Best Practices for Endoscopic Procedures in Covid-19 Pandemic

The corona pandemic has affected the health system of whole world. In India, this potentially long winding pandemic is overwhelming the capacity of outpatient and inpatient facilities, emergency as well as high dependency units of hospitals lead to severe shortage of resources, beds and staff. This has resulted in compromise in patient safety and outcomes. Endoscopic procedures have diagnostic as well as therapeutic importance and can aid in settling down acute illness following which definitive surgery can be planned later. Being aerosol generating procedures (AGPs), safe practices need to be adopted at both institutional and personal level. There is tremendous impact on health care settings due to the COVID-19 situation in a very short span of time. In this COVID-19 pandemic scenario, while performing flexible endoscopic procedures. Elective endoscopies should be stopped. Flexible endoscopic and therapeutic interventions to be done only when absolutely necessary emergency and urgent cases. Proper PPE kits and N95 masks should be provided to all involved personnel in every endoscopic procedure. All patients undergoing emergency procedures should be considered Covid-19 positive and treated accordingly with every precaution to avoid infection transmission. Comprehensive and well-designed written-informed consent with inclusion of all necessary information of the Covid-19 situation should be taken from the patient and relative before all endoscopies. Urgent and Emergency endoscopic procedures must preferably be done under GA with very careful endotracheal intubation. High level of disinfection is required in endoscopies and the accessories used should either be disposable or thoroughly sterilized if reusable. As the fight against COVID-19 pandemic seems to be long-lasting we have to learn to live with it, prioritise resources and facilities keeping in mind patient needs in endoscopy departments. Protocols need to be introduced to encourage "new best practises" in the Endoscopy Department to ensure successful preventive measures against COVID-19 infection. This article addresses best practices to be followed and our experience of gastrointestinal endoscopy procedures during ongoing COVID-19 pandemic.