Effect of COVID‐19 infection on the gastrointestinal tract considering preventive methods during endoscopic procedures

OBJECTIVES: This study aimed to prevent the infection risk of environmental contamination by feces during endoscopic procedures. We evaluated the effect of coronavirus disease 2019 (COVID‐19) on the gastrointestinal tract using fecal polymerase chain reaction (PCR) and examined risk factors affecting endoscopic procedures, to develop infection prevention strategies. METHODS: This single‐center prospective observational study enrolled 32 patients diagnosed with COVID‐19 at Tokyo Medical University Hospital between January and December 2022. We performed reverse transcriptase‐PCR to detect severe acute respiratory syndrome coronavirus 2 in human stool specimens and evaluated the COVID‐19 positivity rate in stool, the effect of vaccination on infection detection, and differences in positivity rates considering different patient backgrounds. RESULTS: Among the 32 nasal PCR‐positive patients who underwent fecal PCR testing, the fecal PCR positivity rate was 21.8%. Compared to the negative cases, 71.4% vs. 32% were older than 65 years (p < 0.016), 71.4% vs. 0.8% (p < 0.001) had malignant tumors, the rate during BA.5 variant outbreaks was significantly higher (100% vs. 60% [p = 0.044]), and the rate of diarrheal symptoms was also higher (42.9% vs. 24%). The median collection period for fecal PCR‐positive cases was 2 days after sampling. CONCLUSIONS: The severe acute respiratory syndrome coronavirus 2 affects not only the upper respiratory tract but also the gastrointestinal tract. These findings may indicate the risk of digestive fluid infection in older patients with gastrointestinal symptoms and immunocompromised patients with malignant tumor comorbidities, especially during the early stages of viral infection. Therefore, it is advisable to establish a system to prevent infection by using personal protective equipment, including eye guards, in future endoscopic procedures.