Endoscopy 2020; 52(10): 891-898
DOI: 10.1055/a-1213-5761
Position Statement

ESGE and ESGENA Position Statement on gastrointestinal endoscopy and COVID-19: An update on guidance during the post-lockdown phase and selected results from a membership survey

Ian M. Gralnek*
 1   Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, and Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
Cesare Hassan*
 2   Nuovo Regina Margherita Hospital, Rome, Italy
Ulrike Beilenhoff
 3   Ulm, Germany
Giulio Antonelli
 2   Nuovo Regina Margherita Hospital, Rome, Italy
Alanna Ebigbo
 4   III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
Maria Pellisé
 5   Department of Gastroenterology, Hospital Clinic de Barcelona. Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Universitat de Barcelona, Barcelona, Spain
Marianna Arvanitakis
 6   Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
Pradeep Bhandari
 7   Gastroenterology, Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom
Raf Bisschops
 8   Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospitals Leuven, Leuven, Belgium
Jeanin E. Van Hooft
 9   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
Michal F. Kaminski
10   Department of Cancer Prevention and Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Konstantinos Triantafyllou
11   Hepatogastroenterology Unit, 2nd Department of Internal Medicine – Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
George Webster
12   Department of Gastroenterology, University College London Hospitals, London, United Kingdom
Andrei M. Voiosu
13   Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, Bucharest, Romania
Heiko Pohl
14   Dartmouth Geisel School of Medicine, Hanover New Hampshire, VA Medical Center, Section of Gastroenterology, White River Junction, Vermont, USA
Irene Dunkley
15   North West Anglia NHS Foundation Trust, Hinchingbrooke, United Kingdom
Björn Fehrke
16   Inselspital, Bern, Switzerland
Mario Gazic
17   General Hospital, Bjelovar, Croatia
Tatjana Gjergek
18   University Medical Centre, Ljubljana, Slovenia
Siiri Maasen
19   Tallinn Healthcare College, Tallin, Estonia
Wendy Waagenes
20   Hvidovre Hospital, Copenhagen, Denmark
Marjon de Pater
21   Amsterdam UMC location AMC, Amsterdam, The Netherlands
Thierry Ponchon
22   Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
Peter D. Siersema
23   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
Helmut Messmann
 4   III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
Mario Dinis-Ribeiro
24   Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
› Author Affiliations


In response to the prolonged lockdown period and implemented measures of social distancing/personal hygiene, most European countries are now (June 2020) experiencing a suppression of the COVID-19 viral pandemic [1]. This post-outbreak sustained (i. e., > 14 days) viral deceleration is being referred to as the “post-lockdown” phase of the COVID-19 pandemic. Sadly, at its height, the COVID-19 pandemic led to innumerable deaths throughout Europe, including many frontline health care professionals (HCPs) fighting the virus [2]. Therefore, we must remain vigilant in protecting HCPs, including our endoscopy unit personnel, by continuing to follow personal protective equipment (PPE) recommendations [3].

It must be stressed however, that the observed deceleration of the viral outbreak is not equivalent to the disappearance of COVID-19 transmission, as a large reservoir of the virus remains present in most European countries [4]. This generates the risk of future COVID-19 outbreaks as the protocols of infection control are gradually relaxed, as multiple viral outbreak clusters in various countries are now showing. Therefore, strategies aiming to triage, separate, and track gastrointestinal (GI) endoscopy patients, as outlined in our original Position Statement, remain highly relevant and necessary in this new post-lockdown phase of the pandemic [3]. An additional new tool, potentially available for GI endoscopy units to further assist in patient care, is pre-endoscopy viral testing to more accurately triage patients and/or health care personnel through the identification of COVID-19 viral RNA using nasopharyngeal swabbing [5].

The prolonged lockdown period across Europe resulted in the cancellation of elective GI endoscopies as only emergent/urgent endoscopies were performed [6]. As GI endoscopy is largely used for screening, early diagnosis, and treatment of digestive tract cancers, there is a growing concern about a possible mid- or long-term increase in the GI cancer burden because of the many elective GI endoscopy procedures that were cancelled [7]. Competition for endoscopy slots between those cancelled endoscopy procedures and those procedures previously scheduled is now occurring and needs to be addressed. We must do this by striking a careful balance between the ongoing need to maintain infection prevention and control (IPC) protocols within the endoscopy unit and the need to increase endoscopy procedure capacity. Despite there being an excessive backlog of endoscopy cases, there remains no consensus on the best way to efficiently yet safely re-open access for elective endoscopy procedures. Moreover, the status of COVID-19 in Europe is neither uniform nor generalizable across the continent since some regions of Europe may not yet be in the “post-lockdown” phase of the pandemic.

The aim of this present Position Statement is to provide updated evidence-based guidance on endoscopy practice for the post-lockdown phase of the COVID-19 pandemic. Moreover, in this updated Position Statement, guidance is given on IPC in the post-lockdown period, on the emerging role of COVID-19 viral testing, and on issues related to returning to full endoscopy capacity. Unless otherwise stated, all the guidance statements from the original Position Statement of the European Society for Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) remain valid and applicable in the post-lockdown phase [3]. Last, to better understand how the COVID-19 pandemic was impacting endoscopy units in Europe, ESGE and ESGENA surveyed their members on the status of their endoscopy practice as related to the COVID-19 pandemic. Thus, in addition to the updated guidance recommendations offered within this Position Statement, we also report selected results from our member survey.

* Co-first authors

Supplementary material

Publication History

Accepted Manuscript online:
06 July 2020

Article published online:
14 July 2020

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