Procedures in Chronic Liver Disease Patients During COVID-19

COVID-19 poses challenges to healthcare services, requiring a balance between minimizing viral spread and providing quality care. Endoscopy in chronic liver disease patients must consider SARS-CoV-2 transmission risks. Specific procedures like endoscopic band ligation and ERCP are indicated based on variceal bleeding, signs of bleeding, cholangitis, and suspicion of cholangiocarcinoma. Paracentesis and TIPS are recommended for managing refractory conditions, all requiring strict adherence to full PPE protocols.

• Liver disease
• Procedures
• Endoscopy
• COVID-19
• Healthcare services

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1. Performing procedures in chronic liver disease patients Rui Gaspar Guilherme Macedo Centro Hospitalar Univers t rio de S o Jo o

2. COVID-19 created several challenges to healthcare services: Avoid physician-patient contact to minimize viral dissemination At the same time we should provide high-quality health care services

3. Endoscopy and SARS-Cov-2 transmission: Human-to-human transmission occurs mainly through respiratory secretions and aerosols, but also by feces and contaminated environmental surfaces.1- 3 Endoscopy is a high risk procedure as healthcare providers will be exposed to respiratory and/or gastrointestinal fluids.3 Thus, it is very important to strictly select the emergent procedures. 1. Xiao F, Gastroenterology 2020; 2. Del Rio C, JAMA 2020; 3. Soetikno R, Gastrointest Endosc 2020.

4. When to perform proceduresin chronicliver disease patients? Endoscopic band ligation: Patients with large varices and red spots Recent variceal bleeding Signs of active bleeding (hematemesis, malaena) ECRP: Cases of cholangitis, sepsis or high suspicion of cholangiocarcinoma

5. When to perform procedures in chronic disease patients? liver Paracentesis: Therapeutic paracentesis in patientswith refractorylarge volume paracentesis TIPS: Cases of refractory variceal bleeding

6. When to perform procedures in chronic disease patients? liver All the procedures should be performed under full set of PPE, including N95 masks and double gloves5,6 5. Sultan S, Gastroenterology 2020. 6. Repici A, Gastrointest Endosc 2020.