International consensus recommendations to guide endoscopy recovery in the postpandemic phase of COVID-19
| Statement number | Statements | Consensus after round 1 | Statement modification | Final consensus |
| Pre-endoscopy | ||||
| 1 | All patients coming for endoscopy should have a clinical history taken to diagnose active COVID-19 disease or contact with any infected person in the past 2 weeks | 97.1% | None | 97.1% |
| 2 | The absence of clinical symptoms does not exclude SARS-CoV-2 infection as asymptomatic infections are not uncommon | 94.1% | None | 94.1% |
| 3 | All patients undergoing endoscopy should be tested for SARS-CoV-2 infection 24–72 hours before endoscopy | 65.5% | All patients undergoing endoscopic procedures should be tested for SARS-CoV-2 infection 24–72 hours before endoscopy in high-prevalence regions | 82.4% |
| 4 | Patients who have tested negative for SARS-CoV-2 infection may still be infective | 80.6% | None | 80.6% |
| 5 | Data on the accuracy of point-of-care tests to detect active infection are limited but promising. They should be used in a research or audit setting until more data become available | 69% | Early data on the accuracy of point-of-care tests for detection of active infection are promising and these tests could be used to aid risk stratification of patients before endoscopy in high-prevalence regions | 91.1% |
| 6 | All patients having endoscopic procedures lasting longer than 1 hour should be tested for SARS-CoV-2 infection | 51.7% | In the absence of universal testing, all patients having therapeutic endoscopic procedures lasting longer than 1 hour should be tested for SARS-CoV-2 infection in high-prevalence regions | 85.3% |
| 7 | All healthcare professionals should be self-reporting any new symptoms to a responsible health professional who is able to advise on further appropriate action | 100% | None | 100% |
| 8 | All healthcare professionals working in endoscopy should be tested for SARS-CoV-2 infection on a cyclical basis | 58.6% | All healthcare professionals working in endoscopy should be tested once for SARS-CoV-2 infection, undergo daily symptom and temperature checks and, in high-prevalence regions, consider regular retesting | 88.2% |
| 9 | All patients attending for endoscopic procedures should wear simple surgical masks at all times apart from the time when an endoscope has to be inserted into the oral cavity | 97.1% | None | 97.1% |
| 10 | All healthcare professionals should be wearing surgical masks at all times in clinical areas within the endoscopy department | 94.1% | None | 94.1% |
| 11 | Elective endoscopy for patients with suspected or confirmed COVID-19 should be deferred until they are asymptomatic and have tested negative | 94.1% | None | 94.1% |
| 12 | Self-isolation of patients for 1 week before endoscopy is not necessary if they are undergoing testing for SARS-CoV-2 infection before endoscopy | 44.8% | Patients should observe adequate social distancing for 1 week before endoscopy in high-prevalence regions to minimise the risk of viral exposure to healthcare professionals in endoscopy departments | 80.6% |
| 13 | Healthcare professionals should receive appropriate training in infection control practices and handling of personal protective equipment (PPE) | 100% | None | 100% |
| During endoscopy | ||||
| 14 | Gastroscopy is an aerosol-generating procedure and healthcare professionals should wear enhanced personal protective equipment (N95/FFP3 respirators) in high-prevalence regions | 82.3% | None | 82.3% |
| 15 | The use of enhanced personal protective equipment (N95/FFP3) respirators is recommended for all endoscopic procedures in the upper and lower gastrointestinal tract | 69% | In high-prevalence regions, the use of enhanced PPE (N95/FFP3 respirators) for both upper and lower gastrointestinal endoscopic procedures is recommended due to uncertainty surrounding the risk of infection during colonoscopy | 88.2% |
| 16 | Standard PPE with a surgical mask is sufficient for low aerosol-generating procedures, such as colonoscopy | 37.9% | In low-prevalence regions, standard PPE (surgical mask) is sufficient for low aerosol-generating procedures such as colonoscopy | 82.4% |
| 17 | In the absence of active testing all patients undergoing endoscopic procedures should be presumed to be potentially infective and healthcare professionals should wear enhanced PPE (N95/FFP3 respirators) | 85.3% | None | 85.3% |
| 18 | The 'donning' area (where PPE is worn) should be located outside the endoscopy room and away from the 'doffing' area (where PPE is removed) | 94.0% | None | 94.0% |
| 19 | All patients in high-prevalence regions should change into hospital gowns before entering the endoscopy suites | 85.3% | None | 85.3% |
| 20 | All patients with suspected or confirmed COVID-19 infection should be endoscoped in negative pressure rooms. In the absence of a negative pressure room, endoscopy departments should have a designated room and /or specific slots for these patients | 100% | None | 100% |
| Postendoscopy | ||||
| 21 | The 'doffing' area for removal of PPE could be appropriately positioned in one corner of the room | 85.2% | None | 85.2% |
| 22 | The endoscopy procedure room should be deep cleaned after every procedure | 69% | The endoscopy procedure room should be deep cleaned after every procedure in a suspected or confirmed case of COVID-19 | 97.1% |
| 23 | Patients with suspected or confirmed COVID-19 infection should be allowed to recover in a designated area away from all the other non-COVID-19 patients | 97.1% | None | 97.1% |
| 24 | Staff in the recovery area (for non-COVID-19 patients) should wear standard PPE with surgical masks | 72.4% | In high-prevalence regions, healthcare professionals in the endoscopy recovery areas (for non COVID-19 patients) should wear standard PPE with surgical masks | 85.3% |
| 25 | Strict adherence to endoscope disinfection policies is mandatory | 100% | None | 100% |
| 26 | Adequate social distancing should be maintained throughout all areas of the endoscopy unit in high-prevalence regions | 100% | None | 100% |
| 27 | All patients should be followed up by phone in 14 days to identify any symptoms suggestive of COVID-19 | 62% | All patients should be followed up by phone in 10–14 days to identify any symptoms suggestive of COVID-19 in high-prevalence regions | 82.3% |
| Rejected statements | ||||
| 1 | All units should aim to move towards single-use (disposable) accessories | 75.9% | All units in high-prevalence regions should aim to move towards single-use (disposable) accessories such as biopsy forceps, snares, needles, biopsy valves, etc | 73.5% |
| 2 | Use of general anaesthesia with endotracheal intubation should be considered for all upper GI procedures taking longer than 30 minutes | 37.9% | Use of general anaesthesia with endotracheal intubation should be considered for all upper GI procedures in high-prevalence regions taking longer than 30 minutes | 50% |
| 3 | The endoscopy procedure room should be left empty for 20–30 minutes after the patient leaves the room to allow all droplets to settle down before deep cleaning is performed | 51.7% | The endoscopy procedure room in high-prevalence regions should be left empty for 20–30 minutes after the patient leaves the room to allow all droplets to settle down before deep cleaning is performed | 67.7% |