Improvement in appropriateness and diagnostic yield of fast-track endoscopy during the COVID-19 pandemic in Northern Italy

Abstract

Background and study aim: During the COVID-19 outbreak in Italy only fast-track endoscopic procedures have been performed; nevertheless, a significant drop in their number has been reported. We evaluated whether the pandemic has impacted the appropriateness and diagnostic yield of fast-track endoscopic procedures in comparison with those performed in 2019. Patients and methods: This retrospective survey has involved Endoscopic Services in Northern Italy; we compared data regarding endoscopic procedures performed in March and April 2020 with those performed in the same period in 2019. Results: We observed in 2020 a reduction of 53.6% in the number of procedures. Patients undergoing endoscopy in 2020 were younger than in 2019. Both appropriate referral and diagnostic yield increased in 2020 and it regarded both upper and lower endoscopy. A higher rate of cancer was diagnosed in 2020 by upper endoscopy (3.6% vs 6.6%, p=0.04). Conclusions: The high level of inappropriate endoscopic referral registered in 2019 has significantly improved during the COVID-19 outbreak with an increase in the diagnostic yield.

The Impact of the COVID-19 Epidemic on Diagnosis, Treatment, Concerns, Problems, and Mental Health in Patients with Gastric Cancer

“…During the COVID-19 epidemic, the number of screenings for gastric cancer has been decreased [ 2 , 4 , 5 , 15 – 19 , 27 ]. In Italy, the number of endoscopies has decreased by 53.6% compared to 2019 [ 19 ]. In the Netherlands, the rate of gastroscopy has decreased by 57%.…”

Endoscopy during COVID – what have we learned?

“…The study from Northern Italy found a 44 % decline in the absolute number of new cancer diagnoses and a relatively small increase in the proportion of endoscopies with a cancer diagnosis (from 6.0 % to 7.3 %) [2]. Although this is a far smaller study ( < 3000 procedures), data were obtained from individual chart review and cancers were histologically confirmed.…”

“…To that end, the study from Northern Italy made appropriateness of endoscopic procedures the main objective of the study [2]. Aside from a relative increase in cancer diagnoses, the study also found a dramatic increase in clinically relevant findings per endoscopic procedure.…”

“…Assessing the appropriateness of performing endoscopies during a time of restricted access is novel. The proportion of appropriate urgent procedures increased from 57 % in 2019 to 67 % during the lockdown in 2020 [2]. While this clearly indicates an improvement in appropriateness, the proportion is still fairly low.…”

“…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.…”