Some IBD Patients Require Endoscopy Despite COVID-19 Pandemic

By Reuters Staff

April 29, 2020

NEW YORK (Reuters Health) - Several scenarios call for endoscopy in patients with inflammatory bowel disease (IBD) during the COVID-19 pandemic, researchers report.

In an effort to limit the spread of COVID-19, all nonessential endoscopic procedures have been canceled in many countries. Nevertheless, there may be times when an endoscopy should be considered as urgent and required in patients with IBD.

Dr. Marietta Iacucci of the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, in the UK, and colleagues considered four urgent scenarios that might necessitate endoscopy and suggested algorithms for addressing these situations.

The first scenario involves confirmation of a new diagnosis of IBD. First, gastrointestinal manifestations of COVID-19 should be considered and other gastrointestinal infections should be excluded. Especially in this stressful time, irritable bowel syndrome should also be ruled out. Only then should endoscopy be considered for patients who continue to have symptoms and for whom there remains a high suspicion of moderate-to-severe IBD, the authors say.

In scenario 2, a possible severe acute flare-up of ulcerative colitis, again the first step is to rule out the symptoms being associated with COVID-19. Then, endoscopy can be considered if the patient has not had a colonoscopy in the past three months. Patients who have had a recent colonoscopy that showed moderate-to-severe ulcerative colitis might, at the gastroenterologist's discretion, be spared an endoscopy and be treated presumptively for a severe acute flare-up.

When subacute obstruction is suspected in patients with IBD, scenario 3, patients with ulcerative colitis should be a high priority for colonoscopy, whereas cross-sectional imaging is a better first choice for patients with Crohn's disease.

Endoscopy is also justified in patients with anastomotic strictures, which can often be relieved by balloon dilatation, the authors write in The Lancet Gastroenterology and Hepatology.

Scenario 4, worsening cholangitis and jaundice in patients with IBD and primary sclerosing cholangitis, calls for emergency or urgent endoscopic retrograde cholangiopancreatography (ERCP) for those with evidence of stricture on magnetic resonance cholangiopancreatography (MRCP).

Any endoscopy should be done with attention to personal protective equipment (PPE) and after careful screening of patients about contact with COVID-19-infected or symptomatic people.

The authors also provide a suggested prioritization of access to endoscopy for the backlog of patients with IBD once the pandemic has passed.

Dr. Iacucci did not respond to a request for comments.

SOURCE: Lancet Gastroenterology and Hepatology, online April 16, 2020.