Infection risk related to gastrointestinal endoscopic procedures during the SARS-CoV-2 pandemic Results from a nation-wide, cross-sectional questionnaire

Introduction: COVID-19 significantly affects endoscopic labs' workflow. Endoscopic examinations are considered high-risk for virus transmission. Objectives: To determine impact of COVID-19 pandemic on Hungarian endoscopic labs' workflow and on infection risk of endoscopic staff.Method: A nation-wide, cross-sectional online questionnaire was sent to heads of endoscopic labs in Hungary. The average number (with 95% confidence intervals) of upper and lower gastrointestinal endoscopies performed in 2020 was compared to that in 2019. The number of SARS-CoV-2-infected endoscopic staff members and the source of infection was also investigated.Results: Completion rate was 30% (33/111). Neither the number of upper (1.593 [743-1.514] vs. 1.129 [1.020- 2.166], p = 0.053), nor that of lower gastrointestinal endoscopies (1.181 [823-1.538] vs. 871 [591-1.150], p = 0.072) decreased in 2020, but both upper and lower gastrointestinal endoscopies' number decreased by 80% during peak phases. Separate examination room was available in 12% of institutes. Appropriate quality personal protective equipment (PPE) was available during the first and second peak phase in 70% and 82%, respectively. Infection risk stratification by questionnaire and PCR testing was routinely performed in 85% and 42%, respectively. Employee number decreased by 33% and 26% for physicians, and by 19% and 21% for assistants during peak phases, mainly due to age restrictions and COVID care assignments. 32% of assistants and 41% of physicians were infected (associated with inappropriate PPE use in 16% and 18%, respectively). Conclusion: Peak phases' restrictions increase endoscopic workload afterwards. Despite PPE availability, 15% of em-ployees' COVID infection resulted from inappropriate PPE use in pre-vaccination era.