Proposal for returning to routine endoscopy during the COVID-19 pandemic: what is really feasible?

The European Society of Gastrointestinal Endoscopy proposals [1] to reorganize endoscopy units during the COVID-19 outbreak have been made possible by postponing nonurgent procedures. Before returning to pre-COVID activity, applicability of the proposals should be re-evaluated according to the organization and characteristics of endoscopy units [2].

Our department consists of two high-volume endoscopy units in two hospitals – one new (4 years old) and an older one (25 years old) – in Lombardy, which is the region most affected by COVID-19 but also the region with the best healthcare in Italy. We are currently performing < 20 % of our pre-crisis activities. About 25 % of staff are involved in COVID-19 departments; waiting and recovery areas in both hospitals are too small to allow distancing and safety pathways with pre-crisis workflows. As COVID-19 will be with us throughout 2020 and beyond, it is unrealistic for us to think about returning to pre-crisis activity in the next few months, and this condition is likely to be shared by nearly all endoscopy units in Italy.

At present, polymerase chain reaction testing prior to procedures is not available in Italy; antibody testing is available but is only marginally useful as less than 20 % of average-risk people are positive [3]. The great challenge of the resume phase is thus represented by the need to redesign the organization models of endoscopy units and their interaction with territorial services. The Italian open-access endoscopy system should be shifted to a filtered one, through strict application of guidelines and close collaboration with general practitioners in order to facilitate triaging and scheduling/rescheduling of patients and to minimize inappropriate procedures [4]. The high number of postponed and already scheduled nonurgent procedures should be canceled, and prescribing physicians should be asked to re-evaluate indication and timing of endoscopy [5]. We should not waste the opportunity to improve the organization of endoscopy units, as what we are planning today will probably be the foundation of our organization when the pandemic is over.

Publication History

Article published online:
26 August 2020

• References

• 1 Gralnek IM, Hassan C, Beilenhoff U. et al. ESGE and ESGENA position statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy 2020;
• 2 Decreto del Presidente del Consiglio dei Ministri. Gazzetta ufficiale della Repubblica Italina; 2020 Im Internet: https://www.gazzettaufficiale.it/eli/id/2020/04/27/20A02352/sg
• 3 Comar M, Brumat M, Concas MP. et al. COVID-19 experience: first Italian survey on healthcare staff members from a Mother-Child Research Hospital using combined molecular and rapid immunoassays test. MedRxiv 2020; Available at:
• 4 Meggio A, Mariotti G, Gentilini M. et al. Priority and appropriateness of upper endoscopy out-patient referrals: two-period comparison in an open-access unit. Dig Liver Dis 2019; 51: 1562-1566
• 5 Amato A, Rondonotti E, Radaelli F. Lay-off of endoscopy services for the COVID-19 pandemic: how can we resume the practice of routine cases?. Gastroenterology 2020;