Gastro-esophageal reflux disorder (GERD) is the most common gastrointestinal tract disorder with high morbidity and heavy economic burden. Despite being treated with high-dose proton-pump inhibitors or H2 receptor blockers, a considerable percentage of patients have GERD that is only partially controlled or refractory. The majority of these patients forego surgical treatment for fear of adverse outcomes, putting them at a financial disadvantage and causing loss of productivity. Untreated GERD is the sole known risk factor for developing Barrett's esophagus and esophageal adenocarcinoma if left untreated. With the advancement in therapeutic modalities in recent years, and given the issues such as medication compliance, the risk of adverse events with long-term antisecretory treatment, and fear of undergoing surgical treatment, endoscopic treatments such as Stretta and transoral incisionless fundoplication (TIF) have become a safe, cost-effective, and resilient option for the treatment of refractory GERD. Patients with refractory GERD ineligible for endoscopic therapies due to a large hiatal hernia can have their hiatal hernia corrected simultaneously with TIF (C-TIF). For the treatment of refractory GERD, endoscopic therapy is a viable and compelling option. Endoscopic therapies for refractory GERD patients are highly recommended due to their reproducible and standardized results as well as the potential to address the fundamental mechanical issue.

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e15522 Background: The COVID-19 pandemic imposed significant restraints on healthcare systems, raising concerns regarding care delays and excess cancer-related deaths. We aimed to investigate the impact of COVID-19 on colorectal cancer (CRC) screening and the time to treatment initiation (TTI) for cases with a confirmed diagnosis of CRC. Methods: We conducted a retrospective study in which we included all patients who underwent screening colonoscopy between April 2019 and March 2021 at our hospital. Patients with a diagnosis of CRC have been confirmed with the data from our cancer center to check if they could continue cancer staging workup and start their treatment. Patients were stratified into pre-COVID-19 (April 2019-March 2020) and COVID-19 (April 2020-March 2021) groups. Descriptive statistics and multivariate regression analysis were applied using SAS software, version 9.4. Results: A total of 1439 patients underwent screening colonoscopies during the study period. 746 during pre-COVID-19 group, and 693 during COVID-19 group (p = 0.1624). In the pre-COVID-19 group, 47 patients were found to have CRC, and 25 patients (53%) continued cancer staging workup and started treatment in our cancer center. Among 36 patients with confirmed CRC diagnosis in the COVID-19 group, only five patients (14%) continued cancer staging workup and started treatment (p = 0.0003). All patients with confirmed CRC in the COVID -19 group had localized disease compared to 25 patients (96%) in the pre-COVID-19 group. TTI in the COVID-19 group (mean of 21 days ± 13.3) was shorter compared to the pre-COVID-19 group (mean of 33 days ± 46.7) (p = 0.025). Comparative analysis between the study groups didn’t show any statistically significant difference based on age, sex, race, or insurance status. Conclusions: In our hospital, the COVID-19 pandemic didn’t appear to affect the accessibility to CRC screening or delay in TTI. However, a limited number of patients with confirmed CRC during the COVID-19 pandemic were able to continue cancer staging workup and receive treatment.