Advice on Performing Endoscopy During the COVID-19 Pandemic

Posted by

Douglas G. Adler, MD, FACG, AGAF, FASGE reviewing Soetikno R et al. 

Gastrointest Endosc 2020 Mar 27

Many new practices need to be implemented to protect endoscopists, staff, and patients during the pandemic. 

Key Recommendations

  • All gastrointestinal (GI) procedures should be triaged by trained personnel and rescheduled if not time-sensitive. This includes most screening and surveillance colonoscopies.
  • Healthcare workers performing upper or lower GI procedures:
    1. Should use the N95 mask, regardless of a patient’s COVID-19 status. Alternatives are the N99 mask and powered air-purifying respirators.
    2. Should notuse surgical masks as a substitute for N95 masks during GI procedures in patients with confirmed or presumed COVID-19.
    3. In resource-limited settings, reuse of the N95 mask is preferred to surgical mask use during GI procedures.
    4. Should double-glove (i.e., one pair under the gown sleeve and another above it) during procedures regardless of a patient’s COVID-19 status.
  • If available, negative-pressure rooms are preferred.
  • Standard endoscope reprocessing and disinfection are effective and do not need to be altered.
  • Providers should practice and be observed practicing donning and doffing of personal protective equipment (PPE). These maneuvers are detailed on the CDC website.

Detailed Summary:

Globally, hospitals and clinics are grappling with the new reality of practicing medicine during the COVID-19 pandemic. Endoscopy labs, which perform a wide range of aerosol-generating procedures, have been the focus of significant attention. In a new report, endoscopists from the U.S., Hong Kong, and other countries share practical suggestions for reducing COVID-19 transmission risk, based on the literature and their own experience.

Their key points and recommendations include the following:

  • All endoscopic procedures are aerosol generating.
  • All surfaces in the procedure room can potentially become contaminated and need appropriate disinfection.
  • Ensure performance of fit testing for N95 masks or other appropriate personal protective equipment (PPE).
  • Practice proper hand hygiene.
  • Set up a reception bay to screen and stratify patients by their risk for COVID-19 infection before allowing them to even enter the waiting area.
  • Test all suspected infected patients before the procedure.
  • Use a dedicated procedure and recovery room for COVID-19 patients and wear appropriate PPE.
  • Don and doff PPE in a designated area.
  • Have staff take their own temperature daily to rule out unsuspected fevers.
  • Limit the number of healthcare providers participating in any procedure to only those absolutely necessary.
  • For procedures under general anesthesia, only the anesthesiologist and key assistants should be present during intubation.

Reference Link :


  1. Most endoscopy labs are scrambling to obtain enough PPE, train their personnel on its proper use, and perform procedures on COVID-19–positive and COVID-19–negative patients. This report now joins other recent guidance on endoscopy during COVID-19, including recommendations from endoscopists in Italy (NEJM JW Gastroenterol Mar 17 2020; [e-pub] and Gastrointest Endosc 2020 Mar 14; [e-pub]) and a new guideline from the American Gastroenterological Association (NEJM JW Gastroenterol Apr 3 2020; [e-pub] and Gastroenterology

    • Patients are categorized according to COVID-19 risk:
      • Low-risk patients are those with no symptoms (cough, fever, dyspnea, diarrhea), no contact with an infected person, and no travel to a high-risk area in the preceding 14 days.
      • Intermediate-risk patients have symptoms but no contact or travel history, or no symptoms but contact with an infected person or travel to a high-risk area.
      • High-risk patients have symptoms in addition to either contact with an infected person or travel to a high-risk area. (Note: As the authors suggest, clinicians should continually seek the most up-to-date information on high-risk areas through the CDCor WHO).
    • Prior to a scheduled procedure, all patients are called and surveyed about respiratory symptoms and rescheduled if needed. Patients are reassessed when they present to the healthcare facility.
    • Patient interactions (such as informed consent, vital signs) have to be performed with physical distancing, and rigorous hand washing routines before and after interactions.
    • PPE is to be worn for all procedures, and the components vary according to patient risk stratification.
      • For all low-risk patients and for intermediate-risk patients undergoing lower GI procedures: surgical mask, hairnet, goggles, single-use gown, and gloves.
      • For high-risk patients and for intermediate-risk patients undergoing upper GI procedures: respirator mask (such as N95), hairnet, goggles and/or face shield, long-sleeved water-resistant gowns, and at least two pairs of gloves.
    • Negative-pressure rooms should be utilized when possible, especially for high-risk patients.
  2. AGA recommendations emphasize increased use of personal protective equipment.

    Sponsoring Organization: American Gastroenterological Association (AGA)

    Background: AGA has now issued recommendations to mitigate risk to endoscopy personnel, based on a systematic review of the literature.

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