Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2020; 26(43): 6880-6890
Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6880
Barriers for resuming endoscopy service in the context of COVID-19 pandemic: A multicenter survey from Egypt
Omar Elshaarawy, Sameh Aldesoky Lashen, Nahed A Makhlouf, Doaa Abdeltawab, Mariam Salah Zaghloul, Rasha M Ahmed, Hayam Fathy, Shimaa Afifi, Muhammad Abdel-Gawad, Eman Abdelsameea, Sherief Abd-Elsalam, Salem Youssef Mohamed, Mohammed Tag-Adeen, Mina Tharwat, Ahmed Alzamzamy, Ahmed Nasr Bekhit, Alshaimaa M Eid, Abeer Awad, Mohammad Aamr, Waleed A Abd El Dayem, Mohamed-Naguib Wifi, Mohamed Alboraie
Omar Elshaarawy, Eman Abdelsameea, Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Egypt
Omar Elshaarawy, Department of Internal Medicine and Center of Alcohol Research and Liver Diseases, Salem Medical Center, Heidelberg University, Heidelberg 69121, Germany
Sameh Aldesoky Lashen, Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria 21521, Egypt
Nahed A Makhlouf, Doaa Abdeltawab, Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Mariam Salah Zaghloul, Department of Hepatology, Gastroentrology and Infectious Diseases, Kafrelsheikh University, Faculty of Medicine, Kafrelsheikh 33565, Egypt
Rasha M Ahmed, Hayam Fathy, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Shimaa Afifi, National Hepatology and Tropical Medicine Research Institute, Cairo 11638, Egypt
Muhammad Abdel-Gawad, Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Assiut 71524, Egypt
Sherief Abd-Elsalam, Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
Salem Youssef Mohamed, Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
Mohammed Tag-Adeen, Department of Internal Medicine, Gastroenterology Unit, Qena Faculty of Medicine, South Valley University, Qena 83523, Egypt
Mina Tharwat, Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Aswan University, Aswan 81528, Egypt
Ahmed Alzamzamy, Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo 11771, Egypt
Ahmed Nasr Bekhit, Department of Tropical Medicine, Zagazig General Hospital, Zagazig 42511, Egypt
Alshaimaa M Eid, Department of Hepatology and Gastroenterology and Infectious Disease, Faculty of Medicine, AlAzhar University, Cairo 11562, Egypt
Abeer Awad, Mohamed-Naguib Wifi, Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11759, Egypt
Mohammad Aamr, Department of Hepatology and Gastroentorolgy, Shebin Elkom Teaching Hospital, Shebine Elkom 3521, Egypt
Waleed A Abd El Dayem, Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
Mohamed Alboraie, Department of Internal Medicine, Al-Azhar University, Cairo 11651, Egypt
Author contributions: Elshaarawy O is guarantor of the article; Elshaarawy O and Alboraie M contributed the study conception and design; Elshaarwy O, Lasheen SA and Alboraie M provided methodology; Lasheen SA contributed formal analysis and investigation; all authors wrote original draft preparation, reviewed and edited the manuscript; Elshaarawy O and Alboraie M contributed supervision; all authors approved the final version of the manuscript.
Institutional review board statement: The study was approved by the Institutional Review Board of the National Liver Institute, Menoufia University, Egypt (NLI IRB 00003413) in June 2020, protocol number 00203/2020.
Informed consent statement: It is survey no consent was needed from patients.
Conflict-of-interest statement: Nothing to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed Alboraie, MD, MRCP, MSc, Lecturer, Department of Internal Medicine, Al-Azhar University, ElMokhayam El Daem St., Nasr City, Cairo 11651, Egypt. alboraie@azhar.edu.eg
Received: October 14, 2020
Peer-review started: October 14, 2020
First decision: November 3, 2020
Revised: November 3, 2020
Accepted: November 9, 2020
Article in press: November 9, 2020
Published online: November 21, 2020
Processing time: 36 Days and 11.1 Hours
Abstract
BACKGROUND

The current coronavirus disease 2019 (COVID-19) pandemic has affected routine endoscopy service across the gastroenterology community. This led to the suspension of service provision for elective cases. 

AIM

To assess the potential barriers for resuming the endoscopy service in Egypt.

METHODS

A national online survey, four domains, was disseminated over a period of 4 wk in August 2020. The primary outcome of the survey was to determine the impact of the COVID-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s).

RESULTS

A hundred and thirteen Egyptian endoscopy centers participated in the survey. The waiting list was increased by ≥ 50% in 44.9% of areas with clusters of COVID-19 cases (n = 49) and in 35.5% of areas with sporadic cases (n = 62). Thirty nine (34.8%) centers suffered from staff shortage, which was considered a barrier against service resumption by 86.4% of centers in per-protocol analysis. In multivariate analysis, the burden of cases in the unit locality, staff shortage/recovery and the availability of separate designated rooms for COVID-19 cases could markedly affect the resumption of endoscopy practice (P = 0.029, < 0.001 and 0.02, respectively) and Odd’s ratio (0.15, 1.8 and 0.16, respectively).

CONCLUSION

The COVID-19 pandemic has led to restrictions in endoscopic volumes. The staff shortage/recovery and the availability of COVID-19 designed rooms are the most important barriers against recovery. Increasing working hours and dividing endoscopy staff into teams may help to overcome the current situation.

Keywords: COVID-19; Endoscopy; Practice; Pandemic; Egypt; Barriers

Core Tip: This survey study included 113 endoscopy centers from all over Egypt. Our findings highlighted the barriers for resuming endoscopy in different types of health care facilities in Egypt as well as reporting the current practice in Egyptian endoscopy units during the pandemic. Our study offers real life based snapshot of the current practice and recommendations for routine endoscopic practice during the second wave.