time of covid-19. N Engl J Med. 2020; 382:e79.

25. Firth P, Eyal N. Allocating medical resources in the time of covid-19. N Engl J Med. 2020; 382:e79.

26. Supady A, Brodie D, Curtis JR. Ten things to consider when implementing rationing guidelines during a pandemic. Intensive Care Med. 2021; 47:605–608.

27. Vergano M, Bertolini G, Giannini A, et al. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic. Crit Care. 2020; 24:165.

28. Vanella G, Capurso G, Boškoski I, et al. How to get away with COVID-19: endoscopy during post-peak pandemic. A perspective review. Therap Adv Gastroenterol. 2020; 13:1756284820965070.

29. Coronavirus in Lombardia, tutti gli aggiornamenti in diretta. [Internet]. Milano: Lombardia Notizie Online;[updated 2021 Apr 1, cited 2021 April 1] Available from: https://www.lombardianotizie.online/coronavirus-in-lombardia-i-dati-di-aprile-2020/.

30. Coronavirus in Lombardia, tutti gli aggiornamenti in diretta. [Internet]. Milano: Lombardia Notizie Online;c2020 [cited 2021 October 24]. Available from: https://www.lombardianotizie.online/coronavirus-lombardia-novembre-2020.