ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic

Update 1 (18.03.2020)


The outbreak of COVID-19 disease has recently spread from its original cluster in Hubei province, China [1,2] throughout the world, and has been declared to be a pandemic by the World Health Organization [3]. Europe appears to be severely affected with an exponential increase of number of COVID-19 cases and deaths [4]. The clinical manifestations of COVID-19 are subtle, encompassing a broad spectrum from asymptomatic mild disease, to severe critical respiratory illness leading to respiratory failure, shock, multiorgan dysfunction and death [1,2,5–7]. Thus, high clinical suspicion and appropriate risk stratification are needed.

Health care professionals in endoscopy units are at increased risk of infection by COVID-19 from inhalation of airborne droplets, conjunctival contact, and feces and touch contamination [2,8]. Periendoscopic aerosolized infections have also been reported, potentially placing upper GI endoscopy among the high-risk aerosol-generating procedures (AGPs) [9]. In addition, live virus has been found in patient stool [8,10–12], and angiotensin-converting enzyme II (ACE2) the receptor used by the virus to enter human cells [2], is widely expressed in the intestinal tract [13]. In addition, infected health workers may transmit the infection to their patients as hospital-based epidemics have been reported.

Infection prevention and control (IPC) has been shown to be dramatically effective in assuring the safety of both health care professionals and patients. This is not limited to the use of personal protective equipment (PPE), but is based on a transparent and detailed IPC strategy, risk stratification, correct use of PPE, and selected interventions for patients at high risk of COVID-19 [14–16]. A rational approach regarding limited resources is equally important as the simultaneous outbreak in all European countries severely affects the availability of health resources [15].

The European Society of Gastrointestinal Endoscopy ( and the European Society of Gastroenterology and Endoscopy Nurses and Associates ( are joining forces to provide guidance in order to assure the highest level of protection against COVID-19 for both patients and health care personnel.

This guidance statement will be updated online as needed.