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.

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INTRODUCTION: Complementary and alternative medicine are commonly used by patients with gastrointestinal symptoms often in conjunction with a naturopath or herbalist provider. It is unknown how often patients seen in gastroenterology clinic also consult with a naturopath or herbalist provider, what diagnoses patients are subsequently given, and how this affects management of their gastrointestinal symptoms. The purpose of this study was to determine the prevalence of naturopath and herbalist co-management, and details of this alternative medical care, in patients seen in gastroenterology clinic. METHODS: An optional survey was administered to patients attending gastroenterology clinic at a county hospital. The study period was January to May of 2019. The survey queried subjects on consultation with a naturopath or herbalist, which symptoms prompted this consultation, and what diagnoses and management recommendations were subsequently received. Patients unable to consent or those who did not demonstrate proficiency with written English language were excluded. Data were analyzed with descriptive statistics using Excel (Version 16.23). Institutional Review Board approval was obtained. RESULTS: A total of 60 subjects completed the survey. Forty-nine (82%) respondents were female, and median age was 43-years-old. Twelve (20%) subjects reported consultation with a naturopath or herbalist in the past year for gastrointestinal symptoms. The majority of these subjects were female (92%). The most common symptoms prompting referral were abdominal pain, nausea and constipation, but numerous other symptoms were also reported (see Figure 1). The most common diagnoses given to subjects were irritable bowel syndrome, food allergies, leaky gut and small intestinal bacterial overgrowth (25% for each diagnosis). Seven (58%) subjects reported receipt of herbal medications following consultation. CONCLUSION: One-fifth of subjects referred to gastroenterology clinic had also consulted with a naturopath or herbalist. A wide variety of gastrointestinal symptoms prompted these consultations, and more than half of subjects received treatment with herbal medications.

INTRODUCTION: Cannabinoids are compounds derived from the Cannabis sativa plant. These include the psychoactive delta-9-tetrahydrocannabinol (Δ9-THC), although non-psychoactive compounds such as cannabidiol also exist. Given the prevalence of cannabinoid receptors in the enteric nervous system, use of cannabinoids may contribute to the pathophysiology or treatment of gastrointestinal motility and functional disorders. However, little is known about the prevalence of cannabinoid use in patients referred to out-patient gastroenterologists. The aim of this study was to determine the prevalence of cannabinoid use, and its relation to specific gastrointestinal symptoms, in patients seen in gastroenterology clinic. METHODS: An optional survey was administered to patients attending gastroenterology clinic at a county hospital in a state where both recreational and medical cannabis use are legal. The study period was January to May of 2019. The survey queried subjects on type of cannabinoid product used, frequency of use, whether cannabinoids were used for treatment of gastrointestinal symptoms, and efficacy. Diagnosis was recorded following review of the electronic medical record. Patients who were unable to consent or those who did not demonstrate proficiency with written English were excluded. Data were analyzed with descriptive statistics using Excel (Version 16.23). Institutional Review Board approval was obtained. RESULTS: A total of 60 subjects completed the survey. Forty-nine (82%) respondents were female, and median age was 43-years-old. Twenty-nine (48%) subjects reported use of cannabinoids within the past year; the most common substances were marijuana (90%) or marijuana and cannabidiol (48%). The most common diagnosis for these subjects was chronic abdominal pain (see Figure 1). Thirty-one percent of patients reported using cannabinoids more than once daily. Twenty-eight percent of subjects reported use of cannabinoids to alleviate gastrointestinal symptoms, with a median improvement of 6 on a scale of 0-10 (0 representing no relief, 10 representing full relief). The most common reported symptom for this subset of patients was abdominal pain (see Figure 2). CONCLUSION: Use of cannabinoids, including both marijuana and cannabidiol products, was common in subjects with gastrointestinal symptoms referred to a gastroenterology clinic in a state where use is legal. More than half of subjects using cannabinoids did so for relief of a wide variety of gastrointestinal symptoms.