key: cord-0873496-hsf0snyd authors: Irisawa, Atsushi; Furuta, Takahisa; Matsumoto, Takayuki; Kawai, Takashi; Inaba, Tomoki; Kanno, Atsushi; Katanuma, Akio; Kawahara, Yoshiro; Matsuda, Koji; Mizukami, Kazuhiro; Otsuka, Takao; Yasuda, Ichiro; Tanaka, Shinji; Fujimoto, Kazuma; Fukuda, Shinsaku; Iishi, Hiroyasu; Igarashi, Yoshinori; Inui, Kazuo; Ueki, Toshiharu; Ogata, Haruhiko; Kato, Mototsugu; Shiotani, Akiko; Higuchi, Kazuhide; Fujita, Naotaka; Murakami, Kazunari; Yamamoto, Hironori; Ito, Tohru; Okazaki, Kazuichi; Kitagawa, Yuko; Mine, Tetsuya; Tajiri, Hisao; Inoue, Haruhiro title: Gastrointestinal endoscopy in the era of the acute pandemic of coronavirus disease 2019: Recommendations by Japan Gastroenterological Endoscopy Society (Issued on April 9th, 2020) date: 2020-05-28 journal: Dig Endosc DOI: 10.1111/den.13703 sha: f25492318cc5e26b54ffa1d368e2fc8ec21ab237 doc_id: 873496 cord_uid: hsf0snyd All gastrointestinal endoscopic procedures have a high risk of aerosol contamination of the coronavirus disease 2019 (COVID‐19) to endoscopists, nurses, and healthcare assistants. Given the current pandemic situation of COVID‐19, the Japan Gastroenterological Endoscopy Society issued the recommendation for gastrointestinal (GI) endoscopy based on the status of COVID‐19 as of April 9, 2020, in Japan: (i) indications for GI endoscopy in the pandemic of COVID‐19; (ii) practical protective equipment for medical personnel depending on the risk for COVID‐19; (iii) preprocedural management, such as pharyngeal local anesthesia using lidocaine spray which has a potential to generate the aerosols; (iv) ideal settings of the endoscopy room including the numbers of the staff and the patients; (v) postprocedural management, such as undressing and follow‐up of the patients, as well as the involved staff, were documented to fit the practical scenarios in GI endoscopy, with the available data in Japan and the world. We believe that certain measures will prevent further spread of COVID‐19. G IVEN THE CURRENT status of the coronavirus disease 2019 (COVID-19) pandemic, gastrointestinal endoscopy must be performed following the policies set forth by the government of Japan as well as the Ministry of Health, Labour and Welfare. Considerations should also be made on factors such as the situation of each healthcare facility. The following recommendations by the Japan Gastroenterological Endoscopy Society (JGES) for endoscopic procedure take the current status of the COVID-19 pandemic into account and do not impose any restrictions on procedures to be performed at each facility. Each facility must refer to this proposal and develop detailed policies through collaboration with related internal departments and other groups, depending on the local and organizational situation. The recommendations are based on the status of COVID-19 as of April 9, 2020. Please note that the information provided in this document is subject to future changes in the situation and updates by the government. This recommendation was developed by the JGES Health and Safety Committee, and has been authorized by the JGES board of directors. T HE PRIMARY MODES of coronavirus transmission are droplets and contact. It has been presumed that this is also the case for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus. 1, 2 Gastrointestinal endoscopies, especially those through the nasal and oral cavities, may induce coughing and subsequent emission of droplets and increase the risk of exposure of medical staff, including endoscopists, nurses, and healthcare assistants, to aerosol contamination. 3 The risk of viral transmission is presumed to increase during a prolonged stay in a closed environment, such as the endoscopic suite. In addition, transmission via colonoscopy has been suggested because viruses can be found in the feces. 4,5 T HE JAPANESE NATIONAL COVID-19 Unit has been updating the basic policy daily (https://corona.go.jp/en/). Given the current pandemic situation and unless it is urgently required (Table S1 ), gastrointestinal endoscopy should be avoided or postponed in a patient who has tested positive for SARS-CoV-2 on polymerase chain reaction testing and meets any of the criteria provided below (confirmed COVID-19 cases or clinically suspected COVID-19 cases: high-risk patients). [4] [5] [6] [7] [8] [9] [10] Meanwhile, those who do not meet the criteria (without clinically suspected cases of COVID-19: low-risk patients) may still have the virus and infect others. Therefore, gastrointestinal endoscopy should be performed on such patients after extensive deliberation, and it should also be postponed unless it is urgently required. Especially, in areas where a state of emergency has been declared according to the Act on Special Measures Concerning COVID-19 from the Japanese government, postponement or cancellation is strongly recommended to prevent the spread of infection and protect healthcare workers, even for low-risk patients. This is extremely important for saving personal protective equipment. In addition, if it is necessary to perform emergency gastrointestinal endoscopy, the procedure should be performed according to the facility's rules. (Table S1 ). The use of personal protective equipment (PPEs), including a face mask with a face shield (or a goggle and a face mask), gloves, a cap, and a gown (long sleeves) should be enforced. The PPEs should not be reused for examinations; new ones must be used. Areas from fingertips through the elbow of both hands should be carefully washed after each examination. Infection prevention measures should be implemented to the maximum possible extent, depending on the availability of medical resources such as PPEs at each facility. Special attention should be paid to the avoidance of coughing and aerosols when administering lidocaine; Jackson Spraying for local anesthesia of the pharynx should be opposed. Please consider using the above PPEs on this occasion. Finally, please take the above-mentioned precautions seriously for carrying and cleansing endoscopic instruments after each examination. The guidelines issued by the JGES for standardized cleansing and disinfection of gastrointestinal endoscopes 11 must be followed. Furthermore, the countermeasures for pre-and postendoscopic procedure (e.g., the disinfection/closure of the endoscopy room, the possible duration of the closure, and the time of reopening the room) should be discussed at each facility for the following situations: (i) endoscopic procedure must be performed in a patient with a confirmed case of COVID-19; (ii) if COVID-19 is revealed after the endoscopic procedure. 12 The PPEs used for the patient with a confirmed case of COVID-19 must be disposed of immediately after use. I F ENDOSCOPISTS OR medical staff meet any of the above criteria 1-6, they should not be involved in the performance of endoscopic procedures, even if the situation allows, from the perspective of infection control. O N THE DAY of endoscopy, a detailed medical interview and the measurement of body temperature are highly recommended before entering the endoscopy suite. The decision to proceed with endoscopy should be carefully made, based on the information. It is also important for patients preparing to undergo gastrointestinal endoscopies to distribute thermometry tables in advance and regularly describe their body temperature and abnormalities until the day of the examination. At the endoscopy suite, it is important to keep all patients at an appropriate distance from each other. 13 A UTHORS ATSUSHI IRISAWA and Akio Katanuma are an Associate Editor of Digestive Endoscopy, and Takayuki Matsumoto is an Editor-in-Chief of Digestive Endoscopy. Other authors declare no Conflict of Interests for this article. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster Evidence of airborne transmission of the severe acute respiratory syndrome virus COVID-19 may transmit through aerosol COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission COVID-19 and the digestive system Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms Self-reported olfactory and taste disorders in SARS-CoV-2 patients: A cross-sectional study Review article: Gastrointestinal features in COVID-19 and the possibility of faecal transmission Guidelines for standardizing cleansing and disinfection of gastrointestinal endoscopes Perioperative COVID-19 defense: an evidence-based approach for optimization of infection control and operating room management Practice of endoscopy during COVID-19 pandemic: Position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements) A DDITIONAL SUPPORTING INFORMATION may be found in the online version of this article at the publisher's web site.Table S1 Measures to be taken for high-risk patients.