Table 1.

Executive Summary of Recommendations

Summarized below are the recommendations with comments related to the role of testing in endoscopy. The strength of a recommendation is expressed as strong or conditional, based on the GRADE methodology and has the following interpretation: Strong recommendation: All centers should follow the recommended course of action, and only a small minority may not. Conditional recommendation: The majority of centers in this situation should follow the suggested course of action but many would not; different choices may be appropriate. These recommendations assume that: 1. All centers have access to PPE, including face shield, eye protection, and surgical mask or N95 (or N99, powered air-purifying respirators) 2. All centers have implemented universal screening of patients for COVID-19 symptoms, using a screening checklist and have implemented universal precautions. including physical distancing, masks, and hand hygiene in the endoscopy unit

Recommendation 1: The AGA suggests against routine preprocedure testing for SARS-CoV2 in patients undergoing upper endoscopy or lower endoscopy (the terms upper and lower endoscopy include all related gastrointestinal procedures, eg, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and flexible sigmoidoscopy) irrespective of the vaccination status of patients.Conditional recommendation, very low certainty evidence Remarks: Centers that prioritize the small potential benefit (staff and patient reassurance, detection of asymptomatic positive cases) over the harms (burden of testing on patients, downstream consequences of false positives, potential delays in care and decreased endoscopy efficiency) may choose to implement a pre-procedure testing strategy as outlined in Recommendation 2.

Recommendation 2: In endoscopy centers that implement a preprocedure testing strategy, the AGA suggests using standard nucleic acid testing (laboratory-based NAAT or rapid RT-PCR)arather than a rapid isothermal test or antigen tests, in patients undergoing upper endoscopy or lower endoscopy (the terms upper and lower endoscopy include all related gastrointestinal procedures, eg, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and flexible sigmoidoscopy) irrespective of the vaccination status of patients. Conditional recommendation, very low certainty evidence Remarks: Rapid RT-PCR tests that can be easily performed on the day of endoscopy (results within 1 h) are preferable as they pose less burden to patients. In the preprocedure setting, the utility of rapid isothermal tests or antigen tests is limited due to concerns of assay sensitivity. There is no role of antibody tests for preprocedure testing.

^aStandard NAATs include laboratory-based NAAT and rapid RT-PCR tests that detect viral RNA and have the best diagnostic test accuracy. Rapid RT-PCR tests are defined as tests that provide results in 1 h. Rapid isothermal tests detect viral RNA. Antigen tests detect viral proteins, with the vast majority of tests detecting nucleocapsid antigen. Most antigen tests are rapid, providing results within 15 min.