Reduction in endoscopy activity during pandemic: cause for alarm?

Dr Julian Schulberg

The early COVID-19 pandemic clinic restrictions led to a dramatic reduction in endoscopy services but did not reduce cancer detection rates, Victorian gastroenterologists report.

The number of endoscopy procedures performed at St Vincents Hospital in Melbourne was cut by 66% during the five-week lockdown period from 26 March to 1 May 2020 compared to the same period in 2019, according to Dr Julien Schulberg and colleagues in the Department of Gastroenterology

But their model of care that deferred all non-urgent category 2 and all category 3 cases did not result in lower  numbers of highly significant pathology was found, they report in an article published in Gut.

The six new malignancy diagnoses during the five week COVID-19 lockdown period are in keeping with the median monthly cancer rate of 5.5 diagnoses over the last two years, they say.

The pandemic model of care also included specific clinics set up with experienced endoscopists to re-triage outstanding cases. Screening colonoscopy as part of the national bowel cancer screening programme following positive FOBTs was largely continued.

The number of procedures during the lockdown period was 141 (79% category 1, 21% category 2) compared to 410 (45% category 1, 45% category 2, 10% category 3) in a similar pre-COVID era. Colonoscopy was reduced to 46% of pre-COVID levels and gastroscopy to 25%.

In their article, the authors note that of the 4621 gastroscopies and 4573 colonoscopies performed in the past two years, 94% of the newly diagnosed upper and lower GI cancers were triaged as category 1 endoscopies and only 6% were category 2.

The conclude that the disruption to endoscopy services in Australia while significant, has not yet been as severe as in the UK and US, where some centres have reported endoscopy activity dropping to as low as 5% of pre-COVID levels and cancer detection rates reduced by 72%

“Our findings suggest the risk of missing significant and time-critical pathology can be mitigated by a model of care prioritising category 1 and urgent category 2 upper and lower GI endoscopies,” they write.

“Thus, increasing from minimal endoscopic activity up to 34% of usual levels may achieve a dramatic increase in malignancy diagnosis while still preserving capacity for COVID-19 patient care within the hospital system.”

However they caution that questions remain regarding the pandemic’s influence on screening programs including FOBT and visits to primary care for concerning GI symptoms.

“With COVID-19 remaining a worldwide pandemic, its impact on endoscopy services and cancer detection will undoubtedly become increasingly significant. For that reason, continuing to perform diagnostic endoscopic procedures above a minimum threshold will be critical to prevent a cancer healthcare crisis in the future,” they conclude.

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