Pre-Endoscopy COVID-19 screening and SARS-CoV-2 nucleic acid amplification testing in the VA Healthcare System: Clinical practice patterns, outcomes, and relationship to procedure volume.

BACKGROUND & AIMS: The COVID-19 pandemic has had profound impacts worldwide, including upon the performance of gastrointestinal endoscopy. We aimed to 1) describe the performance and outcomes of pre-endoscopy COVID-19 symptom and exposure screening and SARS-CoV-2 nucleic acid amplification (NAAT) across the national Veterans Affairs healthcare system and 2) describe the relationship of SARS-CoV-2 NAAT use and resumption of endoscopy services.

METHODS: COVID-19 screening and NAAT results from March 2020-April 2021 were analyzed to determine use, performance characteristics of screening, and association between testing and endoscopic volume trends.

RESULTS: Of 220,891 completed endoscopies identified, 115,890 (52.5%) had documented pre-procedure COVID-19 symptom and exposure screenings, and 154,127 (69.8%) had pre-procedure NAAT results within 7 days prior to scheduled endoscopy. Of 131,894 total cancelled endoscopies, 26,475 (20.1%) had screening data and 28,505 (21.6%) had SARS-CoV-2 NAAT results. Overall, positive NAAT results were reported in 1.8% of all individuals tested and in 1.3% of those who screened negative. Among completed and cancelled endoscopies, COVID-19 screening had a 34.6% sensitivity (95% CI 32.4%-36.8%) and 96.4% specificity (95% CI 96.2-96.5%) when compared to NAAT. COVID-19 screening had a positive predictive value of 15.0% (95% CI 14.0%-16.1%) and a negative predictive value of 98.7% (95% CI 98.7%-98.8%). There was a very weak correlation between monthly testing and monthly endoscopy volume by site (Spearman rank correlation coefficient = 0.09).

CONCLUSION: These findings have important implications for decisions about pre-procedure testing, especially given breakthrough infections among vaccinated individuals during the SARS-CoV-2 delta and omicron variant surge.