Recommendations and algorithms to deal with gastroenterological procedures, inflamma-tory bowel diseases, liver diseases and transplantation during COVID-19 Pandemic: Re-view article and regional expert opinion

Coronavirus Disease 2019 (COVID-19) has emerged in Wuhan, China, in December 2019, then spread to become a worldwide pandemic with significant morbidity and mortality. This has left healthcare systems worldwide vulnerable to the surge in the number of patients. With the exponential spread of the disease and increasing demand for medical care, a signifi-cant proportion of medical procedures were canceled or delayed to decrease viral transmis-sion. Most inflammatory bowel disease patients are on immunosuppressive agents, which are presumed to put them at a higher risk for acquiring the infection. However, some studies have shown that immunosuppressive agents did not increase mortality from COVID-19 at any age. Although most of the morbidity and mortality of this condition are related to respira-tory manifestations, some patients develop extra-pulmonary manifestations including gastro-intestinal and hepatic derangements. Studies have shown that liver chemistry abnormalities are common with COVID-19. There is currently no vaccine or effective treatment for COVID-19, so the only thing we can do is reduce the virus's transmission. In this review, we addressed the dilemma of how to deal with gastroenterological procedures in times of a spreading pandemic, to decide which procedures can or cannot be postponed based on cur-rent international available data. As well as, to ensure the continuation of the essential management of inflammatory bowel diseases (IBDs) patients, many of whom are on immuno-suppressive and biologic agents, thus, making the decisions about which medications the patient can stay on to prevent disease attacks. Finally, studying the hepatic manifestations during the COVID-19 pandemic. We have also postulated local recommendations that can serve as a guide for managing liver diseases during COVID-19 and when to go to liver transplantation with the least risk possible for viral transmission.