IFSO Endoscopy Committee Position Statement on the Practice of Bariatric Endoscopy During the COVID-19 Pandemic
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LETTER TO THE EDITOR
IFSO Endoscopy Committee Position Statement on the Practice of Bariatric Endoscopy During the COVID-19 Pandemic Gianfranco Donatelli 1
&
Fabrizio Cereatti 1,2 & Jean-Loup Dumont 1
Received: 15 July 2020 / Revised: 13 August 2020 / Accepted: 14 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
We read with great interest the “IFSO Endoscopy Committee Position Statement on the Practice of Bariatric Endoscopy during the COVID-19 Pandemic,” and we would like to report our experience in a European endoscopy private tertiary center performing advanced therapeutic and bariatric interventional endoscopy. As a private center, we received a “call to arms,” asking us to contribute to the management of the pandemic. Following the recommendation of the French Society of Digestive Endoscopy (SFED) (http://www.sfed.org/professionels/ covid19-et-endoscopie), we interrupted all elective endoscopic activities from 11 March 2020 onwards. Moreover, we dedicated 80 beds to COVID-19 patients. Furthermore, we upgraded 10 beds for post-surgical critical care to fully equipped intensive care unit beds. Nonetheless, our Unit continued to perform semi-urgent and urgent interventional procedures such as follows: EUS and ERCP for biliary acute pancreatitis and cholangitis and management of the few surgical adverse events. We fully agree with the authors, when they affirm the importance of withholding elective procedures, but we would like to share our experience in two clinical cases, which we find to offer perspicuous insights, on the one hand, on how to rethink the new standard of care for patients “in the world after COVID-19” and, on the other, on how to adjust current recommendations in case of a new pandemic outbreak. A 59-year-old woman with a BMI of 40.2 kg/m underwent sleeve gastrectomy (SG) at the beginning of pandemic outbreak, when we still performed elective procedures. At post-
* Gianfranco Donatelli [email protected] 1
Unité d’Endoscopie Interventionnelle, Ramsay Santé, Hôpital Privé des Peupliers, 8 Place de l’Abbé G. Hénocque, 75013 Paris, France
2
Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Cremona, Italy
operative day 2, she presented an intra-abdominal collection that required urgent surgical drainage. During her stay in the intensive care unit, she tested positive for COVID-19 and developed a mild ground-glass pneumonia. In addition to morbid obesity, the patient suffered from type II diabetes and hypertension. At post-operative day 7, she underwent endoscopic drainage, coupled with enteral feeding in order to remove external surgical drain and avoid chronic fistula [1]. Ultimately, she recovered from COVID-19 despite multiple comorbidities, and at the 1-month endoscopic follow-up, she showed no medium extravasation from previous leak. Therefore, we recommended that she re-started normal diet. She did well and after 3 months (mid-June), we definitively removed the pigtail stent. At the last follow-up, she was asymptomatic and had a BMI of
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