The new strain of coronavirus is responsible for the coronavirus disease 2019 (COVID-19) pandemic, starting early 2020. The pandemic has substantially influenced the patterns of endoscopic practice and has necessitated gradual adaptation to the new milieu in the endoscopic field. I read the article with interest regarding the change in endoscopy during COVID-19 outbreak. Lahat et al. [1] showed that the total endoscopic cases did not differ significantly in January and February between 2020 and the previous two years. However, in March 2020 the numbers were reduced by 44% compared to previous years. There have been several similar reports from around the world. An Italian study reported reduction of normal endoscopies by 97.6% [2]. A survey in New York revealed an overall 71% reduction since the onset of COVID-19 [3]. The plausible explanation for these phenomena might be the stringent policies initiated, including lockdown, social distancing, and/or self-quarantine. The fear of viral contamination might have resulted in relatively high rates of cancelling or re-scheduling non-urgent endoscopic activities. Lahat et al. [1] showed a high rate of upper gastrointestinal bleeding during endoscopic procedures conducted during March 2020; however, no further details were provided regarding this unusual observation. Interestingly, Lahat et al. [1] highlighted that there was no remarkable change in the number of endoscopic retrograde cholangiopancreatographies (ERCPs), although many ERCP patients usually visit the emergency room due to acute cholangitis, high fever, or abdominal pain. No mention was made of the indications for ERCP in this article.

During the COVID-19 outbreak, telemedicine has become a potentially viable option for ensuring a protective physical barrier between healthcare providers and patients. Virtual technology can deliver medical information including triage, avoid potential viral exposure in the hospital, and minimize evaluation time prior to the endoscopy [4].

Further evaluation of the change in numbers, indications, and therapeutic modalities of emergent endoscopies can provide a better understanding of changes in endoscopic patterns.