Table 2.

Gastrointestinal endoscopy for GI bleeding in patients with COVID-19 infection

General Principles/Topic	Clinical Applications	Reasons
PCR testing for COVID-19 infection.	Many institutions with high institutional prevalence of COVID-19 infection standardly screen all patients scheduled for GI endoscopy by PCR testing for COVID-19 infection. Alternatively, institutions screen all patients with planned GI endoscopy for history of exposure to someone with known COVID-19 within <14 d, and for symptoms suspicious of COVID-19 (eg, cough, dyspnea, or diarrhea). Patients who have at least 1 such exposure or symptom should undergo PCR testing for SARS-CoV-2.	Reduce COVID-19 exposure of endoscopy staff.
EGD is theoretically a high-risk procedure for transmitting COVID-19 infection from a patient with COVID-19 to endoscopy staff because of the presence of aerosolized infective droplets. However, the actual risk of transmission seems to be manageable. Risk to endoscopy staff may be higher in an infected patient with active overt hematemesis.	Endoscopy staff should strongly consider using PPE, including wearing an N95 face mask during endoscopy performed on COVID-19-infected patients.	Reduce personnel exposure to COVID-19 infection from infected patients.
Much less performance of EGD for elective indications in patients with active COVID-19 infection as compared with noninfected patients.	Generally, defer EGD for elective indications until patient recovers from acute COVID-19 infection.	Some risks to endoscopy staff from exposure to patient with COVID-19 infection during GI endoscopy. Patient with complicated acute COVID-19 infection may not tolerate EGD. Some patients with COVID-19 infection (eg, patients with severe pneumonia) may require prophylactic endotracheal intubation for EGD.
Similar frequency of performing EGD for emergency/urgent indications in patients with acute COVID-19 infection versus noninfected patients.	Perform EGD for overt life-threatening GI bleeding, when therapeutic EGD is likely needed, and when EGD is needed before contemplated GI surgery.	Cannot wait for patient to recover from acute COVID-19 infection when EGD is required emergently or urgently. Maximize patient hemodynamic stability and respiratory status before performing EGD.
Deferral of elective GI endoscopy in a COVID-19-infected patient.	Wait a few weeks after the acute infection until the patient tests negative by PCR on a new COVID-19 test.	Reduce risk to endoscopy staff and reduce risks of endoscopy in a patient with active COVID-19 infection.
Prophylactic intubation for EGD in COVID-19-infected patients.	In the initial pandemic surge (March-May 2020) patients were generally intubated before EGD. From June 2020 onward only selected patients underwent prophylactic intubation for specific reasons.	Reason for current selective policy for endotracheal intubation before EGD is difficulty in extubating patients with respiratory compromise (especially from COVID-19 pneumonia).
Precautions during EGD in COVID-19-infected patients.	Endoscopy staff should exercise universal precautions when performing EGD on all patients during the pandemic, but especially in performing EGD on COVID-19-infected patients.	EGD properly performed with precautions seems to result in a low risk of COVID-19 transmission to endoscopy staff.
Routine screening and surveillance colonoscopy often deferred in patients with active COVID-19 infection until after the patient clears the virus as proven by nasal swab.		No reason to subject patient to increased risks of elective colonoscopy when the patient has active COVID-19 infection. No reason to subject the endoscopy staff to the risks of contracting the virus from infected patients.
Patients with GI bleeding associated with COVID-19 infection may have higher risks of morbidity and mortality than patients with GI bleeding without COVID-19 infection.	Patients with GI bleeding associated with severe COVID-19 pneumonia, respiratory compromise, and other serious complications of COVID-19 should generally be followed by an intensivist in an ICU.	Patients with severe pneumonia, respiratory compromise, and other serious complications of COVID-19 are at higher risk of mortality.
Protecting endoscopy personnel during EGD performed on a COVID-19-infected patient.	Endoscopy personnel in the endoscopy suite should be minimized during intubation and extubation of patients with COVID-19 infection.	Reduce exposure of endoscopy staff to COVID-19 infection.
Management of anticoagulation in COVID-19 patients with GI bleeding: these patients seem to have higher rates of thrombotic complications. Anticoagulation can complicate the management of GI bleeding. This may be particularly important in planning endoscopic therapy for overt, active GI bleed, which may require withholding anticoagulation just before and after therapeutic endoscopy.	Contemplated endoscopic therapy for overt, active GI bleed may require withholding anticoagulation just before and just after therapeutic endoscopy.	COVID-19 patients likely have higher rates of thrombotic complications. Anticoagulation can complicate the management of GI bleeding. This may be particularly important in planning endoscopic therapy for overt, active GI bleed, which may require withholding anticoagulation just before and after therapeutic endoscopy.
Telemedicine.	May be considered as an alternative to ambulatory physical patient visits for follow-up after GI endoscopy.	Reduce hospital staff exposure to COVID-19-infected patients.

Abbreviation: PCR, polymerase chain reaction.