Gastrointestinal and hepatic manifestations of COVID-19 infection: Lessons for practitioners

Table 12 Procedures that can be delayed during the ongoing pandemic

Procedures that can be delayed	Procedures that cannot be delayed
Diagnostic procedures for mild/stable dysphagia[177].	Endoscopies for upper GI bleeding (Blatchford score > 1)[166,171,177].
Diagnostic procedures for suspected GI malignancy can be delayed for up to a few months[171].	Upper endoscopies for foreign body with severe/progressive dysphagia[177].
Routine surveillance and screening colonoscopies are non-urgent and can be postponed[171].	Lower endoscopies for acute obstruction requiring decompression[177].
Procedures for asymptomatic (with normal LFTs) gallstones and biliary strictures can be postponed[177].	ERCP for acute cholangitis or symptomatic common bile duct stone[166,177].
Follow up Colonoscopies for positive FIT test can be delayed for up to 7 to 9 mo without any adverse impact on outcomes[178].	Follow up band ligation for recent variceal bleeding[166,177].
	Placement of percutaneous endoscopic gastrostomy or jejunostomy tubes[177].
	Procedures that can significantly impact medical decisions should be performed. These can include endoscopies for evaluation of high likelihood GI malignancies, resection of high-grade dysplasia or histologically proven neoplasia and investigation for IBD flares[171,177].
	Colonoscopies for lower GI bleeding can be delayed up to 72 h without any change in outcome[178].
	Liver biopsies to diagnose autoimmune hepatitis and transplant rejection in liver transplant patients[166].
	Transplant surgeries are categorized Tier 3b by CMS and should be performed[175].
	Endoscopic drainage of infected pancreatic fluid collections and necrosectomies[177].

GI: Gastrointestinal; LFT: Liver function test; ERCP: Endoscopic retrograde cholangiopancreatography; IBD: Inflammatory bowel disease; CMS: Centers for Medicare & Medicaid Services.