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Up to 4 February 2020, over 20000 laboratory-confirmed cases of novel coronavirus (2019-nCoV) infection have been reported in China, of which more than 60% are in Wuhan city and Hubei province. Patients may display a wide range of symptoms, while others are asymptomatic or have minimal symptoms after becoming infected [1, 2]. Although fever, fatigue, and dry cough are the most common symptoms, diarrhea has been observed as the first symptom in many young patients, while abdominal discomfort and poor appetite are shown in elderly patients. Our data have shown that more than 50% of patients with confirmed or suspected infection present with diarrhea (16/28). The transmission rate indicated by reproductive number (Ro) is 4.08 according to a recent study [3]. The total mortality rate of 2019nCoV pneumonia is only 2%, according to the analysis of public data. However, the mortality rate of severe cases of 2019-nCoV pneumonia has been between 10% and 40% on different days of the outbreak in Wuhan. As the Chinese Spring Festival holiday comes to an end, most endoscopy centers in China will reopen to patients who need endoscopic operations. 2019-nCoV has been described to be transmitted from respiratory secretions, feces, and contaminated environmental surfaces [1, 4]. In addition, the virus is spread not only by patients with symptoms but also by asymptomatic individuals [2]. Due to the inevitable exposure to respiratory secretions during upper gastrointestinal (GI) endoscopy and exposure to feces during colonoscopy, all individuals in the endoscopy center are at high risk of exposure to the virus, especially the staff in the operating room. To prevent 2019nCoV transmission in the endoscopy center, we offer the following summary and recommendations for infection prevention and control in digestive endoscopy during the current outbreak of 2019nCoV according to the epidemiological characteristics we have observed, combined with past experience and the literature (▶Fig. 1)

Suggestions for infection prevention and control in digestive endoscopy during current 2019-nCoV pneumonia outbreak in Wuhan, Hubei province, China