Gastrointestinal endoscopy during the COVID-19 pandemic: an updated review of guidelines and statements from international and national societies.

To the Editor:

We read with great interest the publications by Repici et al and Soetikno et al in Gastrointestinal Endoscopy on recommendations for endoscopic examinations during the coronavirus 2019 disease (COVID-19) pandemic. Health care workers (HCWs) are at increased risk for COVID-19 because upper GI endoscopy is a high-risk aerosol-generating procedure, and oral–fecal transmission may be a potential route for COVID-19.

Recommendations have been changing rapidly and need to be updated, mainly because we are facing a scenario of sustained community transmission of COVID-19 worldwide. To conduct an overview of the recommendations for endoscopic procedures during the COVID-19 pandemic, we assessed the electronic sites of international and national societies of gastroenterology and GI endoscopy to review the current recommendations up to March 27, 2020. Overall, 93 international and national societies were identified, and 21 of them have elaborated specific recommendations for endoscopy during the COVID-19 pandemic. A total of 95% recommended temporarily postponing elective/nonurgent procedures; 86% recommended stratifying patients for risk of COVID-19 before the examination (questionnaire regarding symptoms and/or taking patient’s body temperature); 38% recommended reducing the number of people who accompany patients; 33% recommended requiring self-surveillance of signs and symptoms by HCWs; and 19% recommended contacting patients 14 days after the examination to check symptoms (Supplementary Fig. 1 and Supplementary Table 1, Supplementary Table 2, Supplementary Table 3, available online at www.giejournal.org).

Supplementary Figure 1

Flow chart of identified recommendations for endoscopy during COVID-19 pandemic.

Supplementary Table 1

Summary of recommendations for endoscopy during the COVID-19 pandemic from international/national societies of gastroenterology/gastrointestinal endoscopy, updated on March 26, 2020

Recommendation	Report	All	International and USA	Canada,Latin America	Europe	Asia-Pacific
		N = 21	N = 6	N = 7	N = 5	N = 3
Postpone nonurgent examinations	Yes	20 (95)	5 (83)	7 (100)	5 (100)	3 (100)
	Not reported	1 (5)	1 (17)	0 ( 0)	0 ( 0)	0 (0)
Prescreening of patients	Yes	18 (86)	5 (83)	7 (100)	3 (60)	3 (100)
	Not reported	3 (14)	1 (17)	0 (0)	2 (40)	0 (0)
Patients should use masks	Yes for all	4 (19)	1 (17)	2 (29)	1 (20)	0 (0)
	Yes if symptoms	3 (14)	1 (17)	1 (14)	0 (0)	1 (33)
	Not reported	14 (67)	4 (67)	4 (57)	4 (80)	2 (67)
Reduce people who accompany patients	Yes	8 (38)	1 (17)	5 (71)	1 (20)	1 (33)
	Not reported	13 (62)	5 (83)	2 (29)	4 (80)	2 (67)
Train PPE use by HCW	Yes	10 (48)	4 (67)	3 (43)	1 (20)	2 (67)
	Not reported	11 (52)	2 (33)	4 (57)	4 (80)	1 (33)
Measure body temperature of HCW before starting work	Yes	6 (29)	3 (50)	2 (29)	0 (0)	1 (33)
	Not reported	15 (71)	3 (50)	5 (71)	5 (100)	2 (67)
HCW should use standard medical masks when in contact with patients before examinations	Yes for all	5 (24)	2 (33)	1 (14)	0 (0)	2 (67)
	Not reported	16 (76)	4 (67)	6 (86)	5 (100)	1 (33)
Use of PPE during examination	Yes	21 (100)	6 (100)	7 (100)	5 (100)	3 (100)
Check patient’s temperature before, during, or after endoscopic procedure	Yes	4 (19)	2 (33)	1 (14)	0 (0)	1 (33)
	Not reported	17 (81)	4 (67)	6 (86)	5 (100)	2 (67)
Contact patient 14 days after GIE procedure for signs/symptoms surveillance	Yes	4 (19)	3 (50)	1 (14)	0 ( 0)	0 ( 0)
	Not reported	17 (81)	3 (50)	6 (86)	5 (100)	3 (100)
Self-surveillance by of HCW for symptoms	Yes	7 (33)	1 (17)	2 (29)	2 (40)	2 (67)
	Not reported	14 (67)	5 (83)	5 (71)	3 (60)	1 (33)
Follow standard reprocessing of endoscopes	No	12 (57)	4 (67)	4 (57)	2 (40)	2 (67)
	Yes	1 (5)	0 (0)	0 (0)	0 (0)	1 (33)
	Not reported	8 (38)	2 (33)	3 (43)	3 (60)	0 (0)

Data expressed as n (%).

GIE, GI endoscopy; HCW, healthcare worker; PPE, personal protective equipment.

Supplementary Table 2

Web links of recommendations for endoscopy during the COVID-19 pandemic from international/national societies of gastroenterology/gastrointestinal endoscopy, updated March 26, 2020

Name of society; region or country	Date	URL
International Societies
European Society of Gastrointestinal Endoscopy (ESGE); Europe	March 18, 2020	https://www.esge.com/assets/downloads/pdfs/general/ESGE_ESGENA_Position_Statement_gastrointestinal_endoscopy_COVID_19_pandemic.pdf
Sociedad Interamericana de Endoscopia Digestiva (SIED); Canada/Central and Latin America	March 18, 2020	http://siedonline.org/wp-content/uploads/2020/03/COVID19-info-ACTUALIZADA-ingles.pdf
World Endoscopy Organization (WEO); Global	March 24, 2020	http://www.worldendo.org/2020/03/24/weo-advice-on-digestive-endoscopy-and-the-covid-19-pandemic/
National Societies – United States
American College of Gastroenterology (ACG); USA	March 15, 2020	https://gi.org/2020/03/15/joint-gi-society-message-on-covid-19/
American Gastroenterological Association (AGA); USA	March 18, 2020	https://www.gastro.org/press-release/new-covid-19-info-for-gastroenterologists-and-patients
American Society for Gastrointestinal Endoscopy (ASGE); USA	March 27, 2020	https://www.asge.org/home/advanced-education-training/covid-19-asge-updates-for-members/
National Societies – Canada / Central and South America
Asociación Mexicana de Endoscopia Gastrointestinal; México	Not reported	http://www.amegendoscopia.org.mx/index.php/endoscopia-covid19
Canadian Association of Gastroenterology; Canadá	March 16, 2020	https://www.cag-acg.org/images/publications/CAG-Statement-COVID-&-Endoscopy.pdf
Federación Argentina de Asociaciones de Endoscopía Digestiva; Argentina	March 16, 2020	http://www.faaed.org.ar/
Sociedad Chilena de Gastroenterología; Chile	Not reported	http://sociedadgastro.cl/gastroweb/index.php/noticias/423-guia-de-recomendacion-ached-schge-para-el-funcionamiento-de-la-unidad-de-endoscopia-durante-el-brote-de-coronavirus-covid-19
Sociedad Dominicana de Gastroenterologia; República Dominicana	March 16, 2020	http://sodogastro.com/esp/proteccion-en-unidades-de-endoscopia-digestiva-frente-al-covid-19/
Sociedad Uruguaya de Endoscopía Digestiva; Uruguay	March 13, 2020	http://www.sued.com.uy/noticias/sued-coronavirus/es
Sociedade Brasileira de Endoscopia Digestiva; Brazil	March 21, 2020	https://www.sobed.org.br/sobed-comunica/noticias/single/nid/atualizacao-003-das-recomendacoes-sobed-para-endoscopia-segura-durante-a-pandemia-por-coronavirus/
National Societies – Europe
British Society of Gastroenterology (BSG); United Kingdom	March 22, 2020	https://www.bsg.org.uk/covid-19-advice/
French Society of Digestive Endoscopy (SFED); France	March 11, 2020	https://www.sfed.org/professionnels/covid19-et-endoscopie
Portuguese Society of Digestive Endoscopy (SPED); Portugal	March 15, 2020	https://www.sped.pt/index.php/component/content/article/28-novidades/destaques/1246-recomendacoes-sped-covid-19?Itemid=101
Romanian Society of Gastrointestinal Endoscopy (SRED)	March 15, 2020	http://www.sred.ro/en/to-the-attention-of-all-the-members-of-the-romanian-society-of-digestive-endoscopy/a106
Spanish Association of Digestive Endoscopy (SEED) ; Spain	March 15, 2020	https://wseed.es/images/site/guia_clinica/2020/RecomendacionesSEED_ProteccionUnidadesEndoscopia_Coronavirus.pdf
National Societies – Asia-Pacific
Indian Society of Gastroenterology; India	March 18, 2020	http://www.isg.org.in/downloads/COVID.pdf
Gastroenterological Society of Australia (GESA); Austrália	March 20, 2020	https://www.gesa.org.au/resources/covid-19
Philippine Society of Gastroenterology; Philippines	March 13, 2020	http://www.psde.org.ph/wp-content/uploads/2020/03/PSDE-CoVID-19-Clinical-and-Procedural-Guidance.pdf

Supplementary Table 3

Societies accessed to review the recommendations for endoscopy during the COVID-19 pandemic from international/national societies of gastroenterology/gastrointestinal endoscopy

Society	URL	Accessed on
International
Asian Pacific Association of Gastroenterology (APAGE)	http://www.apage.org/index.html	March 27, 2020
European Society of Gastrointestinal Endoscopy (ESGE)	https://www.esge.com/	March 27, 2020
Sociedad Interamericana de Endoscopia Digestiva (SIED)	https://siedonline.org/	March 27, 2020
World Endoscopy Organization (WEO)	http://www.worldendo.org/	March 27, 2020
USA
American Gastroenterological Association (AGA)	https://www.gastro.org/	March 27, 2020
American College of Gastroenterology (ACG)	https://gi.org/	March 27, 2020
American Society for Gastrointestinal Endoscopy (ASGE)	https://www.asge.org/	March 27, 2020
Sociedad Puertoriqueña de Endoscopia Terapéutica	Not available
Europe, Middle East, and Africa
Endoscopic Group of the Austrian Society of Gastroenterology (ÖGGH)	http://www.oeggh.at/	March 25, 2020
Belgian Society of Gastrointestinal Endoscopy (BSGIE)	http://www.bsgie.be/	March 25, 2020
British Society of Gastroenterology (BSG)	https://www.bsg.org.uk/	March 27, 2020
Association of Gastroenterologists of Bosnia and Herzegovina (AGBH)	Not available
Bulgarian Association of Surgeons and Gastroenterologists (BASGO)	Not available
Endoscopic Section of Croatian Society of Gastroenterology (HGD)	http://www.hgd.hr/	March 25, 2020
Cyprus Society of Gastroenterology (CSG)
Czech Gastroenterological Society (CSG)	http://www.endoskopiste.cz/	March 25, 2020
Danish Society for Gastroenterology and Hepatology (DSGH)	https://www.dsgh.dk/	March 25, 2020
Egyptian Society for the Study of Endoscopy and Hepatogastroenterology (ESHG)	Not available
Estonian Society of Gastrointestinal Endoscopy (EGEÜ)	http://www.egeu.ee/en	March 25, 2020
Finnish Society of Gastroenterology	https://www.gastroenterologiayhdistys.fi/	March 25, 2020
French Society of Digestive Endoscopy (SFED)	https://www.sfed.org/	March 25, 2020
Endoscopic Section of the German Society of Gastroenterology (DGVS)	https://www.dgvs.de/	March 25, 2020
Endoscopy Section of the Hellenic Society of Gastroenterology (HSG)	https://www.hsg.gr/	March 25, 2020
Endoscopy Section of the Hungarian Society of Gastroenterology (HSGE)	http://www.endoszkopos-szekcio.hu/	March 25, 2020
Endoscopic Section of the Iraqi Society of Gastroenterology & Hepatology (ISGH)	http://www.iraq-git.com/isgh/	March 25, 2020
Irish Society of Gastroenterology (ISG)	https://www.isge.ie/	March 25, 2020
Israel Gastroenterological Association (IGA)	https://www.gastro-israel.org.il/	March 25, 2020
Italian Society of Digestive Endoscopy (SIED)	http://www.sied.it/	March 25, 2020
Jordanian Society of Gastroenterology & Hepatology (JSGH)	Not available
Latvian Association of Gastrointestinal Endoscopy (LAGE)	Not available
Lebanese Society of Gastroenterology (LSGE)	http://www.lsge.org/	March 25, 2020
Libyan Society of Gastrointestinal Endoscopy (LSGE)	Not available
Lithuanian Society of Gastrointestinal Endoscopy (LSGE)	Not available
Luxembourg Society of Gastroenterology & Digestive Endoscopy (SLGE)	Not available
Macedonian Society of Gastroenterohepatology (MSG)	Not available
Gastroenterohepatology Association of Montenegro (GAM)	http://ugcg.me/en/	March 25, 2020
Moroccan Society of Digestive Endoscopy (SMED)	http://www.smed-maroc.org/#	March 25, 2020
Netherlands Society of Gastroenterology (NVGE)	https://www.nvge.nl/	March 25, 2020
Norwegian Gastroenterology Society (NGA)	Not available
Palestinian Society of Gastroenterology	Not available
Endoscopy Group of the Polish Society of Gastroenterology (PTG-E)	http://www.ptg-e.org.pl/en	March 25, 2020
Portuguese Society of Digestive Endoscopy (SPED)	https://www.sped.pt/	March 25, 2020
Romanian Society of Gastrointestinal Endoscopy (SRED)	http://www.sred.ro/	March 25, 2020
Russian Society for Digestive Endoscopy (REndO)	Not available
Serbian Society of Gastrointestinal Endoscopy (SSGE)	http://www.geus.rs/	March 25, 2020
Endoscopy Section of the Slovak Gastroenterological Society	https://www.sgssls.sk/	March 25, 2020
Slovenian Society of Gastrointestinal Endoscopy (SAGH)	Not available
Spanish Association of Digestive Endoscopy (SEED)	https://www.wseed.org/	March 25, 2020
Sudanese Society of Gastroenterology (SSG)	Not available
Swedish Society of Gastroenterology	https://svenskgastroenterologi.se/	March 25, 2020
Swiss Society of Gastroenterology (SSG)	https://sggssg.ch/	March 25, 2020
Endoscopy Branch of the Syrian Society of Gastroenterology (SSGE)	Not available
Tunisian Society of Gastroenterology & Digestive Endoscopy (TSG)	Not available
Turkish Society of Gastroenterology (TGD)	http://www.tgd.org.tr/	March 25, 2020
Ukrainian Association of Endoscopy (UAE)	Not available
Emirates Gastroenterology and Hepatology Society	Not available
Yemeni Study Association for Liver, Biliary & GIT Diseases (YSALBG)	Not available
Asia-Pacific
Gastroenterological Society of Australia (GESA)	https://www.gesa.org.au/resources/covid-19	March 25, 2020
Bangladesh Gastroenterology Society	http://www.bgs-bd.org/index.html	March 25, 2020
Chinese Society of Gastroenterology	http://www.csge.org.cn/en#/index	March 25, 2020
The Hong Kong Society of Gastroenterology	http://www.hksge.org/home.htm	March 25, 2020
Indian Society of Gastroenterology	http://www.isg.org.in/	March 25, 2020
The Indonesian Society of Gastroenterology	Not available
The Japanese Society of Gastroenterology	http://www.jsge.or.jp/english/index	March 25, 2020
The Korean Society of Gastroentestinal Endoscopy	https://www.gie.or.kr/eng/	March 25, 2020
Macao Society of Gastroenterology & Hepatology	http://www.msgeh.com/main.html	March 25, 2020
Malaysian Society of Gastroenterology & Hepatology	http://www1.msgh.org.my/	March 25, 2020
Nepalese Society of Gastroenterologists	Not available
New Zealand Society of Gastroenterology	https://nzsg.org.nz/	March 25, 2020
Pakistan Society of Gastroenterology and GI Endoscopy	Not available
Philippine Society of Gastroenterology	https://www.psgastro.org/	March 25, 2020
Gastroenterological Society of Singapore	https://www.gastro.org.sg/	March 25, 2020
The Chinese Taiwan Gastroenterological Society	http://www.gest.org.tw/	March 25, 2020
The Gastroenterological Association of Thailand	http://www.gastrothai.net/th/	March 25, 2020
Canada, Central America, and South America
Federación Argentina de Asociaciones de Endoscopía Digestiva	http://www.faaed.org.ar/	March 26, 2020
Sociedad Boliviana de Gastroenterología y Endoscopia Digestiva	Not available
Sociedade Brasileira de Endoscopia Digestiva	https://www.sobed.org.br/	March 26, 2020
Canadian Association of Gastroenterology	https://www.cag-acg.org/	March 26, 2020
Sociedad Chilena de Gastroenterología	http://sociedadgastro.cl/	March 26, 2020
Asociación Colombiana de Endoscopía Digestiva	http://aced.org.co/	March 26, 2020
Gastroenterología y Endoscopía Digestiva de Costa Rica	http://gastroenterologoscr.com/	March 26, 2020
Sociedad Cubana de Gastroenterología	Not available
Sociedad Ecuatoriana de Endoscopia Digestiva	Not available
Asociación de Gastroenterología y Endoscopía de El Salvador (AGEDES)	http://agedes.org/	March 26, 2020
Asociación Guatemalteca de Gastroenterologia, Hepatología y Endoscopia Gastrointestinal	www.gastroenterologosdeguatemala.org	March 26, 2020
Asociación Mexicana de Endoscopia Gastrointestinal	http://www.amegendoscopia.org.mx/	March 26, 2020
Asociación Panameña de Gastroenterología y Endoscopía Digestiva	https://gastropanama.org/	March 26, 2020
Sociedad Paraguaya de Gastroenterología y Endoscopia Digestiva	http://www.spge.org.py/	March 26, 2020
Sociedad de Gastroenterología del Perú	https://www.socgastro.org.pe/	March 26, 2020
Sociedad Dominicana de Gastroenterologia	http://sodogastro.com/esp/	March 26, 2020
Sociedad Uruguaya de Endoscopía Digestiva	http://www.sued.com.uy/inicio/es	March 26, 2020
Sociedad Venezolana de Gastroenterología	https://sovegastro.org/	March 26, 2020

All societies recommended the use of personal protective equipment (PPE) during the examination (gloves, mask, goggles or face shield, gown, and hairnet; double gloves and use of N95 or FFP2/3 masks were recommended in highly suspected or confirmed cases), and 43% recommended that the endoscopy team must be trained in wearing and removing PPE (Table 1 ). There was not any mention of using preexposure or postexposure prophylaxis for HCW. All international societies recommended following a standardized reprocessing procedure for flexible endoscopes.

Table 1

Recommendations for endoscopy during the COVID-19 pandemic from International/National Societies of gastroenterology/gastro-intestinal endoscopy, updated March 26, 2020

Society; region or country	Date	Postpone nonurgent examinations	Urgent procedures	Prescreening of patients	Patients should use masks	Training for PPE use	Type of recommended PPE	Contact patients 14 days after examination	Self-surveillance by HCW
International Societies
European Society of Gastrointestinal Endoscopy (ESGE); Europe	March 18, 2020	Yes	Not reported	Yes; questionnaire	Yes for all	Yes; how to wear and to remove	Double gloves, mask (FFP2/3), goggles or face shield, gown, hairnet	Yes	Not reported
Sociedad Interamericana de Endoscopia Digestiva (SIED); Canada/Central and Latin America	March 18, 2020	Yes	Not reported	Yes; questionnaire	Not reported	Not reported	Double gloves, mask (surgical), goggles or face shield, gown, hairnet	Not reported	Yes
World Endoscopy Organization (WEO); Global	March 24, 2020	Yes	Upper GI bleeding, foreign body/obstruction; acute cholangitis	Yes; questionnaire	Not reported	Yes; how to wear and to remove	Gloves, mask (N95;FFP2/3), goggles or face shield, gown, hairnet	Not reported	Not reported
National Societies – United States
American College of Gastroenterology (ACG); USA	March 15, 2020	Yes	Upper GI bleeding, foreign body/obstruction; acute cholangitis, care of cancer, prosthetic removals	Yes; questionnaire	Not reported	Yes; how to wear and to remove	Gloves, mask (type not reported), goggles or face shield, gown	Yes	Not reported
American Gastroenterological Association (AGA); USA∗	March 18, 2020	Not reported	Not reported	Not reported	Not reported	Not reported	Gloves, mask (N95), goggles or face shield, gown	Not reported	Not reported
American Society for Gastrointestinal Endoscopy (ASGE); USA†	March 27, 2020	Yes	Upper GI bleeding, foreign body/obstruction; acute cholangitis, care of cancer	Yes; questionnaire, body temperature	Yes if symptoms	Yes; how to wear and to remove	Gloves, mask (N95/FFP2), goggles or face shield, gown	Yes	Not reported
National Societies – Canada / Central and South America
Asociación Mexicana de Endoscopia Gastrointestinal; México	Not reported	Yes	Upper GI bleeding, foreign body/obstruction; acute cholangitis, care of cancer, drainage of pancreatic collection, nutritional tube	Yes; questionnaire	Yes for all	Yes; how to wear and to remove	Gloves, mask (type not reported), goggles or face shield, gown, hairnet; double gloves, special masks (N95, FFP2/3), goggles and face shield in highly suspected or confirmed cases	Not reported	Not reported
Canadian Association of Gastroenterology; Canadá	March 16, 2020	Yes	Upper GI bleeding, foreign body/obstruction; acute cholangitis	Yes; questionnaire	Not reported	Not reported	Gloves, mask (surgical), goggles or face shield, gown; double gloves and special mask (N95 or FFP2/3) in highly suspected or confirmed cases	Not reported	Not reported
Federación Argentina de Asociaciones de Endoscopía Digestiva; Argentina	March 16, 2020	Yes	Not reported	Yes; questionnaire	Yes if symptoms	Not reported	Gloves, mask (surgical, N95 in highly suspected or confirmed cases), goggles or face shield, gown, hairnet	Not reported	Not reported
Sociedad Chilena de Gastroenterología; Chile	Not reported	Yes	Not reported	Yes; questionnaire, body temperature	Not reported	Yes; how to wear and to remove	Gloves, mask (surgical), goggles or face shield, gown; double gloves and special mask (N95 or FFP2/3) in highly suspected or confirmed cases	Not reported	Yes
Sociedad Dominicana de Gastroenterologia; República Dominicana	March 16, 2020	Yes	Not reported	Yes; questionnaire, body temperature	Not reported	Not reported	Not reported	Not reported	Yes
Sociedad Uruguaya de Endoscopía Digestiva; Uruguay	March 13, 2020	Yes	Not reported	Yes; questionnaire, body temperature	Not reported	Not reported	Gloves, mask (surgical), goggles or face shield, gown; special mask (N95 or FFP3) in confirmed cases	Not reported	Not reported
Sociedade Brasileira de Endoscopia Digestiva; Brazil	March 21, 2020	Yes	Upper GI bleeding, foreign body/obstruction; acute cholangitis, care of cancer, endoscopic ligation band; endoscopic dilatation	Yes; questionnaire	Yes for all	Yes; how to wear and to remove	Double gloves, double mask (surgical plus N95), goggles or face shield, gown, hairnet	Yes	Not reported
National Societies – Europe
British Society of Gastroenterology (BSG); United Kingdom	March 28, 2020	Yes	Upper GI bleeding, foreign body/obstruction; acute cholangitis, care of cancer, urgent inpatient nutrition support (PEG/NJ tube), endoscopic vacuum therapy for perforations/leaks; infected pancreatic collections	Not reported	Not reported	Yes; how to wear and to remove	Gloves, mask (FFP3), goggles or face shield, gown, hairnet	Not reported	Not reported
French Society of Digestive Endoscopy (SFED); France	March 11, 2020	Yes	Not reported	Yes; questionnaire	Yes for all	Not reported	Gloves, mask (surgical; FFP2 in symptomatic patients), goggles or face shield, gown.	Not reported	Yes
Portuguese Society of Digestive Endoscopy (SPED); Portugal	March 15, 2020	Yes	Not reported	Yes; Questionnaire	Not reported	Not reported	Gloves, mask (surgical), goggles or face shield, gown. Double gloves and special mask (FFP2) in confirmed cases	Not reported	Yes
Romanian Society of Gastrointestinal Endoscopy (SRED)	March 15, 2020	Yes	Not reported	Yes; not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Spanish Association of Digestive Endoscopy (SEED); Spain	March 15, 2020	Yes	Upper GI bleeding, foreign body/obstruction; acute cholangitis, care of cancer,	Not reported	Not reported	Not reported	Gloves, mask (surgical), goggles or face shield, gown; double gloves and special mask (FFP3) in confirmed cases	Not reported	Not reported
National Societies – Asia-Pacific
Indian Society of Gastroenterology; India	March 18, 2020	Yes	Upper GI bleeding, foreign body/obstruction; acute cholangitis, care of cancer, urgent inpatient nutrition support (PEG/NJ tube), drainage of infected pancreatic collections	Yes; questionnaire, body temperature	Yes if symptoms	Yes; how to wear and to remove	Gloves, mask (type not reported), goggles or face shield (both in highly suspected patients), gown	Not reported	Yes
Gastroenterological Society of Australia (GESA); Austrália	March 20, 2020	Yes	Not reported	Yes; questionnaire	Not reported	Yes; how to wear and to remove	Gloves, mask (surgical, N95 or FFP2/3 in highly suspected or confirmed cases), goggles or face shield, gown	Not reported	Not reported
Philippine Society of Gastroenterology; Philippines	March 13, 2020	Yes	Upper GI bleeding, foreign body/obstruction; acute cholangitis, care of cancer, urgent inpatient nutrition support (PEG/NJ tube)	Yes; questionnaire, body temperature	Not reported	Not reported	Gloves, mask (surgical), goggles or face shield (both in highly suspected cases), gown, hairnet; special masks (N95), goggles and face shield in highly suspected or confirmed cases	Not reported	Yes

Web links for all societies and recommendations are available in the supplementary material online at www.giejournal.org.

PPE, Personal protective equipment; HCW, healthcare worker(s); NJ, nasojejunal.

Recommendations based on publication by Ungaro et al, CGH https://doi.org/10.1016/j.gie.2020.03.3758 and joint GI society message from ACG, AASLD, ACG, ASGE.

Recommendations based on publication by Soetikno et al, GIE doi https://doi.org/10.1016/j.gie.2020.03.3758.

In summary, we validated the recommendations for endoscopy during the COVID-19 pandemic described by our colleagues based on an extensive and updated review of statements of international and national societies of gastroenterology and GI endoscopy worldwide. The situation is rapidly evolving, and this guidance may be updated regularly.

Disclosure

All authors disclosed no financial relationships. This work was supported by funding from INI-FIOCRUZ (Programa de Incentivo à Jovens Pesquisadores for HP grant number INI-003-FIO-19-2-5) and from University Estacio de Sa (UNESA) [Programa Pesquisa e Produtividade for GP. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) (Finance Code 001 for ECCF). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.