<b><i>Introduction:</i></b> Coronavirus disease 2019 (COVID-19) is a global pandemic that has severely affected health care systems around the world. During the emergency state declared in Portugal in the months of March and April 2020, there was a severe reduction in medical activity in order to reduce the pressure on health systems. This study aimed to assess the impact of COVID-19 in gastroenterology departments across Portugal and the strategies developed to overcome this challenge. <b><i>Methods:</i></b> This was a cross-sectional study based on an online survey. A detailed questionnaire concerning different aspects of gastroenterology department activity was sent via e-mail to the heads of gastroenterology departments of Portuguese District Hospitals (Núcleo de Gastroenterologia dos Hospitais Distritais). Two periods were assessed, i.e., the emergency state and the recovery period between May and September. The responses were collected between September and October 2020. <b><i>Results:</i></b> A total of 21 hospitals were enrolled (80.8% response rate). Twenty-eight percent of the responders reported healthcare professionals from their unit infected with COVID-19. At least 1 member (mostly fellows) of the department was deployed to another workplace in 66.7% of the hospitals. During the emergency state, 47.6% of the hospitals only performed urgent/emergent endoscopic procedures. In 38.5% of the hospitals the need to ration personal protective equipment led to the suspension of endoscopic training. Regarding the recovery period, nonurgent procedures were restarted in almost all of the centers. The same was reported for the colorectal cancer screening program. Remarkably, 81% of the responders confirmed that they had postponed procedures at patients’ request for “fear of getting infected.” Remote consultation was maintained in 81% of the hospitals. Globally, the fellows had resumed their training. <b><i>Discussion/Conclusion:</i></b> This study provides a snapshot of the impact and consequences of the first wave of the COVID-19 pandemic across Portuguese hospitals. It is important to understand how the gastroenterology world dealt with the first impact of COVID-19 and what strategies were implemented in order to better prepare for what might follow.

<b><i>Introduction:</i></b> The COVID-19 pandemic drastically changed the daily routine of all healthcare systems worldwide, and endoscopy units were no exception. Endoscopic exams were considered to have a high risk of transmission, and therefore, the safety of endoscopy units and the consequent need for pre-endoscopy SARS-CoV-2 screening were questioned early on. The aim of our study was to assess the safety of endoscopy units during the COVID-19 pandemic, as well as the effectiveness/necessity for SARS-CoV-2 screening prior to endoscopies. <b><i>Material and Methods:</i></b> This is a retrospective and single-center study carried out in a Portuguese tertiary hospital. All patients who underwent endoscopic procedures between September 1, 2020 and February 28, 2021 were included. The pre-endoscopy screening consisted of a specific questionnaire or a RT-PCR test for SARS-CoV-2 (nasal and oropharyngeal swab). Data were obtained through patient’s clinical records and the Trace COVID platform. <b><i>Results:</i></b> A total of 2,166 patients were included. Patients had a mean age of 61.8 years and were predominantly male (56.2%, <i>n</i> = 1,218). Eighty-one (3.7%) patients had previous SARS-CoV-2 infection, with a median difference of 74 days (IQ 40.5:160.5) between infection and endoscopy. Most patients (70.2%, <i>n</i> = 1,521) underwent PCR screening for SARS-CoV-2 up to 72 h before the procedure, with the remaining patients (29.8%, <i>n</i> = 645) answering a questionnaire of symptoms and risk contacts up to 3 days before endoscopy. Of the patients who underwent RT-PCR screening for SARS-CoV-2, 21 (1.4%) tested positive, and all were asymptomatic at the time of the screening. The evaluation for SARS-CoV-2 infection up to 14 days after the endoscopic exams identified 9 positive patients (0.42%) for SARS-CoV-2. The median difference in days between endoscopy and the diagnosis of infection was 10 days. <b><i>Discussion/Conclusion:</i></b> Pre-endoscopy screening with RT-PCR test for SARS-CoV-2 identified a very small number of patients with COVID-19 infection as well as patients with COVID-19 infection in the following 14 days. Therefore, the risk of infection in endoscopy units is negligible if screening of symptoms and risk contacts is applied and individual protective equipment is used.

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An 85-year-old woman presented to the emergency department with a 5-day history of melena and epigastric pain. On admission, the patient was dehydrated, pale, and hemodynamically stable. Initial blood work revealed a hemoglobin level of 6 g/dL (microcytic). Esophagogastroduodenoscopy revealed, in the greater curvature of the gastric body, a 35-mm polypoid lesion with dark pigment and oozing blood (a). A mixture of diluted epinephrine and methylene blue was injected into the submucosa, with successful en bloc mucosal resection, using a 25-mm hot snare (SnareMaster, Olympus, Tokyo, Japan) in cut mode (Endocut Q, effect 3, VIO 300 D, Erbe, Tubingen, Germany). Two hemostatic clips were applied, with no complications after endoscopic resection. The histopathologic examination revealed a neoplasia with a diffuse growth pattern of epithelioid cells (b) with prominent nucleoli, expressing S-100 and SOX10 on immunohistochemistry (c). Submucosal invasion was shown, with horizontal and vertical free margins and no angioinvasion or neuroinvasion. An extensive ophthalmologic, dermatologic, and gynecological examination excluded the presence of melanoma outside the gastrointestinal tract. Moreover, whole-body positron emission tomography (18-FDG-PET/CT) did not reveal pathological uptake in any other organs, reinforcing the clinical diagnosis of primary malignant melanoma. In the 36-month follow-up, the patient remained asymptomatic and without recurrence. This case suggests that early-stage primary gastrointestinal melanoma can be safely and effectively resected by endoscopy and may be a minimally invasive alternative to surgery. (The authors obtained informed consent from the patient for the publication of their information and imaging.