January 2020 marked the very early period of SARS-CoV-2's arrival in Japan. At the time, we immediately and strictly adopted the use of enhanced PPE, including a N95, gown, gloves, eye protection, and an apron, during every endoscopic procedure for every patient, with or without COVID-19. One reason why we use enhanced PPE for every patient is because all endoscopic procedures should be considered aerosol-generating procedures, and another reason is that asymptomatic patients with COVID-19 cannot be identified during a pandemic. The volume of endoscopic screening/surveillance endoscopies decreased markedly, but therapeutic endoscopies did not decrease. In contrast, urgent endoscopic hemostasis has increased more than ever. The most common reason for the increase might be that the lack of protective equipment and the need for medical staff to deal with an unknown virus, creating a pandemic panic in emergency medicine.
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