Safely restarting GI endoscopy in the era of COVID-19

The COVID-19 pandemic has placed extraordinary demands on healthcare services worldwide. Strategic planning for acute COVID-19 care has, during the peak phase of the pandemic, rightly overshadowed the provision of diagnostic services, which have been further restricted by the need to minimise viral transmission to reduce the attendant risks to patients and staff. The risk is compounded by the asymptomatic phase of COVID-19 infection1 and is particularly important in relation to GI endoscopy, given the aerosol-generating nature of many endoscopic procedures.2–4 The British Society of Gastroenterology released early guidance to assist local teams in prioritising certain indications for GI endoscopy, even during the tight restrictions demanded by the peak phase of the pandemic.2 Other endoscopy societies or expert groups have also published guidance on the management of GI endoscopy during the pandemic, and these are summarised elsewhere.5 In the deceleration phase of the pandemic, as defined by a sustained fall in new infectious cases over 14 consecutive days,6 7 healthcare systems will rightly look to implement measures to safely restart activity. Endoscopy capacity should be restored as far as possible while ensuring mechanisms are in place to reassure and protect patients and staff from avoidable risk. There is significant risk in continued delay of diagnostic services. For GI endoscopy, this relates to cancers as well as other time-critical conditions such as IBD. While COVID-19 has tragically accounted for over 200 000 reported deaths by the end of April 2020,8 there were around 18 million cases of cancer worldwide in 2018 and 10 million cancer deaths, with colorectal and gastric cancer accounting for 17% of deaths.9 It has been conservatively estimated that delays to cancer diagnoses and treatment could be responsible for nearly 7000 additional deaths in England and over 30 000 deaths in the USA.10 It …