Chest computed tomography for severe acute respiratory syndrome coronavirus 2 infection screening for COVID-19 before emergency and elective upper endoscopy: Pilot study.

The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus has spread worldwide and may present as an asymptomatic or subclinical infection. Upper gastrointestinal endoscopy is associated with a high risk of the coronavirus disease 2019 (COVID‐19) owing to aerosol generation. Chest computed tomography (CT) can be undertaken in general clinical facilities and is as accurate in COVID‐19 diagnosis as real‐time reverse transcription‐polymerase chain reaction (RT‐PCR). In April 2020, 31 patients underwent urgent or elective esophagogastroduodenoscopy at our institution. Among those, 21 patients experienced chest CT. None had fever, respiratory symptoms, or olfactory abnormalities. Patient characteristics are shown in Table 1. CT revealed possible COVID‐19 findings in two patients (Fig. 1a,b), and the endoscopic procedure was postponed. The first patient underwent RT‐PCR twice, and the second patient also underwent LAMP test twice, all examinations showed negative results. Although SARS‐Cov‐2 infection could not be confirmed in these patients, the endoscopic procedures were postponed to 2 weeks later owing to the possibility of a false‐negative result. In the first patient showing occlusive jaundice caused by bile duct obstruction, endoscopic retrograde cholangiopancreatography (ERCP) tube stenting was performed after negative RT‐PCR results were confirmed twice. The second patient diagnosed with interstitial pneumonia was stared on steroid therapy. When undertaking endoscopy during the COVID‐19 pandemic, enhanced personal protective equipment (PPE), in addition to full PPE, is required for endoscopic interventions in patients with RT‐PCR‐confirmed SARS‐Cov‐2 infection. Recent studies have emphasized the importance of chest CT in COVID‐19 patients. During the pandemic, it is impossible to examine all patients by RT‐PCR testing before urgent endoscopy. Although there is a limitation that only 54% of asymptomatic patients have pneumonic changes on CT, chest CT screening before procedural endoscopy may contribute to identify COVID‐19 patients during the pandemic.

Table 1

Patient characteristics

	n = 21
Age (mean ± SD) (y)	72.9 ± 9.9
Sex (Male/Female)	16/5
Clinical diagnosis (%)
Gastric cancer	7 (33.3)
Hemorrhagic gastric ulcer	1 (4.8)
GIST in stomach	1 (4.8)
Common bile duct stone	6 (28.6)
Cholangiocarcinoma	3 (14.3)
Acute cholecystitis	1 (4.8)
Pancreatitis	1 (4.8)
Benign biliary stricture	1 (4.8)
Planed endoscopic procedure (%)
EGD	1 (4.8)
Gastric ESD	7 (33.3)
ERCP	11 (52.4)
EUS	2 (9.5)

EGD, esophagogastroduodenoscopy; ERCP, endoscopic retrograde cholangiopancreatography; ESD, endoscopic submucosal dissection; EUS, endoscopic ultrasonography; GIST, gastrointestinal stromal tumor.

Figure 1

Chest CT images of first case (A is axial section, and B is coronal section). Ground‐glass opacities (GGO) were demonstrated in the left lung fields (S4), and GGO was located in the subpleural area. Crazy paving appearance was not demonstrated.

Conflict of Interest

Takuji Gotoda is a Deputy Editor‐in‐Chief of Digestive Endoscopy. Other authors declare no Conflict of Interests for this article.