In the present setting, the Board of Directors defined that the recommendations and guidelines generated by Asociación Argentina de Cirugía during COVID-19 pandemic should be implemented considering the following aspects:

The responsibility in the decision making during the surgical act corresponds to the surgeon and to the regulations emanated from the Crisis Committee, according to the phase or stage of the pandemic (Spanish Association of Surgeons Classification) of each Health Institution and to the viral replication in the corresponding geographical area, ad-referendum of the recommendations of the National and Regional Health Authorities.

The AAC Flexible Endoscopy Committee supports and shares the protective measures for Gastrointestinal Endoscopy Services developed and published by different Scientific Societies worldwide, to facilitate the access of all our members and the medical community in general.

In view of the situation generated by the pandemic caused by the SARS-CoV-2, and its respiratory disease known as COVID-19, the following suggestions are made for the Gastrointestinal Endoscopy Units, in order to limit the spread of the disease.

1. Limit endoscopic activity to emergency cases, urgent cases or when there is an indication to rule out cancer, until the epidemiological situation allows a return to the usual situation.

2. Recommend the population not to undergo elective procedures at the present time.

3. Use a triage protocol in all the patients attending the endoscopy unit to stratify the risk of COVID-19 according to the criteria established by the WHO: confirmed diagnosis, suspected diagnosis, risk contacts, quarantine.

The protection of the healthcare staff in the unit depends on the patient’s situation and therefore this is considered a critical aspect. For this reason, all patients attending the endoscopy unit should be evaluated for the presence of symptoms (dry cough, sore throat, respiratory distress or fever) which must be recorded. In patients with suspected infection, the procedure will be postponed if it is not an emergency until the diagnosis is clear.

Ideally, the day before the study the patient should be contacted and asked about these symptoms, and if symptoms exist, they should be advised not to undergo the endoscopy.

All the staff must comply with the protective measures common to all the population:

▪▪Hand washing with water and soap or alcohol-based hand rub, before and after each procedure.

▪▪Avoid touching eyes, nose and mouth.

▪▪Cough or sneeze into the crease of the elbow.

▪▪Reduce the number of staff members in the endoscopy room.

▪▪All the staff in the endoscopy room must wear a mask.

▪▪Use personal protective equipment stratified by patient risk.

The level of protection during the endoscopic procedure is summarized in Table 1.

Table 1 Table modified form the Recommendations of the Spanish Society of Gastrointestinal Endoscopy (SEED) 

At the end of an endoscopic procedure in a positive or high-risk patient it is recommended to:

▪▪Dispose gloves, protective gowns and all the material used, including surface cloths on worktables, in a dedicated container.

▪▪Wash hands and forearms.

▪▪Clean the floor of the endoscopy room and contact surfaces as endoscopy towers, worktables, stretchers, and other common contact elements.

▪▪Carry out adequate handling of disposable material and reprocessing by washing and performing high-level disinfection according to institutional guidelines.

Patients hospitalized should not be taken to the recovery room and should avoid staying in common areas with outpatients.

It is recommended to attend with only one escort who is not allowed to enter the endoscopy rooms or the recovery rooms.

Appointment times should be spaced out whenever possible, to avoid crowding patients and escorts in the waiting room.