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Evolution of International Pediatric Endoscopic Practice Changes During the Coronavirus Disease 2019 Pandemic
Wenly Ruan1, Douglas S Fishman1, Diana G Lerner2
1The Section of Pediatric Gastroenterology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Insights
Pediatric endoscopy practices evolved during the COVID-19 pandemic, with increased procedures and screening. However, personal protective equipment (PPE) use decreased, and risk tolerance remained low, highlighting the need for updated guidance.
Area of Science:
- Pediatric Gastroenterology
- Infectious Disease Epidemiology
- Healthcare Management
Background:
- The COVID-19 pandemic significantly disrupted global healthcare, particularly pediatric endoscopic procedures.
- Initial assessments revealed substantial international impacts on pediatric endoscopy practices.
Purpose of the Study:
- To evaluate the evolution of pediatric endoscopic practices seven months after the initial COVID-19 impact assessment.
- To delineate changes in practice patterns, screening protocols, personal protective equipment (PPE) use, and risk tolerance among pediatric endoscopists.
Main Methods:
- A follow-up survey was administered to pediatric gastroenterologists who participated in the initial study.
- Data were collected using Research Electronic Data Capture (REDCap), focusing on procedural volumes, screening/testing, PPE utilization, and risk tolerance.
- Seventy-five institutions across 21 countries responded (51.7% response rate).
Main Results:
- Procedural volumes increased in 70.7% of institutions, with 90.7% performing previously postponed cases.
- Pre-endoscopy screening was implemented by 97% of institutions, and 78.7% tested all patients.
- Despite increased procedures, PPE reuse decreased significantly, and fewer institutions recommended full PPE for all procedures (43.2% vs. 59.2%).
Conclusions:
- This study provides the first longitudinal data on the adaptation of pediatric endoscopic practices during the COVID-19 pandemic.
- Findings indicate a low-risk tolerance for COVID-19 transmission among pediatric endoscopists.
- There is a clear need for updated, evidence-based guidance to support pediatric endoscopic practice amidst the ongoing pandemic.
Objectives:
The coronavirus disease 2019 (COVID-19) pandemic has drastically altered endoscopic practices. We initially reported the international impact of COVID-19 on pediatric endoscopic practice. This follow-up study aimed to assess changes 7 months following the initial survey to delineate practice change patterns as the pandemic evolved.
Methods:
Pediatric gastroenterologists who responded to the initial survey were re-surveyed seven months later using Research Electronic Data Capture (REDCap). The survey recorded information on changes in pediatric endoscopic practice patterns, including COVID-19 screening and testing processes and personal protective equipment (PPE) utilization. Additionally, endoscopists' risk tolerance of COVID-19 transmission was evaluated.
Results:
Seventy-five unique institutions from 21 countries completed surveys from the 145 initial responses (51.7% response rate). Procedural volumes increased at most institutions (70.7%) and most were performing previously postponed cases (90.7%). Ninety-seven percent of institutions were performing pre-endoscopy screening with 78.7% testing all patients. Many institutions (34.7%) have performed procedures on COVID-19 positive patients. There was significantly less PPE reuse (P < 0.05) and fewer institutions recommending full PPE for all endoscopies (43.2% vs 59.2%, P = 0.013). Overall, pediatric endoscopists' risk tolerance of COVID-19 transmission is low.
Conclusions:
This is the first survey to highlight the evolution of pediatric endoscopic practices related to the COVID-19 pandemic, underscoring the need for ongoing pandemic-related guidance for pediatric endoscopic practice.
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