The impact of covid-19 pandemic on urgent endoscopy in Italy: a nation-wide multicenter study

Salerno, Raffaele; Conti, Clara Benedetta; Silvestri, Annalisa De; Davies, Sophia Elizabeth Campbell; Mezzina, Nicolò; Ardizzone, Sandro

doi:10.1080/00365521.2020.1782466

Cited by 42 publications

(55 citation statements)

References 18 publications

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“…Additionally, due to the fact that the pandemic may exist for a long time and the end of the pandemic is not known, physicians cannot postpone all ERCP procedures to a further period. This finding is in accordance with observations from other countries [13,15,16]. No significant differences in urgent ERCP procedures were determined in our study.…”

Section: Discussionsupporting

confidence: 94%

Endoscopic Retrograde Cholangiopancreatography During the COVID-19 Pandemic: Effects of Enhanced Personal Protective Equipment

Düzenli

Köseoğlu

2021

Dig Dis Sci

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Background and Aims Personal protective equipment (PPE) decreases the risk of disease contagion, and because of the COVID-19 pandemic, enhanced PPE (EPPE) is widely used during endoscopic procedures including endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to investigate the effects of EPPE on ERCP success parameters compared to standard PPE (SPPE). Methods ERCP procedures were evaluated retrospectively and ERCP outcomes were compared for similar time periods as before and after the COVID-19 pandemic. Primary outcomes were cannulation time, number of cannulation attempts, cannulation success rate, difficult cannulation rate, undesired pancreatic duct cannulation rate, ERCP-related adverse events, and length of hospital stay. Results Three hundred and eighty ERCP procedures were examined. One hundred and fifty-nine procedures were excluded due to missing data, previous sphincterotomy or altered anatomy. Of the final eligible sample size of 221 ERCPs, 93 were performed using SPPE and 128 were performed under EPPE. Indications of ERCP and demographic parameters were similar between groups. The majority of the ERCP cases included were for benign biliary obstruction of common bile duct stones (88.7%). No significant differences were detected in overall technical success (91.4% vs 92.2%, p = 0.832), cannulation success rates (94.6% vs 96.8%, p = 0.403), cannulation times (median times of both groups were 3 min, p = 0.824), difficult cannulation rates (37.6% vs 33.6%, p = 0.523), undesired pancreatic duct cannulation rates (29% vs 22.7%, p = 0.593), number of cannulation attempts (2.80 vs 2.71, p = 0.731), ERCP-related adverse events (9.7% vs 10.9%, p = 0.762), and length of hospital stay (6.63 vs 6.92 days, p = 0.768) between SPPE and EPPE groups, respectively. Conclusion Biliary obstructions of common bile duct stones were the major indication of ERCP in the current study. The use of EPPE had no negative effects on ERCP performance in this patient group. ERCP can be effectively performed under EPPE.

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Section: Discussionsupporting

confidence: 94%

Endoscopic Retrograde Cholangiopancreatography During the COVID-19 Pandemic: Effects of Enhanced Personal Protective Equipment

Düzenli

Köseoğlu

2021

Dig Dis Sci

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“…A national Italian study of urgent endoscopy reported a 40% reduction in utilisation overall, with bigger reductions in the proportion of patients with a negative finding Open access on upper endoscopy between prepandemic and pandemic periods. 3 A study of three psychiatric emergency services in Paris found a 55% overall reduction in presentations in the first 4 weeks of lockdown, with greater reductions for consultations for anxiety and stress, and smaller reductions for consultations for psychotic disorders. 30 Authors speculated that 'some people may find new strengths and coping strategies during disasters' and 'the current results may arise from an elevation in resilience'.…”

Section: Secondary Outcomementioning

confidence: 99%

“…As the COVID-19 pandemic continues, many studies have reported major changes in utilisation of healthcare services because of such measures as lockdowns and stay-at-home orders. [1][2][3] These changes include large reductions in services, particularly in places hit hard by the pandemic, but also some selective increases, such as for telemedicine. 4 Many people have missed out on much needed care, such as vaccination or life-extending interventions for cancer.…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

et al. 2021

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ObjectivesTo determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic.DesignSystematic review.EligibilityEligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19.Data sourcesPubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact.Data analysisRisk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis.Outcome measuresPrimary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores).Results3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference.ConclusionsHealthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery.PROSPERO registration numberCRD42020203729.

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“…As the COVID-19 pandemic continues, many studies have reported major changes in utilisation of healthcare services because of such measures as lockdowns and stay-at-home orders. 1-3 These changes include large reductions in services, particularly in places hit hard by the pandemic, but also some selective increases, such as for telemedicine. 4 Many people have missed out on much needed care, such as vaccination or life-extending interventions for cancer.…”

Section: Introductionmentioning

confidence: 99%

Pandemic impacts on healthcare utilisation: a systematic review

Moynihan

Sanders

Michaleff

et al. 2020

Preprint

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Objectives: To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. Design: Systematic review Eligibility: Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics, and therapeutics. Studies were excluded if from single-centres or studied only COVID-19 patients. Data sources: PubMed, Embase, Cochrane COVID-19 Study Register, and pre-prints were searched, without language restrictions, until August 10, using detailed searches with key concepts including COVID-19, health services and impact. Data analysis: Risk of bias was assessed by adapting ROBINS-I and Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures, and narrative synthesis. Outcome measures: Primary outcome was change in service utilisation between pre-pandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (e.g. triage scores). Results: 3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services pre-pandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (interquartile range -51% to -20%), comprising median reductions for visits of 42%(-53% to -32%), admissions, 28%(-40% to -17%), diagnostics, 31%(-53% to -24%), and for therapeutics, 30%(-57% to -19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27(45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no change. Conclusions: Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health-systems prioritise higher-value care in the post-pandemic recovery. Funding, Study registration: No funding was required. PROSPERO: CRD42020203729

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The impact of covid-19 pandemic on urgent endoscopy in Italy: a nation-wide multicenter study

Cited by 42 publications

References 18 publications

Endoscopic Retrograde Cholangiopancreatography During the COVID-19 Pandemic: Effects of Enhanced Personal Protective Equipment

Endoscopic Retrograde Cholangiopancreatography During the COVID-19 Pandemic: Effects of Enhanced Personal Protective Equipment

Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

Pandemic impacts on healthcare utilisation: a systematic review

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