Real-World Data on the Impact of COVID-19 on Endoscopic Procedural Delays

Abstract

INTRODUCTION: The initial surge of the coronavirus disease 2019 (COVID-19) pandemic prompted national recommendations to delay nonurgent endoscopic procedures. The objective of this study was to provide real-world data on the impact of COVID-19 on endoscopic procedures in a safety-net healthcare system and cancer center affiliated with a tertiary academic center. METHODS: This retrospective cohort study used a combination of electronic health record data and a prospective data tool created to track endoscopy procedures throughout COVID-19 to describe patient and procedural characteristics of endoscopic procedures delayed during the initial COVID-19 surge. RESULTS: Of the 480 patients identified, the median age was 57 years (interquartile range 46–66), 55% (n = 262) were male, and 59% self-identified as white. Colonoscopy was the most common type of delayed procedure (49%), followed by combined esophagogastroduodenoscopy (EGD) and colonoscopy (22%), and EGD alone (20%). Colorectal cancer screening was the most common indication for delayed colonoscopy (35%), and evaluation of suspected bleeding (30%) was the most common indication for delayed combined EGD and colonoscopy. To date, 46% (223/480) of delayed cases have been completed with 12 colorectal, pancreatic, and stomach cancers diagnosed. Sociodemographic factors, procedure type, and sedation type were not significantly associated with endoscopy completion. The median time to endoscopy after delayed procedure was 88 days (interquartile range 63–119) with no differences by procedure type. DISCUSSION: To minimize potential losses to follow-up, delayed, or missed diagnoses and to reduce progression of gastrointestinal diseases, all efforts should be used to ensure follow-up in those whose endoscopic procedures were delayed because of COVID-19.

Colorectal Surgery in the COVID-19 Era: A Systematic Review and Meta-Analysis

“…The COVID-19 pandemic has significantly decreased the availability of health services for non-covid patients [ 22 ]. With regard to colorectal neoplasias, the unprecedented burden of the pandemic on healthcare systems has led to a considerable reduction in the number of diagnostic and surveillance endoscopic procedures performed in the general population [ 23 , 24 ]. Recent reports indicate that such drastic changes in clinical practice are projected to lead to increased incidence and tumor stage upshifting as missed cancer cases keep accumulating, in turn increasing colorectal cancer-associated mortality [ 25 ].…”

Pediatric Endoscopy During COVID-19 Times

“…Recent studies have demonstrated this impact in specific countries. Issaka et al ( 38 ) retrospectively examined delays in endoscopic procedures in one centre in USA. In the cohort of 480 patients, colonoscopy was most frequently delayed (49%), especially in the setting of colorectal cancer screening.…”

Surgical intervention for acute pancreatitis in the COVID-19 era

“…Compared to 2019, there was a 57.5% reduction in ERCP in 2020 due to the impact of the COVID-19 pandemic[ 26 ]. The median time to endoscopy for AP after a delayed procedure due to COVID-19 was 88 d[ 6 ].…”

“…The COVID-19 pandemic also led to a reduction in the number of surgical resections and increased adoption of non-surgical management for pathologies that were traditionally treated surgically[ 5 ]. On the other hand, many governments published national recommendations to delay nonurgent endoscopic procedures, which lead to decrements of 49% in colonoscopy, 22% in combined esophagogastroduodenoscopy (EGD) and colonoscopy, and 20% in EGD during the pandemic in United States[ 6 ]. Thus, some examinations for pancreatic disorders were delayed and conservative waiting times for definitive surgery increased[ 7 ].…”