Appropriateness of routine pre-endoscopic SARS-CoV-2 screening with RT-PCR in asymptomatic individuals and its impact on delayed diagnosis

As of November 2021, infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has occurred in more than 290,000,000 people and caused over 5,400,000 deaths globally.1 Although the most commonly described symptoms are fever and cough, a recent meta-analysis found that gastrointestinal symptoms were reported in up to 18% of patients with COVID-19.2 Although the transmission of SARS-CoV-2 occurs most commonly through the inhalation of aerosols or droplets, some studies have described that angiotensin converting enzyme 2 receptor (a membrane receptor supporting the entry of SARS-CoV-2 into the cell) is expressed in the glandular digestive epithelia, leading to the possibility of fecal-oral transmission.3, 4

Endoscopy units are considered to be at an increased risk of infection by SARS-CoV-2, not only because of the inhalation of airborne droplets or conjunctival contact but also because of potential fecal-oral transmission.5 For this reason, most of the endoscopy units worldwide decreased (or even stopped) their activity during the first wave of the pandemia, delaying many elective examinations and the diagnosis of potentially life-threatening conditions.6, 7 In fact, a substantial reduction in the diagnosis of new gastrointestinal cancers has already been reported.8 National and international endoscopy societies have proposed recommendations regarding the reopening of endoscopy units. These recommendations include pre-procedure testing, health-professional personal protective equipment (PPE) and prioritization rules for endoscopic examinations. Nevertheless, there is currently no consensus on the use of routine SARS-CoV-2 testing with reverse transcription polymerase chain reaction (RT-PCR) or antigen-tests for asymptomatic individuals scheduled for endoscopic procedures. The European Society of Gastrointestinal Endoscopy and the European Society of Gastroenterology and Endoscopy Nurses and Associates proposed that all patients be required to provide a negative viral test (RT-PCR) performed within 48 h before endoscopy or either documentation of full vaccination status or recovery from COVID-19 infection within the past 6 months.9 The Spanish Gastroenterology societies proposed checking every patient for fever and asking about symptoms such as fever or cough before endoscopy.10 Finally, the American Gastroenterological Association recommended against routine testing irrespective of the vaccination status of patients.11

Nasopharyngeal and throat swabs are widely used to perform SARS-CoV-2 RT-PCR tests on asymptomatic patients as it identifies viral RNA rather than viral infection status. A meta-analysis including seven studies observed a sensitivity of 73.3% and a specificity of 95% for this test.12 Recent studies have demonstrated that SARS-CoV-2 transmission is feasible from people who suffered asymptomatic infection (SARS-CoV-2 detected but symptoms not developed) or during the pre-symptomatic phase (SARS-CoV-2 detected before symptom onset).13 However, more studies evaluating selective screening strategies to optimize the resources are needed, considering that universal screening with RT-PCR may not be available in all centers.

The primary aim of this study is to describe the results of routine pre-endoscopic screening in our endoscopy unit and to correlate them with the administrative epidemiological data of our background population.

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