Impact of the COVID-19 pandemic on gastrointestinal endoscopy in the Netherlands: analysis of a prospective endoscopy database

Abstract

Background COVID-19 has dramatically affected gastrointestinal endoscopy practice. We aimed to investigate its impact on procedure types, indications, and findings. Methods We retrospectively analyzed endoscopies performed in 15 Dutch hospitals by comparing periods 15 March to 25 June of 2019 and 2020 using the prospective Trans.IT database. Results During lockdown in 2020, 9776 patients underwent endoscopy compared with 19 296 in 2019. Gastroscopies decreased by 57 % (from 7846 to 4467) and colonoscopies by 45 % (from 12219 to 5609), whereas endoscopic retrograde cholangiopancreatography volumes remained comparable (from 578 to 522). Although endoscopy results indicative of cancer decreased (from 524 to 340), the likelihood of detecting cancer during endoscopy increased (2.7 % [95 % confidence interval (CI) 2.5 – 3.0] in 2019 versus 3.5 % [95 %CI 3.1 – 3.9] in 2020; P < 0.001). After lifting of lockdown, endoscopy volumes started to return to normal, except for colorectal cancer screening. Conclusions Fewer endoscopies were performed during the COVID-19 lockdown, leading to a significant reduction in the absolute detection of cancer. Endoscopies increased rapidly after lockdown, except for colorectal cancer screening.

Colorectal screening: We have not caught up. A surge of colorectal cancer after the coronavirus disease 2019 (COVID-19) pandemic?

“…The decreased activity has been reported in several studies. 5 , 6 , 7 Our results are consistent with results of other recent studies. 8 The novelty of our current report is the analysis of the post-COVID lockdown activity, which raises a public health concern.…”

“…Similarly, Latinga et al reported a 44% decrease in endoscopy activity after the onset of COVID-19 for colorectal cancer screening in the Netherlands. 6 …”

Endoscopy during COVID – what have we learned?

“…In the study from the Netherlands, the absolute number of newly diagnosed suspected gastrointestinal cancers during lockdown was approximately 35 % lower compared with the previous year [1]. The decline was restricted to esophageal and colon cancers, while the number of suspected rectal and gastric cancers remained similar.…”

“…In this issue of Endoscopy , two studies from Europe highlight potential areas of improvement in our endoscopy practice 1 2 . A 15-center study from the Netherlands 1 and a 5-center study from Northern Italy 2 examined volume, indication, and findings of endoscopic procedures during the COVID-19 lockdown period between March and May 2020 compared with the same period in 2019. Both studies found a major decline of approximately 50 % in the volume of endoscopy procedures.…”

“…Of note, after the lockdown was lifted, the endoscopy volume did not surge above the pre-lockdown volume to accommodate the waiting lists 1 . While this may reflect the adjustments needed to practice safely during the ongoing pandemic (e. g. need for personal protective equipment and screening of patients), it is also plausible that indications were viewed more critically and scrutinized for true relevance and appropriateness.…”