COVID-19: Gastroenterology and GI Endoscopy service guide

April 2020

Scope

This information provides guidance on the management of Gastroenterology (please note there is a separate Hepatology guidance) and GI Endoscopy in Torbay during the Covid-19 pandemic. The information is based on national guidance from the Joint Advisory Group on GI Endoscopy JAG and the British Society of Gastroenterology BSG

National guidance

British Society of Gastroenterology - COVID 19 endoscopy guidance

Key message

  • There is little evidence that a pause of 3 months will pose a significant risk to the great majority of 2WW/Urgent suspected Cancer or Bowel Cancer Screening Program patients, although it is accepted that a small number of patients may have a delay in their diagnosis
  • On the other hand, a much larger number of patients and staff will be put at significant risk of COVID-19 if the 2WW/Urgent Suspected Cancer and Bowel Cancer Screening Programme is continued even at a scaled-down level

2WW referrals

2WW referrals will be vetted on a case by case basis before tests such as upper endoscopy, colonoscopy or CT colonography are organised, to prioritise those felt clinically to be at greatest need, to take account of limited availability of facilities, staff and appropriate PPE.

Urgent referrals - need to continue

We will continue providing clinical review and/or endoscopy for urgent cases wherever possible. Again, these will be prioritised on a case by case basis. Please consider contacting us for advice (see below) in the first instance to help direct these patients through the best pathway.

Examples of urgent cases include:

  • Acute/Severe symptoms with known/suspected IBD
  • Acute Upper GI bleeding
  • Acute oesophageal obstruction – foreign bodies, food bolus, pinhole stricture/cancer where stenting is considered essential
  • Acute cholangitis/jaundice secondary to malignant/benign biliary obstruction
  • Acute biliary pancreatitis and/or cholangitis with stone and jaundice
  • Urgent inpatient nutrition support – PEG/NJ tube

Routine referrals

All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.

Existing new and follow-up routine appointments have been cancelled and changed to telephone / video consultation where appropriate.

Please consider trials of symptomatic treatment in the interim.

Examples of routine work which is not currently taking place include;

  • All routine symptomatic referrals
  • Most non-urgent clinic follow-up
  • Other ERCP cases
  • FIT+ bowel screening colonoscopy
  • Bowel Scope flexible sigmoidoscopy
  • Other elective therapy/intervention
  • Low-risk follow-up and repeat scopes
  • Endoscopic Surveillance -polyp FU, IBD, Barrett's

​Urgent advice

The Gastroenterology of the Day phone (07917071466) will still be in operation but with a reduced service.

We recommend phoning between 09:00-12:00. At times a non-clinician may be covering the phone and will take a message. It would be helpful to have a direct contact number to allow us to get back to you.

Advice & Guidance

Our ability to respond to routine advice and guidance is likely to be significantly reduced.

For urgent issues please use the Gastroenterology of the Day phone (07917071466) it will still be in operation but with a reduced service.

We recommend phoning between 09:00-12:00. At times a non-clinician may be covering the phone and will take a message. It would be helpful to have a direct contact number to allow us to get back to you.

For non-urgent advice please consider deferring the request if possible.

Covid 19 High risk patient advice

All high-risk patients who are known to Gastroenterology in Torbay have been contacted by letter to advise them of the latest recommendations.

Endoscopy is an aerosol-generating procedure which means it is high risk for both staff and patients. Therefore, endoscopy is only being undertaken in emergency cases.

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Last updated: 05-05-2020

 

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