Personal Protective Equipment for Endoscopy in Low-Resource Settings During the COVID-19 Pandemic: Guidance From the World Gastroenterology Organisation.
Identifieur interne : 000956 ( Main/Exploration ); précédent : 000955; suivant : 000957Personal Protective Equipment for Endoscopy in Low-Resource Settings During the COVID-19 Pandemic: Guidance From the World Gastroenterology Organisation.
Auteurs : Desmond Leddin ; David Armstrong [Canada] ; Raja A. Raja Ali [Malaisie] ; Alan Barkun [Canada] ; Amna S. Butt [Pakistan] ; Ye Chen [République populaire de Chine] ; Harshit S. Khara [États-Unis] ; Yeong Yeh Lee [Malaisie] ; Wai Keung Leung [Hong Kong] ; Finlay Macrae [Australie] ; Govind Makharia [Inde] ; Reza Malekzadeh [Iran] ; Elias Makhoul [Liban] ; Anahita Sadeghi [Iran] ; Jean-Christophe Saurin [France] ; Mark Topazian [États-Unis] ; Sandie R. Thomson [Afrique du Sud] ; Andrew Veitch [Royaume-Uni] ; Kaichun Wu [République populaire de Chine]Source :
- Journal of clinical gastroenterology [ 1539-2031 ] ; 2020.
Abstract
Performance of endoscopic procedures is associated with a risk of infection from COVID-19. This risk can be reduced by the use of personal protective equipment (PPE). However, shortage of PPE has emerged as an important issue in managing the pandemic in both traditionally high and low-resource areas. A group of clinicians and researchers from thirteen countries representing low, middle, and high-income areas has developed recommendations for optimal utilization of PPE before, during, and after gastrointestinal endoscopy with particular reference to low-resource situations. We determined that there is limited flexibility with regard to the utilization of PPE between ideal and low-resource settings. Some compromises are possible, especially with regard to PPE use, during endoscopic procedures. We have, therefore, also stressed the need to prevent transmission of COVID-19 by measures other than PPE and to conserve PPE by reduction of patient volume, limiting procedures to urgent or emergent, and reducing the number of staff and trainees involved in procedures. This guidance aims to optimize utilization of PPE and protection of health care providers.
DOI: 10.1097/MCG.0000000000001411
PubMed: 32909973
Affiliations:
- Afrique du Sud, Australie, Canada, France, Hong Kong, Inde, Iran, Liban, Malaisie, Pakistan, Royaume-Uni, République populaire de Chine, États-Unis
- Auvergne-Rhône-Alpes, Guangdong, Minnesota, Ontario, Pennsylvanie, Québec, Rhône-Alpes
- Hamilton (Ontario), Jiangmen, Lyon, Montréal
- Université McGill, Université McMaster
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Raja Ali</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.</nlm:affiliation><country xml:lang="fr">Malaisie</country><wicri:regionArea>Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Barkun, Alan" sort="Barkun, Alan" uniqKey="Barkun A" first="Alan" last="Barkun">Alan Barkun</name><affiliation wicri:level="4"><nlm:affiliation>Department of Medicine, McGill University, Montreal, QC, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Medicine, McGill University, Montreal, QC</wicri:regionArea><orgName type="university">Université McGill</orgName><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="Butt, Amna S" sort="Butt, Amna S" uniqKey="Butt A" first="Amna S" last="Butt">Amna S. 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Khara</name><affiliation wicri:level="2"><nlm:affiliation>Department of Medicine, Geisinger Medical Center, Danville, PA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Medicine, Geisinger Medical Center, Danville</wicri:cityArea></affiliation></author><author><name sortKey="Lee, Yeong Yeh" sort="Lee, Yeong Yeh" uniqKey="Lee Y" first="Yeong Yeh" last="Lee">Yeong Yeh Lee</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, School of Medical Sciences Universiti Sains Malaysia, Kota Bharu, Malaysia.</nlm:affiliation><country xml:lang="fr">Malaisie</country><wicri:regionArea>Department of Medicine, School of Medical Sciences Universiti Sains Malaysia, Kota Bharu</wicri:regionArea><wicri:noRegion>Kota Bharu</wicri:noRegion></affiliation></author><author><name sortKey="Leung, Wai Keung" sort="Leung, Wai Keung" uniqKey="Leung W" first="Wai Keung" last="Leung">Wai Keung Leung</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, University of Hong Kong, Hong Kong.</nlm:affiliation><country xml:lang="fr">Hong Kong</country><wicri:regionArea>Department of Medicine, University of Hong Kong</wicri:regionArea><wicri:noRegion>University of Hong Kong</wicri:noRegion></affiliation></author><author><name sortKey="Macrae, Finlay" sort="Macrae, Finlay" uniqKey="Macrae F" first="Finlay" last="Macrae">Finlay Macrae</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, The Royal Melbourne Hospital, Parkville, Vic., Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Medicine, The Royal Melbourne Hospital, Parkville, Vic.</wicri:regionArea><wicri:noRegion>Vic.</wicri:noRegion></affiliation></author><author><name sortKey="Makharia, Govind" sort="Makharia, Govind" uniqKey="Makharia G" first="Govind" last="Makharia">Govind Makharia</name><affiliation wicri:level="1"><nlm:affiliation>Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences, New Delhi, India.</nlm:affiliation><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences, New Delhi</wicri:regionArea><wicri:noRegion>New Delhi</wicri:noRegion></affiliation></author><author><name sortKey="Malekzadeh, Reza" sort="Malekzadeh, Reza" uniqKey="Malekzadeh R" first="Reza" last="Malekzadeh">Reza Malekzadeh</name><affiliation wicri:level="1"><nlm:affiliation>Digestive Disease Research Institute, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.</nlm:affiliation><country xml:lang="fr">Iran</country><wicri:regionArea>Digestive Disease Research Institute, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran</wicri:regionArea><wicri:noRegion>Tehran</wicri:noRegion></affiliation></author><author><name sortKey="Makhoul, Elias" sort="Makhoul, Elias" uniqKey="Makhoul E" first="Elias" last="Makhoul">Elias Makhoul</name><affiliation wicri:level="1"><nlm:affiliation>Department of Gastroenterology and Hepatology, University Hospital Notre Dame des Secours, Holy Spirit University of Kaslik, Kaslik, Lebanon.</nlm:affiliation><country xml:lang="fr">Liban</country><wicri:regionArea>Department of Gastroenterology and Hepatology, University Hospital Notre Dame des Secours, Holy Spirit University of Kaslik, Kaslik</wicri:regionArea><wicri:noRegion>Kaslik</wicri:noRegion></affiliation></author><author><name sortKey="Sadeghi, Anahita" sort="Sadeghi, Anahita" uniqKey="Sadeghi A" first="Anahita" last="Sadeghi">Anahita Sadeghi</name><affiliation wicri:level="1"><nlm:affiliation>Digestive Disease Research Institute, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.</nlm:affiliation><country xml:lang="fr">Iran</country><wicri:regionArea>Digestive Disease Research Institute, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran</wicri:regionArea><wicri:noRegion>Tehran</wicri:noRegion></affiliation></author><author><name sortKey="Saurin, Jean Christophe" sort="Saurin, Jean Christophe" uniqKey="Saurin J" first="Jean-Christophe" last="Saurin">Jean-Christophe Saurin</name><affiliation wicri:level="3"><nlm:affiliation>Department of Medicine, Hôpital Edouard Herriot, Lyon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Medicine, Hôpital Edouard Herriot, Lyon</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="Topazian, Mark" sort="Topazian, Mark" uniqKey="Topazian M" first="Mark" last="Topazian">Mark Topazian</name><affiliation wicri:level="2"><nlm:affiliation>Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Minnesota</region></placeName><wicri:cityArea>Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester</wicri:cityArea></affiliation></author><author><name sortKey="Thomson, Sandie R" sort="Thomson, Sandie R" uniqKey="Thomson S" first="Sandie R" last="Thomson">Sandie R. Thomson</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Medicine, Groote Schuur Hospital, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Veitch, Andrew" sort="Veitch, Andrew" uniqKey="Veitch A" first="Andrew" last="Veitch">Andrew Veitch</name><affiliation wicri:level="1"><nlm:affiliation>Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust and Nuffield Hospital, Wolverhampton, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust and Nuffield Hospital, Wolverhampton</wicri:regionArea><wicri:noRegion>Wolverhampton</wicri:noRegion></affiliation></author><author><name sortKey="Wu, Kaichun" sort="Wu, Kaichun" uniqKey="Wu K" first="Kaichun" last="Wu">Kaichun Wu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Medicine, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an</wicri:regionArea><wicri:noRegion>Xi'an</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32909973</idno><idno type="pmid">32909973</idno><idno type="doi">10.1097/MCG.0000000000001411</idno><idno type="wicri:Area/Main/Corpus">000172</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000172</idno><idno type="wicri:Area/Main/Curation">000172</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000172</idno><idno type="wicri:Area/Main/Exploration">000172</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Personal Protective Equipment for Endoscopy in Low-Resource Settings During the COVID-19 Pandemic: Guidance From the World Gastroenterology Organisation.</title><author><name sortKey="Leddin, Desmond" sort="Leddin, Desmond" uniqKey="Leddin D" first="Desmond" last="Leddin">Desmond Leddin</name><affiliation><nlm:affiliation>Department of Medicine, Dalhousie University, Halifax, NS.</nlm:affiliation><wicri:noCountry code="subField">NS</wicri:noCountry></affiliation></author><author><name sortKey="Armstrong, David" sort="Armstrong, David" uniqKey="Armstrong D" first="David" last="Armstrong">David Armstrong</name><affiliation wicri:level="4"><nlm:affiliation>Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON.</nlm:affiliation><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Raja Ali, Raja A" sort="Raja Ali, Raja A" uniqKey="Raja Ali R" first="Raja A" last="Raja Ali">Raja A. Raja Ali</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.</nlm:affiliation><country xml:lang="fr">Malaisie</country><wicri:regionArea>Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Barkun, Alan" sort="Barkun, Alan" uniqKey="Barkun A" first="Alan" last="Barkun">Alan Barkun</name><affiliation wicri:level="4"><nlm:affiliation>Department of Medicine, McGill University, Montreal, QC, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Medicine, McGill University, Montreal, QC</wicri:regionArea><orgName type="university">Université McGill</orgName><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="Butt, Amna S" sort="Butt, Amna S" uniqKey="Butt A" first="Amna S" last="Butt">Amna S. Butt</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.</nlm:affiliation><country xml:lang="fr">Pakistan</country><wicri:regionArea>Department of Medicine, Aga Khan University Hospital, Karachi</wicri:regionArea><wicri:noRegion>Karachi</wicri:noRegion></affiliation></author><author><name sortKey="Chen, Ye" sort="Chen, Ye" uniqKey="Chen Y" first="Ye" last="Chen">Ye Chen</name><affiliation wicri:level="3"><nlm:affiliation>Department of Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Medicine, Nanfang Hospital, Southern Medical University, Guangzhou</wicri:regionArea><placeName><settlement type="city">Jiangmen</settlement><region type="province">Guangdong</region></placeName></affiliation></author><author><name sortKey="Khara, Harshit S" sort="Khara, Harshit S" uniqKey="Khara H" first="Harshit S" last="Khara">Harshit S. Khara</name><affiliation wicri:level="2"><nlm:affiliation>Department of Medicine, Geisinger Medical Center, Danville, PA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Medicine, Geisinger Medical Center, Danville</wicri:cityArea></affiliation></author><author><name sortKey="Lee, Yeong Yeh" sort="Lee, Yeong Yeh" uniqKey="Lee Y" first="Yeong Yeh" last="Lee">Yeong Yeh Lee</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, School of Medical Sciences Universiti Sains Malaysia, Kota Bharu, Malaysia.</nlm:affiliation><country xml:lang="fr">Malaisie</country><wicri:regionArea>Department of Medicine, School of Medical Sciences Universiti Sains Malaysia, Kota Bharu</wicri:regionArea><wicri:noRegion>Kota Bharu</wicri:noRegion></affiliation></author><author><name sortKey="Leung, Wai Keung" sort="Leung, Wai Keung" uniqKey="Leung W" first="Wai Keung" last="Leung">Wai Keung Leung</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, University of Hong Kong, Hong Kong.</nlm:affiliation><country xml:lang="fr">Hong Kong</country><wicri:regionArea>Department of Medicine, University of Hong Kong</wicri:regionArea><wicri:noRegion>University of Hong Kong</wicri:noRegion></affiliation></author><author><name sortKey="Macrae, Finlay" sort="Macrae, Finlay" uniqKey="Macrae F" first="Finlay" last="Macrae">Finlay Macrae</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, The Royal Melbourne Hospital, Parkville, Vic., Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Medicine, The Royal Melbourne Hospital, Parkville, Vic.</wicri:regionArea><wicri:noRegion>Vic.</wicri:noRegion></affiliation></author><author><name sortKey="Makharia, Govind" sort="Makharia, Govind" uniqKey="Makharia G" first="Govind" last="Makharia">Govind Makharia</name><affiliation wicri:level="1"><nlm:affiliation>Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences, New Delhi, India.</nlm:affiliation><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences, New Delhi</wicri:regionArea><wicri:noRegion>New Delhi</wicri:noRegion></affiliation></author><author><name sortKey="Malekzadeh, Reza" sort="Malekzadeh, Reza" uniqKey="Malekzadeh R" first="Reza" last="Malekzadeh">Reza Malekzadeh</name><affiliation wicri:level="1"><nlm:affiliation>Digestive Disease Research Institute, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.</nlm:affiliation><country xml:lang="fr">Iran</country><wicri:regionArea>Digestive Disease Research Institute, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran</wicri:regionArea><wicri:noRegion>Tehran</wicri:noRegion></affiliation></author><author><name sortKey="Makhoul, Elias" sort="Makhoul, Elias" uniqKey="Makhoul E" first="Elias" last="Makhoul">Elias Makhoul</name><affiliation wicri:level="1"><nlm:affiliation>Department of Gastroenterology and Hepatology, University Hospital Notre Dame des Secours, Holy Spirit University of Kaslik, Kaslik, Lebanon.</nlm:affiliation><country xml:lang="fr">Liban</country><wicri:regionArea>Department of Gastroenterology and Hepatology, University Hospital Notre Dame des Secours, Holy Spirit University of Kaslik, Kaslik</wicri:regionArea><wicri:noRegion>Kaslik</wicri:noRegion></affiliation></author><author><name sortKey="Sadeghi, Anahita" sort="Sadeghi, Anahita" uniqKey="Sadeghi A" first="Anahita" last="Sadeghi">Anahita Sadeghi</name><affiliation wicri:level="1"><nlm:affiliation>Digestive Disease Research Institute, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.</nlm:affiliation><country xml:lang="fr">Iran</country><wicri:regionArea>Digestive Disease Research Institute, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran</wicri:regionArea><wicri:noRegion>Tehran</wicri:noRegion></affiliation></author><author><name sortKey="Saurin, Jean Christophe" sort="Saurin, Jean Christophe" uniqKey="Saurin J" first="Jean-Christophe" last="Saurin">Jean-Christophe Saurin</name><affiliation wicri:level="3"><nlm:affiliation>Department of Medicine, Hôpital Edouard Herriot, Lyon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Medicine, Hôpital Edouard Herriot, Lyon</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="Topazian, Mark" sort="Topazian, Mark" uniqKey="Topazian M" first="Mark" last="Topazian">Mark Topazian</name><affiliation wicri:level="2"><nlm:affiliation>Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Minnesota</region></placeName><wicri:cityArea>Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester</wicri:cityArea></affiliation></author><author><name sortKey="Thomson, Sandie R" sort="Thomson, Sandie R" uniqKey="Thomson S" first="Sandie R" last="Thomson">Sandie R. Thomson</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Medicine, Groote Schuur Hospital, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Veitch, Andrew" sort="Veitch, Andrew" uniqKey="Veitch A" first="Andrew" last="Veitch">Andrew Veitch</name><affiliation wicri:level="1"><nlm:affiliation>Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust and Nuffield Hospital, Wolverhampton, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust and Nuffield Hospital, Wolverhampton</wicri:regionArea><wicri:noRegion>Wolverhampton</wicri:noRegion></affiliation></author><author><name sortKey="Wu, Kaichun" sort="Wu, Kaichun" uniqKey="Wu K" first="Kaichun" last="Wu">Kaichun Wu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Medicine, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an</wicri:regionArea><wicri:noRegion>Xi'an</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of clinical gastroenterology</title><idno type="eISSN">1539-2031</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Performance of endoscopic procedures is associated with a risk of infection from COVID-19. This risk can be reduced by the use of personal protective equipment (PPE). However, shortage of PPE has emerged as an important issue in managing the pandemic in both traditionally high and low-resource areas. A group of clinicians and researchers from thirteen countries representing low, middle, and high-income areas has developed recommendations for optimal utilization of PPE before, during, and after gastrointestinal endoscopy with particular reference to low-resource situations. We determined that there is limited flexibility with regard to the utilization of PPE between ideal and low-resource settings. Some compromises are possible, especially with regard to PPE use, during endoscopic procedures. We have, therefore, also stressed the need to prevent transmission of COVID-19 by measures other than PPE and to conserve PPE by reduction of patient volume, limiting procedures to urgent or emergent, and reducing the number of staff and trainees involved in procedures. This guidance aims to optimize utilization of PPE and protection of health care providers.</div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32909973</PMID><DateRevised><Year>2020</Year><Month>09</Month><Day>10</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1539-2031</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Sep</Month><Day>08</Day></PubDate></JournalIssue><Title>Journal of clinical gastroenterology</Title><ISOAbbreviation>J. Clin. Gastroenterol.</ISOAbbreviation></Journal><ArticleTitle>Personal Protective Equipment for Endoscopy in Low-Resource Settings During the COVID-19 Pandemic: Guidance From the World Gastroenterology Organisation.</ArticleTitle><ELocationID EIdType="doi" ValidYN="Y">10.1097/MCG.0000000000001411</ELocationID><Abstract><AbstractText>Performance of endoscopic procedures is associated with a risk of infection from COVID-19. This risk can be reduced by the use of personal protective equipment (PPE). However, shortage of PPE has emerged as an important issue in managing the pandemic in both traditionally high and low-resource areas. A group of clinicians and researchers from thirteen countries representing low, middle, and high-income areas has developed recommendations for optimal utilization of PPE before, during, and after gastrointestinal endoscopy with particular reference to low-resource situations. We determined that there is limited flexibility with regard to the utilization of PPE between ideal and low-resource settings. Some compromises are possible, especially with regard to PPE use, during endoscopic procedures. We have, therefore, also stressed the need to prevent transmission of COVID-19 by measures other than PPE and to conserve PPE by reduction of patient volume, limiting procedures to urgent or emergent, and reducing the number of staff and trainees involved in procedures. This guidance aims to optimize utilization of PPE and protection of health care providers.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Leddin</LastName><ForeName>Desmond</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Department of Medicine, Dalhousie University, Halifax, NS.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Armstrong</LastName><ForeName>David</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Raja Ali</LastName><ForeName>Raja A</ForeName><Initials>RA</Initials><AffiliationInfo><Affiliation>Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Barkun</LastName><ForeName>Alan</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Medicine, McGill University, Montreal, QC, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Butt</LastName><ForeName>Amna S</ForeName><Initials>AS</Initials><AffiliationInfo><Affiliation>Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Ye</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Khara</LastName><ForeName>Harshit S</ForeName><Initials>HS</Initials><AffiliationInfo><Affiliation>Department of Medicine, Geisinger Medical Center, Danville, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lee</LastName><ForeName>Yeong Yeh</ForeName><Initials>YY</Initials><AffiliationInfo><Affiliation>Department of Medicine, School of Medical Sciences Universiti Sains Malaysia, Kota Bharu, Malaysia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Leung</LastName><ForeName>Wai Keung</ForeName><Initials>WK</Initials><AffiliationInfo><Affiliation>Department of Medicine, University of Hong Kong, Hong Kong.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Macrae</LastName><ForeName>Finlay</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Department of Medicine, The Royal Melbourne Hospital, Parkville, Vic., Australia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Makharia</LastName><ForeName>Govind</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences, New Delhi, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Malekzadeh</LastName><ForeName>Reza</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Digestive Disease Research Institute, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Makhoul</LastName><ForeName>Elias</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Department of Gastroenterology and Hepatology, University Hospital Notre Dame des Secours, Holy Spirit University of Kaslik, Kaslik, Lebanon.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sadeghi</LastName><ForeName>Anahita</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Digestive Disease Research Institute, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Saurin</LastName><ForeName>Jean-Christophe</ForeName><Initials>JC</Initials><AffiliationInfo><Affiliation>Department of Medicine, Hôpital Edouard Herriot, Lyon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Topazian</LastName><ForeName>Mark</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Thomson</LastName><ForeName>Sandie R</ForeName><Initials>SR</Initials><AffiliationInfo><Affiliation>Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Veitch</LastName><ForeName>Andrew</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust and Nuffield Hospital, Wolverhampton, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>Kaichun</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Department of Medicine, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>09</Month><Day>08</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Clin Gastroenterol</MedlineTA><NlmUniqueID>7910017</NlmUniqueID><ISSNLinking>0192-0790</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>9</Month><Day>10</Day><Hour>12</Hour><Minute>24</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>9</Month><Day>11</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>9</Month><Day>11</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32909973</ArticleId><ArticleId IdType="doi">10.1097/MCG.0000000000001411</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Afrique du Sud</li><li>Australie</li><li>Canada</li><li>France</li><li>Hong Kong</li><li>Inde</li><li>Iran</li><li>Liban</li><li>Malaisie</li><li>Pakistan</li><li>Royaume-Uni</li><li>République populaire de Chine</li><li>États-Unis</li></country><region><li>Auvergne-Rhône-Alpes</li><li>Guangdong</li><li>Minnesota</li><li>Ontario</li><li>Pennsylvanie</li><li>Québec</li><li>Rhône-Alpes</li></region><settlement><li>Hamilton (Ontario)</li><li>Jiangmen</li><li>Lyon</li><li>Montréal</li></settlement><orgName><li>Université McGill</li><li>Université McMaster</li></orgName></list><tree><noCountry><name sortKey="Leddin, Desmond" sort="Leddin, Desmond" uniqKey="Leddin D" first="Desmond" last="Leddin">Desmond Leddin</name></noCountry><country name="Canada"><region name="Ontario"><name sortKey="Armstrong, David" sort="Armstrong, David" uniqKey="Armstrong D" first="David" last="Armstrong">David Armstrong</name></region><name sortKey="Barkun, Alan" sort="Barkun, Alan" uniqKey="Barkun A" first="Alan" last="Barkun">Alan Barkun</name></country><country name="Malaisie"><noRegion><name sortKey="Raja Ali, Raja A" sort="Raja Ali, Raja A" uniqKey="Raja Ali R" first="Raja A" last="Raja Ali">Raja A. Raja Ali</name></noRegion><name sortKey="Lee, Yeong Yeh" sort="Lee, Yeong Yeh" uniqKey="Lee Y" first="Yeong Yeh" last="Lee">Yeong Yeh Lee</name></country><country name="Pakistan"><noRegion><name sortKey="Butt, Amna S" sort="Butt, Amna S" uniqKey="Butt A" first="Amna S" last="Butt">Amna S. Butt</name></noRegion></country><country name="République populaire de Chine"><region name="Guangdong"><name sortKey="Chen, Ye" sort="Chen, Ye" uniqKey="Chen Y" first="Ye" last="Chen">Ye Chen</name></region><name sortKey="Wu, Kaichun" sort="Wu, Kaichun" uniqKey="Wu K" first="Kaichun" last="Wu">Kaichun Wu</name></country><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Khara, Harshit S" sort="Khara, Harshit S" uniqKey="Khara H" first="Harshit S" last="Khara">Harshit S. Khara</name></region><name sortKey="Topazian, Mark" sort="Topazian, Mark" uniqKey="Topazian M" first="Mark" last="Topazian">Mark Topazian</name></country><country name="Hong Kong"><noRegion><name sortKey="Leung, Wai Keung" sort="Leung, Wai Keung" uniqKey="Leung W" first="Wai Keung" last="Leung">Wai Keung Leung</name></noRegion></country><country name="Australie"><noRegion><name sortKey="Macrae, Finlay" sort="Macrae, Finlay" uniqKey="Macrae F" first="Finlay" last="Macrae">Finlay Macrae</name></noRegion></country><country name="Inde"><noRegion><name sortKey="Makharia, Govind" sort="Makharia, Govind" uniqKey="Makharia G" first="Govind" last="Makharia">Govind Makharia</name></noRegion></country><country name="Iran"><noRegion><name sortKey="Malekzadeh, Reza" sort="Malekzadeh, Reza" uniqKey="Malekzadeh R" first="Reza" last="Malekzadeh">Reza Malekzadeh</name></noRegion><name sortKey="Sadeghi, Anahita" sort="Sadeghi, Anahita" uniqKey="Sadeghi A" first="Anahita" last="Sadeghi">Anahita Sadeghi</name></country><country name="Liban"><noRegion><name sortKey="Makhoul, Elias" sort="Makhoul, Elias" uniqKey="Makhoul E" first="Elias" last="Makhoul">Elias Makhoul</name></noRegion></country><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Saurin, Jean Christophe" sort="Saurin, Jean Christophe" uniqKey="Saurin J" first="Jean-Christophe" last="Saurin">Jean-Christophe Saurin</name></region></country><country name="Afrique du Sud"><noRegion><name sortKey="Thomson, Sandie R" sort="Thomson, Sandie R" uniqKey="Thomson S" first="Sandie R" last="Thomson">Sandie R. 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