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Recovery of endoscopy services in the era of COVID-19: recommendations from an international Delphi consensus
  1. Pradeep Bhandari1,2,
  2. Sharmila Subramaniam1,
  3. Michael J Bourke3,
  4. Asma Alkandari4,
  5. Philip Wai Yan Chiu5,
  6. James F Brown2,
  7. Rajesh N Keswani6,
  8. Raf Bisschops7,
  9. Cesare Hassan8,
  10. Gottumukkala S Raju9,
  11. V Raman Muthusamy10,
  12. Amrita Sethi11,
  13. Gary R May12,
  14. Eduardo Albéniz13,
  15. Marco Bruno14,
  16. Michal Filip Kaminski15,16,
  17. Maryam Alkhatry17,
  18. Majid Almadi18,
  19. Mostafa Ibrahim19,
  20. Fabian Emura20,21,
  21. Eduardo Moura22,
  22. Claudio Navarrete23,
  23. Adolfo Wulfson24,
  24. Christopher Khor25,
  25. Ryan Ponnudurai26,
  26. Haruhiro Inoue27,
  27. Yutaka Saito28,
  28. Naohisa Yahagi29,30,
  29. Sergey Kashin31,
  30. Evgeniy Nikonov32,
  31. Honggang Yu33,
  32. Amit P Maydeo34,
  33. D Nageshwar Reddy35,
  34. Michael B Wallace36,
  35. Mark Bennett Pochapin37,
  36. Thomas Rösch38,
  37. Prateek Sharma39,
  38. Alessandro Repici40
  1. 1 Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
  2. 2 School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, Hampshire, UK
  3. 3 Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
  4. 4 Department of Gastroenterology, Al Jahra Hospital, Kuwait City, Al Jahra, Kuwait
  5. 5 Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  6. 6 Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
  7. 7 Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Vlaams Brabant, Belgium
  8. 8 Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
  9. 9 Department of Gastroenterology, Hepatology and Nutrition, Universidad of Texas MD Anderson Cancer Center, Houston, Texas, USA
  10. 10 Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA
  11. 11 Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
  12. 12 Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
  13. 13 Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
  14. 14 Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
  15. 15 Department of Gastroenterology, Hepatology and Oncology, Centre for Postgraduate Medical Education, Warsaw, Poland
  16. 16 Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Instytute of Oncology, Warsaw, Poland
  17. 17 Department of Gastroenterology, Obaidulla Hospital, Ras Al Khaimah, United Arab Emirates
  18. 18 Department of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, Riyadh, Saudi Arabia
  19. 19 Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Giza, Egypt
  20. 20 Gastroenterology Division, Universidad de La Sabana, Chia, Colombia
  21. 21 Department of Advanced GI Endoscopy, EmuraCenter LatinoAmerica, Bogota, Colombia
  22. 22 Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
  23. 23 Department of Surgery, Clinica Santa Maria, Santiago, Chile
  24. 24 Department of Gastroenterology, Hospital de Emergencias Dr Clemente Alvarez, Rosario, Rosario, Argentina
  25. 25 Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
  26. 26 Department of Gastroenterology, Prince Court Medical Centre, Kuala Lumpur, Malaysia
  27. 27 Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan
  28. 28 Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
  29. 29 Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
  30. 30 Cancer Center, Keio University, Tokyo, Japan
  31. 31 Department of Endoscopy, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation
  32. 32 Department of Gastroenterology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
  33. 33 Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
  34. 34 Department of Surgery, Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
  35. 35 Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
  36. 36 Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA
  37. 37 Division of Gastroenterology, NYU Langone Medical Center, New York, New York, USA
  38. 38 Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  39. 39 Endoscopy Unit, Veteran Affairs Medical Center and University of Kansas, Kansas City, Kansas, USA
  40. 40 Gastroenterology and Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy
  1. Correspondence to Pradeep Bhandari, Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK; pradeep.bhandari{at}


The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.

  • endoscopy
  • infectious disease

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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  • PB and SS contributed equally.

  • Contributors PB* - Conception and design of study, constructed statements, critical revision of the manuscript. SS* - Literature review, reviewed statement construct, wrote manuscript. MJB, AA - Consensus participation, critical revision of the manuscript. JFB - Designed voting platform, analysed and compiled voting data. AR - Study design, constructed statements, critical revision of the manuscript. All other coauthors were voting members of the consensus group and contributed to the final revision of the manuscript. *Both PB and SS contributed equally to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PB - Research support from Fujifilm Europe, Boston Scientific, Pentax and Olympus Medical. VRM - consultant and research support for Boston Scientific, Medtronic; consultant: Medivators, Interpace Diagnostics; honoraria/speakers bureau: Torax Medical/Ethicon; equity interest/stockholder: Capsovision.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.