Abstract:Background: The unprecedented situation caused by the coronavirus disease 2019 (COVID-19) pandemic has profoundly affected endoscopic practice in regard to access, volume, and workflow. We aimed to assess the potential changes in the technical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures carried out in patients with confirmed SARS-CoV-2 infection. Methods: We conducted an international, multicenter, retrospective, matched case-control study of ERCP procedures carried out in pati… Show more
“…Whereas initially extreme and difficult to implement precautions were suggested for aerosol-generating procedures (including negative pressure rooms, hazmat suits, various protective devices [6] ), subsequent data has shown the potential for transmission during endoscopic procedures to be much lower than estimated [7] . In a previous multicenter study we found similar changes in volume and tactics in providing ERCP for patients with COVID-19 across 12 referral centers from Europe [8] , and other groups have described comparable adjustments to their workflow and protocols in response to the state of the outbreak in their countries [ 4 , 5 ]. Fig.…”
“…Whereas initially extreme and difficult to implement precautions were suggested for aerosol-generating procedures (including negative pressure rooms, hazmat suits, various protective devices [6] ), subsequent data has shown the potential for transmission during endoscopic procedures to be much lower than estimated [7] . In a previous multicenter study we found similar changes in volume and tactics in providing ERCP for patients with COVID-19 across 12 referral centers from Europe [8] , and other groups have described comparable adjustments to their workflow and protocols in response to the state of the outbreak in their countries [ 4 , 5 ]. Fig.…”
“…Similarly, a study reported the safety of ERCP procedures where ERCP was conducted for 18 patients who tested positive for COVID-19. The study compared COVID-19 and a control group with respect to complications of the ERCP procedure and found no significant impact on patient safety [ 34 ].…”
Background
The British Society of Gastroenterology (BSG) recommended that during the COVID-19 pandemic, endoscopy units perform endoscopic retrograde cholangiopancreatography (ERCP) for obstructive biliary pathologies in an emergency. We assessed the local performance of ERCP during the first wave of COVID-19 at our local endoscopy center, in particular the technique to common bile duct (CBD) cannulation.
Methodology
All ERCP procedures performed from January to June 2020 were retrospectively assessed and compared with procedures performed between January and June 2019 at the Royal Lancaster Infirmary. The indications for ERCP, success rate, and complications were studied separately. Correlation analysis was conducted using Spearman's rank correlation coefficient. The binary logistic regression model was used to compute the factors associated with successful ERCP. Significance was established when the two-sided P-value < 0.05. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 25 for Windows (SPSS Inc., Chicago, IL, USA, 2017).
Results
A total of 281 ERCP were included in this study, with 169 and 112 performed during the first six months of 2019 and 2020, respectively. A statistically significant (0.0087) higher proportion of cases with liver dysfunction presented for ERCP before the COVID-19 outbreak (152, 89.94%). All patients before COVID-19 underwent wire control-assisted ERCP, while 82 (73.21%) received assisted ERCP during the first wave (P < 0.001). There was no statistically significant difference (P = 0.10) in the number of patients who underwent sphincterotomy before and during the first wave of COVID-19, with 97 (57.39%) and 76 (67.85%), respectively. The success rate of ERCP before COVID-19 was relatively high, accounting for 146 (86.39%) patients in contrast to 87 (77.67%) patients during the first wave (P = 0.074). Sphincterotomy (
β
= 2.800, P = 0.028) and stent insertion (
β
= 0.852, P = 0.046) were statistically significant predictors of ERCP outcomes. There was no statistically significant impact of cholangitis on the success of ERCP (
β
= 1.672, P = 0.109).
Conclusion
The first wave of COVID-19 had a statistically proven negative impact on the expected standards of ERCP performance. Although the complication rate was significantly higher during the first wave case difficulty, the American Society of Anesthesia (ASA) status was not assessed on an individual basis. Both ASA status and case difficulty are now included in our endoscopy selection process. We recommend adding the complexity of cases and ASA to the local and national recording databases. This is a rare study on UK-based hospitals.
“…They can be transmitted by respiratory droplets or faecal-oral, and they can also remain for a long time on surfaces contaminated with stool and endoscopic biopsy specimens (9,10). Healthcare workers are more vulnerable than the general population due to their high level of contagiousness, transmission routes, and long-term survival (9,11,13).…”
mentioning
confidence: 99%
“…Appointments and non-urgent procedures were postponed by following the instructions, and the number of endoscopic procedures decreased (12,13,14). It was observed that the postponing process increased the number of deaths and workload due to postponement after the pandemic (12,13,14).…”
mentioning
confidence: 99%
“…Appointments and non-urgent procedures were postponed by following the instructions, and the number of endoscopic procedures decreased (12,13,14). It was observed that the postponing process increased the number of deaths and workload due to postponement after the pandemic (12,13,14). Simultaneously, patients were afraid of leaving home and coming to the hospital during the pandemic, and due to late admission and restrictive policies, diseases were detected in late stages (11,12).…”
NTRODUCTION: We aimed to investigate the effects of Covid-19 on Endoscopic retrograde cholangiopancreatography (ERCP) and to investigate what should be considered in the next possible epidemic situations.
METHODS: In our study, patients who applied to XXX University School of Medicine, Department of General Surgery for ERCP (Endoscopic retrograde cholangiopancreatography) between March 2019 and March 2021 were evaluated, retrospectively. Percentages, mean, standard deviation, median and interquartile range were used as the descriptive statistics. Mann-Whitney U test was used for the variations which are contrary to the normal distribution range in the comparison of two groups. The relations between qualitative variations were studied by the Pearson Chi-Square test and Fisher's Exact test. Significant value was determined as 0.05 for all statistical analyses.
RESULTS: Prior to COVID-19, ERCP indications were in the order of stone (90.1%), stent removal (8%) and tumor (1.1%), while in the period of COVID-19, the ranking changed to stone (73.8%), tumor (13.7%), and stent removal (12.4%).. The diagnostic use of ERCP has been greatly reduced (from 0.7% to 0.0%). No perforation was detected in both periods, there was no bleeding, but a small increase (4.7% to 5.9%) was found in pancreatitis in the COVID-19 period. In the pre-COVID-19 period, stones were detected in 46.2% of the patients and all of them were successfully removed, but during the COVID-19 period, stones were detected in 50.6% of the patients and the stones could not be removed in 1.3% of the patients.
DISCUSSION AND CONCLUSION: It was observed that the number of ERCPs decreased due to the delay in admissions to the hospital and the fear of coming to the hospital during the Covid-19 epidemic period, and the number of malignancies diagnosed with ERCP increased in this process. In such epidemic periods, more scheduled health services will provide better results for both patients and health personnel.
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