British Society of Paediatric Gastroenterology, Hepatology and Nutrition

BSPGHAN is working to support recovery and restoration plans.

We are revising the list of conditions for children who should be shielded in line with what we know about the risks associated with COVID-19. This work, with the RCPCH, should provide the basis for advice on who should continue to shield once schools return. It emphasises the need for identification to be led by paediatricians/MDTs for those instances beyond a small core list of severe conditions.   

Content of todays bulletin

NEW BSPGHAN consensus statements on endoscopy recovery and management of EoE (attached and will be added to Covid Information Hub)
Survey feedback (attached)
Thanks from BSPGHAN to charitable partners
Advocacy for traineesArticles of interest
NEW Check out the BSPGHAN Covid Information Hub https://bspghan.org.uk/news/covid-information-and-guidance-information

BSPGHAN consensus statement on Paediatric endoscopy recovery and restoration during the Covid-19 pandemic May 10th 2020

  1. BSPGHAN endorses the British Society of Gastroenterology (BSG) position paper with some paediatric-specific amendments.

https://www.bsg.org.uk/covid-19-advice/bsg-guidance-on-recommencing-gi-endoscopy-in-the-deceleration-early-recovery-phases-of-the-covid-19-pandemic/

  1. The risks of transmission of SARS-CoV-2 to staff (especially those handling and cleaning the scopes) as a consequence of undertaking endoscopy are still unknown. Paediatric endoscopy takes place in a high-risk area; an anaesthetic is given by general anaesthetic (GA) or by total intravenous anaesthetic (TIVA) with laryngeal mask (LMA) which are both aerosol-generating procedures. We advise that upper and lower GI endoscopy under GA or TIVA be undertaken with level 2 PPE (FFP3 masks or respirators) until risk of transmission from faeces becomes clear. The BSG guidance acknowledges that there are other circumstances to be considered when deciding on PPE and states “It is important that consideration is given to other elements of endoscopy as well as the procedure itself. These might include but not be restricted to: use of nitrous oxide, oxygen gas (Entonox), use of nasal oxygen, administration of throat spray or enemas”
  2. Careful consideration needs to be given to the risk of exposing children and their families to a high-risk environment vs. the benefit of performing diagnostic endoscopy. The risk for staff also needs to be evaluated particularly in light of the evidence of increased risk amongst BAME colleagues. Chief Executive of NHSE, Sir Simon Stevens suggests that: “regarding people from BAME backgrounds … we recommend employers should risk assess staff at potentially greater risk and make more appropriate arrangements accordingly. Organisations should continue to assess staff who may be at increased risk including older colleagues, pregnant women, and those with underlying health conditions and make adjustments including working remotely or in a lower risk area”.
  3. BSPGHAN supports units trying to re-establish diagnostic endoscopy for suspected new IBD presentations where possible and to continue emergency endoscopy provision.
  4. Centres should adhere to the same COVID-19 screening protocols developed by their co-located adult colleagues in gastroenterology and/or the pathways developed for paediatric surgical patients undergoing urgent and elective procedures.
  5. Where possible paediatric endoscopy pathway should be in COVID-19-free areas of the hospital
  6. Please refer to Gov.uk guidance on PPE (Appendix 1)

BSPGHAN Eosinophilic Esophagitis (EoE) Working Group
Position Statement: Management of paediatric EoE during the Coronavirus outbreak.  28th April 2020

Survey Feedback: Thank you very much for your responses; the majority within the first few hours. It’s  a helpful snapshot of views while planning recovery, restoration of paused services and supporting families as the lock down eases.

Heartfelt thanks to charitable partners
BSPGHAN sent sincere thanks from all our members to the teams at CCUK, CICRA, and CLDF for their work in championing the needs of families.  They are facing a serious funding crisis at a time when we are relying on them more than ever. They work tirelessly in partnership with us to provide invaluable support and tailored family information that we have struggled to offer. They also make a massive contribution to the working life of professionals, by taking on communication strategies and campaigns. We offered a small token of financial support to thank them and show how much we appreciate their work.

Advocacy for trainees:  https://www.rcpch.ac.uk/news-events/news/advocacy-trainees-over-covid-19-pandemic

Articles of interest :
1.Challenges in chronic paediatric disease during the COVID-19 pandemic: diagnosis and management of inflammatory bowel disease in children.  https://adc.bmj.com/content/early/2020/05/07/archdischild-2020-319482 
2.COVID-19 and the gastrointestinal tract: emerging clinical data

a) 10.1% of a cohort with coronavirus–infected pneumonia presented with diarrhoea and nausea, preceding fever and respiratory symptoms by 1–2 days
b) Endoscopy – SARS-CoV-2 was detected in the oesophagus, stomach, duodenum and rectum of the two most severe patients and also in the duodenum. The implication is uncertain but raise the issue of gastrointestinal involvement and potential faeco-oral transmission,
c) Uneventful course in patients with IBD during SARS-CoV 2020 in Northern Italy – awaiting data from Espghan Porto and SECURE-IBD database.
d)The clinical importance of continued presence of RNA in the stool is uncertain and further work is required to determine risk
e) Risk of surgery during incubation period in some does start to ask the question as to whether testing prior to surgery should become routine
https://fg.bmj.com/content/early/2020/04/27/flgastro-2020-101507

3.Gastrointestinal endoscopy during COVID-19: when less is more  https://fg.bmj.com/content/early/2020/04/15/flgastro-2020-101492

Please check out the BSPGHAN website for the new Covid Information.  https://bspghan.org.uk/news/covid-information-and-guidance-information

Thanks to Carla and our webmaster Kwang Yang Lee for their amazing work.
Best wishes to you all; please stay well and in continuing good health. 

Sue Protheroe 
BSPGHAN President May 10th 2020e-mail: President@bspghan.org.uk

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