Elective endoscopies have been postponed or cancelled across Europe during the COVID-19 outbreak [
29] since these procedures were deemed to be at high viral transmission risk. Upper digestive tract endoscopy can cause airborne transmission by inducing coughing, gagging, and retching, whereas colonoscopy can result in the passage of flatus and pathogen-carrying liquid stools. In December 2020, the SIGENP Endoscopy Working Group conducted a web-based survey among 24 Italian pediatric centers that perform digestive endoscopies [
22]. The purpose of this study was to assess the impact of COVID-19 on procedural volumes, indications, healthcare provider safety perceptions, and waiting times for pediatric endoscopies. Between 2019 and 2020, there was a 37.2% decrease in digestive endoscopies, with a substantial decrease in the median number of procedures (111 vs 57,
p < 0.001) [
22]. The median number of procedures performed either for new diagnosis or follow-up declined significantly in 2020 (63 vs 36,
p < 0.001 and 42 vs 21,
p < 0.001, respectively) [
22]. While endoscopies for new diagnoses of celiac disease, functional gastrointestinal disorders (FGIDs), suspected Helicobacter pylori infection, eosinophilic gastroenteropathy, or to exclude FGIDs were significantly reduced, only a minor drop was noted for IBD new diagnoses [
22]. In particular, the total number of endoscopies scheduled for suspected celiac disease at the 24 participating centers declined from 621 to 279 (a 55.1% decrease). However, the updated ESPGHAN recommendation to examine the feasibility of a biopsy-free technique for the identification of celiac disease in a restricted group of children [
30] may have contributed to a decline in the use of endoscopy for celiac disease diagnosis. Moreover, due to the lack of available endoscopic slots during the pandemic, some sites decided to consider a lower antibody threshold to make a biopsy-free diagnosis [
31]. A modification of the indications for digestive endoscopy procedures is warranted in the context of endoscopic restriction. Given pandemic-related resource limitations, patient triage is a priority to balance the need to curtail viral spread with the ramifications of potentially delayed diagnosis, particularly for endoscopic procedures. SIGENP proposed throughout its network triage protocols to help pediatric gastroenterologists in indicating endoscopic procedures during the pandemic (available at:
https://sigenp.org/wp-content/uploads/2020/10/Endoscopia_Digestiva_COVID19.pdf). The North American guidelines outlining a risk stratification of pediatric endoscopic procedures during the pandemic also tried to address this need [
32]. During COVID-19, SIGENP proposed considering avoiding intestinal biopsy for diagnostic confirmation in case of symptomatic patient with positive IgA anti-endomysial antibodies and IgA tissue transglutaminase antibodies > 7.5 × and < 10 × cut-off (
https://sigenp.org/wp-content/uploads/2020/10/MC_COVID.pdf).