Delays from the COVID-19 pandemic have halved the number of surveillance colonoscopies performed in South Australia compared to pre-COVID rates, an audit reveals.
And gastroenterologists are now suggesting that low-risk surveillance colonoscopy could be triaged to FIT to overcome COVID-19 backlog.
The figures come from the audited records of two public healthcare centres in Southern Adelaide between April and June 2020 when clinical services were most affected by COVID-19, compared to the same time period in 2019.
Most of the delayed procedures were for patients on three- and five-year surveillance recall intervals. Many patients of the patients due to undergo the procedure were delayed by more than six months, according to Dr Molla Wassie from Flinders University and colleagues from Royal Adelaide Hospital and Flinders Medical Centre writing in JGH Open.
In 2019, 45.5% (n = 530) of colonoscopies were completed for surveillance, but this proportion dropped to 32.0% (n = 182) during 2020, an overall decrease in the number of surveillance colonoscopies of 65.6%.
Of surveillance colonoscopies that were due in 2020, 46.1% (134/291) were delayed by more than six months – a significant increase compared to 2019 (19.3%; 59/306, P < 0.001), say investigators.
The figures have raised concerns among clinicians involved in the study, who said delays of six months and above were associated with later-stage CRC when screening with FIT.
Triage call
It’s prompted a call for triage of surveillance colonoscopy post COVID-19 to reduce the number of procedures and prioritise urgent colonoscopies for the patients who are now at elevated-risk due to delayed surveillance.
One strategy to reduce the backlog would be to redirect lower-risk surveillance colonoscopies to FIT, which has been found to be effective in detecting advanced colorectal lesions between colonoscopies, investigators proposed.
“Within the audited period of the current study, just over one-third of patients scheduled for surveillance colonoscopy were considered to be at the lowest risk as they had been given a 5-year interval. These patients could be redirected to FIT, helping to reduce the burden on the limited resources.”
But a detailed and individualised risk assessment strategy to determine which patients can safely undergo less frequent colonoscopies would be required, they added.
Investigators pointed out that the main impact of these reductions had been observed on the non-urgent colonoscopies.
And with no significant difference in the time taken for most patients to respond to recall letters during COVID compared to pre COVID researchers say it was likely that the reduction in surveillance colonoscopies was a reflection of the overall reduction in colonoscopy capacity, rather than patient reluctance to undergo colonoscopy.
However, that may be different for a subgroup of patients, those aged 75 and older. In 2020, there were significantly more nonresponders (16/31, 51.6%) compared to 2019 (10/39, 25.6%, P = 0.03)
Over the three months during COVID-19 pandemic, the proportion of urgent colonoscopies increased from 71.2% (828/1163) in 2019 to 78.2% (445/569) in 2020, accompanied by a significant decrease in the number of nonurgent colonoscopies completed from 335 to 124 (63.0% reduction, P = 0.002).
Decisions to carry out some 20 urgent colonoscopies during the pandemic were made in order not to compromise patient care despite the procedure being aerosol generating and increasing the potential for COVID-19 transmission, researchers said.
Some surveillance was also performed, for instance, following a recent past cancer diagnosis and particularly after colonoscopy removal of advanced neoplasia, they note.