Table 2

Summary of recommendations for periprocedural, intraprocedural and postprocedural recommendations including general advice

Articles grouped by country:China*†‡USA§¶UK**††Spain‡‡Singapore
Periprocedural and intraprocedural practices PPE recommendations:
For all patients:
Mask: N95 or PAPR
Clothing: Impermeable clothing wear, shoe covers, work caps, goggles and latex gloves for all procedures.

  • Staff to take caution in putting on and removing PPE to avoid self- contamination.


Infection control measures:

  • Strict hand hygiene for staff.

  • Patients to disinfect hands and must wear face masks.

PPE recommendations:
Low-risk patients:
Mask: Surgical masks.
Clothing: Work cap, goggles, glove, disposable gowns and gloves
*Lower endoscopy in patients with intermediate-risk is downgraded to low risk
High-risk patients:
Mask: FFP2 or FFP3
Clothing: Impermeable clothing, work cap, goggles and/or face shield, double glove, impermeable clothing
*Upper endoscopy=high risk.


Infection control measures:

  • Strict hand hygiene for staff.

  • Staff to pay attention to PPE removal techniques.

  • A negative pressure ventilation room recommended.

  • Essential personnel only.

PPE recommendations:
Low-risk patients:
Mask: Recommendation unclear
Clothing: Standard infection control procedures with PPE; disposable gloves and gowns.
*Lower endoscopy in COVID-19 patients considered low risk, surgical face mask recommended.
High-risk patients:
Masks: FFP3
Clothing: PPE with face shield or goggles if upper endoscopy.
Consider advanced PPE if out-of-hours or emergency cases.


Infection control measures:

  • Strict hand hygiene for staff.

  • Minimise non-essential staff.

PPE recommendations:
For all patients:
Mask: Unspecified mask
Clothing: Gowns, gloves and protective goggles.


Infection control measures:

  • Standard measures

PPE recommendations:
Low-risk patients:
Mask: N95
Clothing: Face shield and standard PPE
High-risk patients:
Mask: PAPR
Clothing: Advanced PPE including goggles, work caps, shoe covers, with required for all staff.


Infection control measures:

  • Strict hand hygiene for staff.

  • Minimise non-essential staff numbers.

  • Negative pressure ventilation room required.

Postprocedural practices Decontamination practices:

  • Decontamination staff to wear disposable impervious isolation clothing, latex gloves, shoe covers (boot covers), and strictly implement hand hygiene.

  • Decontaminate endoscopy room surfaces, PPE and equipment with 2000–5000 mg/L chlorine-containing disinfectant (30 min).

  • Ventilate the room, use plasma air disinfector or air disinfection spray if necessary.

  • Double-bag all medical waste and spray waste bags with 1000 mg/L of chlorine-containing disinfectant.


PPE for transfer:

  • None stated


Post-sedation management:

  • None stated

Decontamination practices:

  • Decontamination staff to wear surgical face masks at all times.

  • Decontaminate all surfaces after each suspected or confirmed COVID-19 case.

  • Bleach containing solutions in ratios of 1:100 was cited.


PPE for transfer:

  • - None stated


Post-sedation management:

  • None stated

  • Phone follow-up on Day seven and Day 14 post-procedure.

Decontamination practices:

  • Decontaminate surfaces with a disinfectant containing 1000 parts per million chlorine.

  • Only deep clean endoscopy room after the procedure if suspected or confirmed COVID-19 patient, or pandemic area.

  • Single rooms six air changes per hour, Negative pressure rooms 12 air changes per hour.


PPE for transfer:

  • Symptomatic patients wear a surgical face mask during transfer.


Postsedation management:

  • None stated

–Decontamination practices:

  • Endoscopy team will de-gown in order-

    1. Gloves and gowns in the isolation room

    2. PAPR and N95 masks to be left outside the patient room or anteroom.

    3. Dirty equipment and scopes to be wiped down with disinfectant.

    4. Dirty scopes placed in double-bagged biohazard bags and placed in a rigid container and labelled ‘Dirty’ for transportation back to endoscopy for washing,

  • Endoscopy room to be deep cleaned after each suspected or confirmed case.


PPE for transfer staff:

  • Transfer staff requires standard PPE during all patient transfers.


Postsedation management:

  • None stated

General advice

  • Staff to check personal body temperature daily and self-refer if T≥37.3°C.

  • 14-day medical isolation and observation if staff comes in contact with a COVID-19 patient without protection or if febrile.

  • Patients with conditions that require long term immuno-suppression should continue with immunosuppressive therapy.

  • Patients to continue immuno-suppression if established and contact the medical team if unwell or exposed to COVID-19 patient

  • Face-to-face evaluation for patients who are on biological treatment, immunosuppressed or if they have a chronic debilitating disease.

  • Formation of stable work teams: (medical physician, anaesthetist or sedation nurse/nurse/assistant).

  • All staff to check personal body temperature twice daily.

  • Endoscopic staff is segregated into isolated teams to reduce social mixing to reduce cross exposure in the event of an outbreak.

  • Articles grouped by the country of publication; recommendations may not necessarily reflect national guidance if any.

  • *Subspecialty group of Gastroenterology, the Society of Paediatrics, Chinese Medical Association. (Prevention and control program on 2019 novel coronavirus infection in children’s digestive endoscopy centre). Zhonghua Er Ke Za Zhi 2020;58, 175–178.

  • †Luo et al (Standardised diagnosis and treatment of colorectal cancer during the outbreak of novel coronavirus pneumonia in Renji hospital). Zhonghua Wei Chang Wai Ke Za Zhi 23, 2020; E003.

  • ‡Gou et al (Treatment of pancreatic diseases and prevention of infection during outbreak of 2019 coronavirus disease). Zhonghua Wai Ke Za Zhi 2020;58, E006.

  • §Pochapin et al American College of Gastroenterology COVID-19 and recommendations for gastroenterologists. 2020.

  • ¶Repici et al Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointestinal Endoscopy 2020.

  • **British Society of Gastroenterology and British Association for the Study of the Liver. COVID-19: Advice for healthcare professionals in Gastroenterology and Hepatology. 2020.

  • ††Public Health England. COVID-19: Guidance for infection prevention and control in healthcare settings (V.1.0). 2020.

  • ‡‡Sociedad Española de Patología Digestiva (SEPD) (Updated SEPD recommendations on infection by the SARS-CoV-2 coronavirus).

  • FFP2, filtering facepiece rating 2; FFP3, filtering facepiece rating 3; PAPR, powered air-purifying respirator; PPE, personal protective equipment.