Supplementary Material for: A Questionnaire-Based Survey on the Impact of the COVID-19 Pandemic on Gastrointestinal Endoscopy in Asia

Introduction: The COVID-19 outbreak abruptly restricted gastrointestinal (GI) endoscopy services during the first wave of the pandemic. We aimed to assess the impact of COVID-19 on the practice of GI endoscopy in Asian countries. Methods: This was an International Questionnaire-based Internet Survey conducted at multiple facilities by the International Gastrointestinal Consensus Symposium. A total of 166 respondents in Japan, China, Hong Kong, South Korea, Philippines, Thailand, Indonesia, and Singapore participated in this study. Results: The volume of endoscopic screening or follow-up endoscopies and therapeutic endoscopies were markedly reduced during the first wave of the pandemic, which was mainly attributed to the decreased number of outpatients, cancellations by patients, and adherence to the guidelines of academic societies. The most common indications for GI endoscopy during the first wave were GI bleeding, cholangitis or obstructive jaundice, and a highly suspicious case of neoplasia. The most common GI symptoms of COVID-19 patients during the infected period included diarrhea, nausea, and vomiting. The pandemic exacerbated some GI diseases, such as functional dyspepsia and irritable bowel syndrome. There were cases with delayed diagnosis of cancers due to postponed endoscopic procedures, and the prescription of proton pump inhibitors/potassium-competitive acid blockers, steroids, immunosuppressive agents, and biologics was delayed or canceled. The personal protective equipment used during endoscopic procedures for high-risk patients were disposable gloves, disposable gowns, N95 or equivalent masks, and face shields. However, the devices on the patient side during endoscopic procedures included modified surgical masks, mouthpieces with filters, and disposable vinyl boxes or aerosol boxes covering the head. Furthermore, the time for education, basic research, clinical research, and daily clinical practice decreased during the first wave. Conclusion: This study demonstrated that the COVID-19 pandemic profoundly affected the method of performing GI endoscopy and medical treatment for patients with GI diseases in Asian countries.

引言：新冠疫情暴发期间，疫情第一波阶段胃肠道内镜检查（gastrointestinal endoscopy，GI）服务被骤然限制。本研究旨在评估新冠疫情对亚洲国家胃肠道内镜诊疗实践的影响。
方法：本研究为国际胃肠道共识研讨会（International Gastrointestinal Consensus Symposium）依托多中心开展的基于国际问卷的网络调查。共收纳来自日本、中国、中国香港、韩国、菲律宾、泰国、印度尼西亚及新加坡的166名受访者参与本研究。
结果：疫情第一波期间，内镜筛查、随访内镜及治疗性内镜的诊疗量均显著下降，这主要归因于门诊患者数量减少、患者取消就诊以及遵循学术学会的诊疗指南。疫情第一波期间，胃肠道内镜检查的最常见适应证为胃肠道出血、胆管炎或梗阻性黄疸，以及高度疑似肿瘤性病变的病例。新冠病毒感染期患者最常见的胃肠道症状包括腹泻、恶心及呕吐。疫情加重了部分胃肠道疾病，例如功能性消化不良（functional dyspepsia）与肠易激综合征（irritable bowel syndrome）。部分患者因内镜检查推迟而出现癌症诊断延迟，质子泵抑制剂（proton pump inhibitors, PPI）/钾竞争性酸阻滞剂（potassium-competitive acid blockers, P-CAB）、糖皮质激素、免疫抑制剂及生物制剂的处方也被推迟或取消。为高危患者行内镜检查时所用的个人防护装备包括一次性手套、一次性手术衣、N95及等效防护口罩与面屏。不过，内镜检查期间患者侧所用的防护装置包括改良式外科口罩、带过滤器的咬嘴，以及覆盖头部的一次性乙烯基箱或气溶胶收集箱。此外，疫情第一波期间，用于教学、基础研究、临床研究及日常临床工作的时间均有所减少。
结论：本研究表明，新冠疫情对亚洲国家胃肠道内镜检查操作方式及胃肠道疾病患者的诊疗工作均产生了深远影响。