This guideline provides updated recommendations on the role of preprocedure testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in individuals undergoing endoscopy in the post-vaccination period and replaces the prior guideline from the American Gastroenterological Association (AGA) (released July 29, 2020). Since the start of the pandemic, our increased understanding of transmission has facilitated the implementation of practices to promote patient and health care worker (HCW) safety. Simultaneously, there has been increasing recognition of the potential harm associated with delays in patient care, as well as inefficiency of endoscopy units. With widespread vaccination of HCWs and the general population, a re-evaluation of AGA's prior recommendations was warranted. In order to update the role of preprocedure testing for SARS-CoV2, the AGA guideline panel reviewed the evidence on prevalence of asymptomatic SARS-CoV2 infections in individuals undergoing endoscopy; patient and HCW risk of infections that may be acquired immediately before, during, or after endoscopy; effectiveness of COVID-19 vaccine in reducing risk of infections and transmission; patient and HCW anxiety; patient delays in care and potential impact on cancer burden; and endoscopy volumes. The panel considered the certainty of the evidence, weighed the benefits and harms of routine preprocedure testing, and considered burden, equity, and cost using the Grading of Recommendations Assessment, Development and Evaluation framework. Based on very low certainty evidence, the panel made a conditional recommendation against routine preprocedure testing for SARS-CoV2 in patients scheduled to undergo endoscopy. The panel placed a high value on minimizing additional delays in patient care, acknowledging the reduced endoscopy volumes, downstream impact on delayed cancer diagnoses, and burden of testing on patients.
Bibliographical noteFunding Information:
Development of the guideline was funded by the AGA and no panel members received any payments. Panel members disclosed all financial, intellectual, or other potential conflicts of interest according to the AGA Institute policy. These are available from the AGA Clinical Guideline Committee staff liaison.
The authors acknowledge Dr Jason Dominitz, MD, MHS and Dr Andrew Gawron, MD, PhD for sharing data on preprocedure testing before endoscopy from the Veterans Affairs Healthcare System and Christoph Meyer-Grimberg for his perspective as a patient representative. This document represents the official recommendations of the American Gastroenterological Association (AGA) Institute and was developed by select members of the Clinical Guideline Committee and Clinical Practice Update Committee and approved by members of the AGA Governing Board.
© 2021 AGA Institute
- Diagnostic Test
- Gastrointestinal Endoscopy
PubMed: MeSH publication types
- Journal Article
- Practice Guideline