**5. COVID-19 screening**

Before patients enter the endoscopy room, they should be evaluated. COVID-19 screening and body temperature checking are mandatory. The screening will

determine the next step. Symptoms such as fever, respiratory problems, and cough will lead healthcare workers to postpone the procedure and transfer the patient to an infectious disease clinic or emergency department for further treatment.

All patients who will undergo GIE should be tested with a SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) swab [10]. According to American Gastroenterological Association (AGA), the suggested testing is nucleic acid examination such as NAAT or rapid RT-PCR for an endoscopy center that implements preendoscopic SARS-CoV-2 testing [17]. One study showed that SARS-CoV-2 RT-PCR examination is an effective approach to resume GIE practice in the United States. They recommended that PCR testing should be employed during the pandemic's second phase [18]. Some experts also recommend the chest CT scan because the result may come out first than the RT-PCR SARS-CoV-2 test, but later findings showed that non-severe COVID-19 patients have no radiographic abnormality displayed, so chest CT has limited value in screening for COVID-19 prior to endoscopy [9, 10].

Healthcare workers in the endoscopy unit must take the right and thoughtful decision regarding the urgency of the patient's condition. Urgent patients are related to time-sensitive factors that if the procedure is postponed, then a higher risk of threat to the patient is inevitable (**Figure 1**). To make it easier, experts recommend using these questions to answer: is the procedure indicated, is the procedure time sensitive, if yes, it has to be done within 2 weeks or 8 weeks, if not time-sensitive, the procedure can be delayed after 8 weeks (**Figure 2**). In a different study, the classification of the patient condition is divided into three conditions: emergent condition must be performed within 1 week; the urgent condition is performed within 1–8 weeks, and non-time-sensitive can be delayed for more than 8 weeks [19]. This action has to consider the patient's medical records, laboratory results, cross-sectional images, and endoscopic reports [9, 20].

The urgent indication has been classified by some studies and includes gastrointestinal bleeding, perforation treatment, stent insertion for gastrointestinal obstruction, biliary sepsis, acute cholangitis, and other conditions, which met the criteria of an urgent situation. Semi-urgent patient includes endoscopic therapy for neoplasia such

**Figure 1.** *Criteria of urgent condition in gastrointestinal endoscopy.*

*Patient Safety and Healthcare Worker Safety in Gastrointestinal Endoscopy during COVID-19… DOI: http://dx.doi.org/10.5772/intechopen.109128*

#### **Figure 2.**

*Prioritization of gastrointestinal endoscopy.*

as polypectomy, endoscopic mucosal resection or dissection, occult gastrointestinal bleeding, enteroscopy, and endoscopic retrograde cholangiopancreatography (ERCP) for pancreatobiliary malignancy. If the COVID-19 patient's condition is not urgent, then the GIE procedure will be delayed for at least 14 days or after negative RT-PCR testing [9, 20].

The patients who will undergo endoscopy procedure need to fill out the form of travel history, close contact with suspected or confirmed COVID-19 persons, and informed consent for GIE procedure [9]. The consent must be clear and include all procedures and interventions that will be taken or reduced during endoscopy [20]. The patients have to wear a surgical mask and perform hand hygiene; some also recommend wearing gloves. While waiting, the patients are encouraged to minimize close contact and communication. Patients can be accompanied by one adult and no visitors are allowed (**Figure 3**) [10].
