CRC prevention can't wait — 2 gastroenterologists on precautions needed to continue screening during the pandemic

With COVID-19 increasing across the U.S., ensuring patients receive access to colorectal screening remains of utmost importance to gastroenterologists across the country.

Here, American Society for Gastrointestinal Endoscopy Value of Colonoscopy co-chairs Joseph Vicari, MD, and Jonathan Cohen, MD, talked about COVID-19's effect on CRC screening and what a second round of elective surgical delays could mean.

Note: Responses were edited for style and content.

Question: With COVID-19 cases rapidly increasing, what can gastroenterologists do to continue screening patients for CRC?

Drs. Joseph Vicari and Jonathan Cohen: It is imperative for the GI community to continue to follow strict safety precautions comprised of pre-screening employees and patients entering facilities, on-site universal temperature checks and COVID-19 testing of patients prior to the date of procedure (typically within 72 hours). Staff should continue appropriate use of personal protective equipment and have access to adequate PPE supplies. Practices should use patient flow alterations to minimize patient exposure to individuals other than the staff providing care.

Using these regimens, GI endoscopy units across the country have been able to deliver safe and effective screening and remain open the past six months despite spikes of COVID-19 cases in communities across the U.S. In order to continue screening and prevent [CRC, GIs] need to communicate the efficacy of these stringent safety measures both to internal medicine referring doctors and to the general public to ease patient concerns.

Colon cancer prevention cannot wait until the pandemic ends. Through implementation of appropriate safety measures, colonoscopy can be performed to detect and remove precancerous polyps and prevent CRC. Our patients go to the supermarket, get haircuts and do other necessary activities with much less precautions against COVID-19 transmission than [GIs] are implementing to keep them safe from COVID-19 and prevent CRC.

Q: If there's another elective surgery delay and it affects screenings, what will the consequences be for GIs and their practices?

JV and JC: Along with countless small businesses, [GIs] and their practices have struggled to stay open and support the salaries of the many staff who heroically came to work as essential workers. Large medical centers that operate outpatient medical facilities rely upon revenue from elective procedures for their financial stability. Many systems are faced with hiring freezes and salary cuts to the very workers who have worked on the front line to combat the pandemic. Privately-owned GI practices have even less buffer to continue support of operating expenses and salaries of nurses, technicians and staff should a significant drop-off in screenings occur. Still, the main reason to promote ongoing screening, despite the recent surge of COVID-19, is to avoid a delay in cancer diagnosis.

Q: If screenings can continue to be performed safely, what should GIs do to ensure their practice is as safe as can be?

JV and JC: Pre-procedure testing is an important component of safe endoscopy practice. Timely, reliable COVID-19 tests for all patients along with ongoing strict adherence to the safety measures firmly in place should allow ongoing safe and effective [CRC] screening. Access to vaccines for healthcare workers is eagerly anticipated; however, the widespread use of PPE, reduced waiting room time, pre-screening and patient testing will need to continue until the pandemic is well under control.

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