AGA issues formal recommendations for PPE during gastrointestinal procedures

April 01, 2020

Bethesda, Maryland (April 1, 2020) -- Today, the American Gastroenterological Association (AGA) published new COVID-19 recommendations in Gastroenterology, the official journal of the AGA: AGA Institute Rapid Recommendations for Gastrointestinal Procedures During the COVID-19 Pandemic.

This rapid recommendation document was commissioned and approved by the AGA Institute Clinical Guidelines Committee, AGA Institute Clinical Practice Updates Committee, and the AGA Governing Board to provide timely, methodologically rigorous guidance on a topic of high clinical importance to the AGA membership and the public.


Treat all patients like they have coronavirus: In the absence of accurate and reliable testing for COVID-19 infection and the prolonged asymptomatic shedding that precedes symptoms, all patients should be considered at risk.

Boost PPE for endoscopic procedures: All health care workers should use N95 (or N99 or PAPR) masks instead of surgical masks and double gloves instead of single gloves as part of personal protective equipment (PPE), regardless of patient's COVID-19 status. There is strong evidence to support this recommendation for upper GI procedures, and lower-certainty evidence for lower GI procedures (i.e., colonoscopy). Also, negative pressure rooms, when available may help mitigate the spread of infection. Data on extended use and re-use of masks was also reviewed with insufficient evidence to comment on the safety of extended use (up to 8 hours) or re-use of masks. Indirect laboratory testing of masks suggests loss of durability and fit of N95 masks after 5 donnings.

Details: Endoscopies can generate aerosolized viral particles that can stay viable for up to 3 hours, depending on airflow dynamics. Furthermore, viral particles can stay viable for 72 hours on plastic surfaces and can easily promote spread through direct contact. SARS-CoV2 RNA can also be shed from stool though the risks associated with exposure are uncertain. Therefore, individuals performing endoscopic procedures are at higher risk of developing infection.

Triage GI procedures: Triaging of GI procedures is necessary to minimize risk to health care providers and patients and to limit the spread of infection during a pandemic. We provide a framework for decision-making that is focused on the impact of the delay on patient-important outcomes. Decisions to defer procedures should be made on a case-by-case basis using telemedicine as an adjunctive tool to help triage.
For all nine evidence-based recommendations and a detailed discussion, review the full publication in Gastroenterology.

Reference: Sultan S, Lim JK, Altayar O, Davitkov P, Feuerstein JD, Siddique SM, FalckYtter Y, El-Serag HB, on behalf of the AGA, AGA Institute Rapid Recommendations for Gastrointestinal Procedures During the COVID-19 Pandemic, Gastroenterology (2020), doi:

AGA is working hard to support the GI community during this pandemic. View all of our COVID-19 resources for GIs.

Contact for media: Rachel Shubert,, 301-272-1603

About the AGA Institute

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization.

About Gastroenterology

Gastroenterology, the official journal of the AGA Institute, is the most prominent scientific journal in the specialty and is in the top 1 percent of indexed medical journals internationally. The journal publishes clinical and basic science studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. The journal is abstracted and indexed in Biological Abstracts, Current Awareness in Biological Sciences, Chemical Abstracts, Current Contents, Excerpta Medica, Index Medicus, Nutrition Abstracts and Science Citation Index. For more information, visit

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