Drastic decrease of urgent endoscopies outside regular working hours during the Covid-19 pandemic in the paris area

Abstract

Highlights The coronavirus 2019 (COVID-19) pandemic has significantly affected medical care worldwide. Protective measures, reallocation of equipment and human resources have changed the operating procedures in all departments. From mid-April 2020 the epidemic stabilized and receded in France, leading to a partial easing of home isolation on in May. The urgent endoscopy caseload outside regular working hours decreased nearly by half during the COVID-19 pandemic. The number of endoscopies for suspected GIB and the number of variceal and non-variceal GIB decreased because of home isolation.

Changes in endoscopic patterns before and during COVID-19 outbreak: Experience at a single tertiary center in Korean

“…In view of the risk of SARS-COV-2 transmission during endoscopic procedures, we placed focus on the protection of HCPs and timely treatment[ 2 , 7 - 9 ]. In the present study , the number of endoscopic procedures fell by ≥ 50% during the COVID-19 outbreak as compared with equivalent periods in 2018 and 2019, which concurs with a French report[ 22 ] and demonstrates that the COVID-19 pandemic had a huge impact[ 15 ]. There are several explanations for the remarkable reductions observed in endoscopic activities.…”

“…A notable change in lifestyle may have reduced the numbers of variceal bleeding and vomiting-related Mallory-Weiss bleeding cases; (2) The stay-at-home-policy by the government appeared to encouraged elderly, cardiocerebrovascular, and immunocompromised patients to take their medications ( e.g., proton pump inhibitors, H2 blockers, and mucosal protectants) regularly. This was somewhat expected as COVID-19 outbreaks are associated with remarkable reductions in ulcer-related GIB cases[ 22 ]; (3) Marked reductions in numbers of invasive procedures, including colon polypectomy, gastric or colon endoscopic submucosal dissection, or endoscopic mucosal resection may have substantially decreased the incidence of GIB, which concurs with the findings of a previous study[ 22 ]. Actually, during the COVID-19 outbreak, most non-urgent, invasive endoscopic procedures were postponed; and (4) Reduced outdoor activities may have lowered trauma-associated incidences of sprains, contusions, and fractures, which are indirectly associated with lower rates of ulcer-related GIBs due to reduced consumption of nonsteroidal anti-inflammatory drugs and over-the-counter painkillers.…”

“…First, we canceled or postponed most routine endoscopic procedures such as regular check-ups and routine follow-up visits after endoscopic submucosal dissection, endoscopic mucosal resection, and polypectomy, and preoperative evaluations. Unlike the situations in Europe or the United States, where governments issued instructions to cancel or postpone routine endoscopy at times of lockdown, no specific directions regarding canceling or postponing endoscopy were issued by the metropolitan task-force committee[ 20 , 22 , 23 ]. Some endoscopies were canceled or postponed by patients because they were concerned about in-hospital infection, and this raised concerns that potential malignancies might be missed.…”

Comparison of the impact of endoscopic retrograde cholangiopancreatography between pre-COVID-19 and current COVID-19 outbreaks in South Korea: Retrospective survey

“…Initially, once the RT-PCR assay for SARS-CoV-2 was confirmed to be positive at the ER, the task force committee of the metropolitan city instructed the shutdown of the ER for 24 h as a preemptive measure, which was later modified. There are a few articles regarding the frameshift of endoscopic procedures, such as the reduction of the number of endoscopies following the lockdown order from the government[ 9 , 16 , 17 ]. However, little is known about the clinical impact of COVID-19 on ERCP procedures, despite the fact that many pancreatobiliary patients require urgent ERCP in the setting of COVID-19 pandemic.…”

“…How can we explain this decrease in the number of elective ERCP procedures? A few explanations can be provided for this phenomenon[ 17 ]. First, the main indications for elective ERCP were asymptomatic bile duct stones, interval ERBD change, ERBD removal, follow-up ERCP for remnant stones with inserted ERBD, or incidental jaundice due to potential pancreatobiliary malignancy.…”