The AGIP Council is aware that much has changed since their initial advice was issued in May 2020. AGIP continues to maintain that oesophageal manometry and pH measurement is an inherently aerosol generating procedure. AGIP acknowledges the recent advice issued by BSG for Endoscopy and recommend where appropriate aligning GI physiology procedures to those implemented by Endoscopy in your hospital.

We point members to the BSG guidance published for performing upper GI endoscopy and therefore upper GI physiology in low prevalence areas where PCR tests are performed prior to investigation, thus being a Covid-minimised environment. Under those conditions with a negative PCR test and appropriate pre-investigation checks indicating minimal Covid risk then the expectation is that upper GI physiology can be performed in standard (level 1) PPE with additional eye and face protection and the need for full room decontamination is reduced. There is need to ensure the confidence and agreement of staff involved if such a move is to be implemented, particularly at this time of increasing incidence of Covid-19.

We continue to recommend Level 1 PPE is sufficient (with the option of additional eye and face protection if requested by staff) for lower GI investigations. We would further recommend that in low prevalence areas the cough manoeuvre can now be undertaken provided the patient wears a mask and has had a pre-investigation negative PCR test as per the BSG recommendations.