As The Mount Sinai Hospital’s Endoscopy Center resumed elective procedures that had been postponed due to the COVID-19 pandemic last spring, it looked to the American College of Gastroenterology’s Endoscopy Resumption Task Force guidelines to mitigate the risk of infection among patients. One recommendation was that all centers conduct polymerase chain reaction (PCR) testing of all patients 48 to 72 hours before their procedure.
“The challenge for us was that, at the time, there was little data on the effectiveness of that testing approach for patients,” says Nikhil A. Kumta, MD, MS, Associate Professor of Medicine (Gastroenterology) at the Icahn School of Medicine at Mount Sinai. “We decided to conduct a study on universal pre-procedure COVID-19 PCR to look at its efficacy and then compare our results with local New York City and New York State infection rates to gauge the impact.”
The study, “Outcomes of Universal Pre-Procedure COVID-19 Testing Prior to Endoscopy in a Tertiary Care Center in New York City,” was a first-of-its-kind review of adult and pediatric patients who underwent endoscopy and PCR testing at The Mount Sinai Hospital from May 1 to June 30, 2020. During the study period, 623 tests were administered—589 among asymptomatic adult patients (52 percent were male, median 62 years) and 34 among children under the age of 18. In most cases, testing was conducted at The Mount Sinai Hospital.
Patients who were confirmed COVID-19-positive had their procedures postponed for at least 14 days unless classified as emergent, and universal COVID-19 infection prevention protocols were followed for all patients regardless of testing outcomes. PCR testing data for all city and state residents tested during the same time span were obtained from the New York Department of Health.
Overall, there were six positive results, all adults, among the 623 Mount Sinai patients tested. Of the six positive cases, five had their endoscopic procedures postponed and one underwent upper endoscopy for suspected esophageal varices. For the month of May, the percentage of positive tests at Mount Sinai was 1.27 percent (2/158), which was significantly lower than the rates reported by New York State (5.34 percent; 63,397/1,186,330) and New York City (6.27 percent; 34,074/543,214). The June results similarly showed Mount Sinai with significantly lower positive percentages—0.86 percent (4/465) versus 1.20 percent for New York State (22,368/1,857,871) and 1.43 percent for New York City (11,711/816,215). Overall, Mount Sinai had a lower percentage of COVID-19-positive tests among asymptomatic endoscopy patients (0.96 percent) than New York State (2.82 percent) and New York City (3.37 percent). The study results were published online July 16, 2020, in Gastroenterology.
“This was the first study of outcomes for universal COVID-19 testing at an ambulatory endoscopy center in New York City, which had the highest prevalence of COVID-19 in the United States in March and April,” Dr. Kumta says. “The findings demonstrate that when resuming endoscopy operations, asymptomatic endoscopy patients have a lower likelihood of testing positive for COVID-19 than the general population in a geographic area. That said, providers should pay close attention to local COVID-19 infection rates when planning endoscopic procedures.”
Although the findings demonstrate that pre-procedure testing, combined with universal infection control protocols, makes endoscopy a safe procedure in any area of prevalence during the pandemic, Dr. Kumta says multicenter studies are required to further assess the efficacy of these measures in preventing the spread of COVID-19. In the meantime, the Mount Sinai team has shared its data with endoscopy centers across the country and the world to help determine the best approach to maintaining service during spikes in COVID-19 infection rates.
“We have also shared these findings with our patients to reassure them that we have created a safe environment for endoscopic procedures at Mount Sinai,” he says. “By addressing their anxiety about potential infection, we can prevent delays in the diagnosis and treatment of gastrointestinal conditions such as cancer and thus continue to deliver world-class care.”
Nikhil Kumta, MD, MS
Associate Professor of Medicine (Gastroenterology)