Abstract
Objective
The 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.
Design
We 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.
Results
A 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).
Conclusion
This 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.
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