COVID-19 outbreak and endoscopy: Considerations in patients encountered in a foregut surgery practice

Severe acute respiratory syndrome coronavirus has become a critical challenge to global health. Since the arrival of coronavirus disease 2019 in the United States, several government agencies and professional societies have issued guidelines to healthcare systems and medical providers. Endoscopy is a substantial portion of the practice of many general surgeons in the United States. With upper endoscopy, manipulation of the upper aerodigestive tract can turn the droplets to an aerosolized form and increase the likelihood of transmission and therefore is considered a high-risk procedure. In this article we review some aspects of the coronavirus disease 2019 outbreak that are relevant to practice of surgical endoscopy. The emphasis of this communication is on the mode of transmission, previous experiences during other coronavirus outbreaks and society guidelines. We then highlight the changes that we have made to our practice to incorporate these factors to improve the safety of patients, health care providers, and community as a whole.