Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis

Abstract

ObjectiveThe COVID-19 pandemic has had a major global impact on endoscopic services. This reduced capacity, along with public reluctance to undergo endoscopy during the pandemic, might result in excess mortality from delayed cancer diagnosis. Using the UK’s National Endoscopy Database (NED), we performed the first national analysis of the impact of the pandemic on endoscopy services and endoscopic cancer diagnosis.DesignWe developed a NED COVID-19 module incorporating procedure-level data on all endoscopic procedures. Three periods were designated: pre-COVID (6 January 2020 to 15 March), transition (16–22 March) and COVID-impacted (23 March–31 May). National, regional and procedure-specific analyses were performed. The average weekly number of cancers, proportion of missing cancers and cancer detection rates were calculated.ResultsA weekly average of 35 478 endoscopy procedures were performed in the pre-COVID period. Activity in the COVID-impacted period reduced to 12% of pre-COVID levels; at its low point, activity was only 5%, recovering to 20% of pre-COVID activity by study end. Although more selective vetting significantly increased the per-procedure cancer detection rate (pre-COVID 1.91%; COVID-impacted 6.61%; p<0.001), the weekly number of cancers detected decreased by 58%. The proportion of missing cancers ranged from 19% (pancreatobiliary) to 72% (colorectal).ConclusionThis national analysis demonstrates the remarkable impact that the pandemic has had on endoscopic services, which has resulted in a substantial and concerning reduction in cancer detection. Major, urgent efforts are required to restore endoscopy capacity to prevent an impending cancer healthcare crisis.

Multicentre prospective study of COVID-19 transmission following outpatient GI endoscopy in the UK

“…The COVID-19 pandemic has had an extraordinary impact on the delivery of GI endoscopy, with an initial reduction to 12% of prepandemic levels in the UK. 1 In the deceleration and early recovery phases (up to end July 2020), this had risen to 42% of repandemic levels. 2 Recovery has been influenced by multiple factors including availability of staff, restrictions caused by longer room cleansing, physical distancing and the use of personal protective equipment (PPE) slowing lists.…”

Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery

“…The results of a recently published UK endoscopy database analysis have revealed that endoscopic activity reduced to 12% of pre-COVID levels, and at its low point, activity was only 5%. 3 The weekly number of cancers detected decreased by 58% and the proportion of missing cancers ranged from 19% (pancreatobiliary) to 72% (colorectal) according to the database analysis. 3 A multicentre survey in Italy conducted at the peak of the pandemic also revealed that majority of the units (60.5%) which had normal endoscopic activities reduced by 75-99%.…”

“…3 The weekly number of cancers detected decreased by 58% and the proportion of missing cancers ranged from 19% (pancreatobiliary) to 72% (colorectal) according to the database analysis. 3 A multicentre survey in Italy conducted at the peak of the pandemic also revealed that majority of the units (60.5%) which had normal endoscopic activities reduced by 75-99%. 4 The results of web-based survey of gastroenterologists across North America also suggest that at the time of response (April 2020), most centres (46/71, 65%) were operating at ≤ 10% of their normal endoscopy volume.…”

The COVID-19 pandemic and colorectal cancer prevention: God tempers the wind to the shorn lamb

“…During the first wave, endoscopy activity has been limited to mostly emergency procedures. A recent study from the UK National Endoscopy Database, which is populated by automated real-time capture of endoscopy reports and contains over 2.5 million endoscopy records, revealed that the first weeks of the UK lockdown saw a reduction in endoscopy activity to 5 % of normal, with activity only recovering to 20 % of pre-COVID-19 levels in the subsequent weeks 1 . After the lockdown, endoscopy services face two immense challenges: 1) the adaptation of endoscopy units and workflows to COVID-19 prevention measures, which include social distancing, enforced downtime, and additional cleaning between procedures, all of which reduce patient throughput; and, simultaneously, 2) the absorption of all postponed procedures into the already overloaded endoscopy agenda.…”

“…Indeed, a recent modeling study indicated that even modest delays in cancer surgery of 3 to 6 months might significantly impact survival, particularly for stage 2 or 3 cancers 3 . As a matter of fact, the recent article from the UK National Endoscopy Database revealed a dramatic and worrying effect of the fall in endoscopy activity on cancer diagnosis, with up to 72 % of expected CRCs not being detected 1 . Accordingly, major concern has arisen regarding the appropriateness of interruptions to such valuable programs.…”