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Endoscopy volumes and outcomes at a tertiary Melbourne centre during the 2020 COVID‐19 lockdowns

Daniel Schneider, Michael Swan and Simon Hew
Med J Aust || doi: 10.5694/mja2.51539
Published online: 6 June 2022

During the coronavirus disease 2019 (COVID‐19) pandemic, elective medical procedures and population cancer screening programs, including colonoscopy, were suspended because of lockdowns and other public health measures.1,2,3,4 Marked declines in endoscopic procedure volumes were reported overseas.1

In Melbourne, two lockdowns restricted non‐urgent endoscopy during 2020. All patients scheduled for elective endoscopy at Monash Health were re‐triaged for priority in accordance with the Gastroenterological Society of Australia COVID‐19 guidelines.5 In this article, we report our assessment of the impact of lockdowns on endoscopic volumes and outcomes at our centre.

We undertook a retrospective analysis of endoscopic procedures at Monash Health during the 2020 lockdowns (24 March – 1 May, 2 August – 28 September 2020) and the corresponding periods in 2019. All patients underwent pre‐procedure COVID‐19 screening (health questionnaire, polymerase chain reaction testing). We collected information on patient demographic characteristics, procedure type, COVID‐19 status, and endoscopic outcomes (cancer and polyp detection). We assessed differences in procedure volumes and rates during the 2019 and 2020 periods in χ2 tests; P < 0.05 was deemed statistically significant. The overall missing cancer number was estimated as the difference between the expected number of cancers (based on procedure volume and detection rate for 2019) and the number of cancers identified during the 2020 lockdowns.1 Our study was approved by the Monash Health Human Research Ethics Committee (QA/68490/MonH‐2020‐232763).

A total of 1147 endoscopic procedures were performed during the two lockdowns; none of the patients were diagnosed with COVID‐19. This number was 42% lower than during the corresponding periods of 2019 (1972 procedures), but the overall cancer detection rate was higher (2020: 77, 6.7% of procedures; 2019: 89, 4.5%; P = 0.008). Colonoscopy detection indicators — the adenoma (2020: 138 of 426 colonoscopies, 32.4%; 2019: 256 of 906; 28.3%; P = 0.12) and sessile serrated polyp detection rates (2020: 17 of 426, 4.0%; 2019: 40 of 906, 4.4%; P = 0.72) — were similar for the two periods (Box). Despite the higher cancer detection rate and the similar quality indicator values, 55 fewer cases of cancer were detected than expected had the number of procedures been the same in 2020 as in 2019.

The data from our Melbourne centre may not be representative of data for other centres with different endoscopy strategies during the pandemic. The 2019 periods corresponding to the 2020 lockdown periods may not reflect baseline endoscopic volume and outcomes, but endoscopic activity during 2019 was regarded as typical for our centre.

Despite a large reduction in case volume because of pandemic lockdowns, the overall cancer detection rate was higher and colonoscopy detection indicators were maintained at pre‐pandemic levels. However, fewer cancers were detected. By enhancing patient selection using guideline‐based re‐triage, we increased our overall cancer detection rate during a period of limited access and resources. Although our missing cancer rate was not as high as reported elsewhere,1 prompt restoration of endoscopy volume should be a focus of pandemic recovery.

 

Box – Endoscopic procedures and outcomes, 24 March – 1 May, 2 August – 28 September, 2019 and 2020

Characteristic

2019

2020

P


Patients

 

 

 

Total number of patients

1606

946

 

 Outpatients

1253 (78%)

646 (68.3%)

 

 Inpatients

353 (22%)

300 (31.7%)

 

Sex (men)

792 (49%)

506 (53.5%)

 

Age (years), median (IQR)

61 (48–72)

64 (51–73)

 

Endoscopic procedures

 

 

 

Total number of procedures

1972

1147

 

 Cancers detected (overall detection rate)

89 (4.5%)

77 (6.7%)

0.008

Gastroscopy

765 (38.8%)

461 (40.2%)

 

 Cancers detected

24 (3.1%)

16 (3.5%)

0.75

Colonoscopy

906 (45.9%)

426 (37.1%)

 

 Cancers detected

24 (2.6%)

18 (4.2%)

0.13

 National Bowel Cancer Screening Program

84 (9.3%)

71 (17%)

< 0.001

 Adenoma detection rate

256 (28.3%)

138 (32.4%)

0.12

 Sessile serrated polyp detection rate

40 (4.4%)

17 (4.0%)

0.72

Flexible sigmoidoscopy

94 (4.8%)

27 (2.4%)

 

 Cancers detected

7 (7%)

2 (7%)

0.99

Endoscopic retrograde cholangiopancreatography

103 (5.2%)

114 (9.9%)

 

 Cancers detected

9 (9%)

10 (9%)

0.99

Endoscopic ultrasound

93 (4.7%)

116 (10%)

 

 Cancers detected

24 (26%)

31 (27%)

0.88

Enteroscopy

9 (0.4%)

2 (0.2%)

 

 Cancers detected

1 (11%)

0

Per‐oral endoscopic myotomy

2 (0.1%)

1 (0.1%)

 


IQR = interquartile range.

 

Received 26 July 2021, accepted 16 February 2022

  • Daniel Schneider
  • Michael Swan
  • Simon Hew

  • Monash Health, Melbourne, VIC


Correspondence: simon.hew@monashhealth.org

Acknowledgements: 

We thank the members of the Monash Health Endoscopy COVID Research Group: Timothy Phan, Kathryn Goss, Declan Connoley, Nicholle Sim, Elaine Koh, Winston Zheng, Tony Long, and Deanne Bonney.

Competing interests:

No relevant disclosures.

  • 1. Rutter MD, Brookes M, Lee TJ, et al. Impact of the COVID‐19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database analysis. Gut 2021; 70: 537‐543.
  • 2. Gralnek IM, Hassan C, Dinis‐Ribeiro M. COVID‐19 and endoscopy: implications for healthcare and digestive cancer screening. Nat Rev Gastroenterol Hepatol 2020; 17: 444‐446.
  • 3. Elli L, Tontini GE, Filippi E, et al. Efficacy of endoscopic triage during the Covid‐19 outbreak and infective risk. Eur J Gastroenterol Hepatol 2020; 32: 1301‐1304.
  • 4. Yoshida S, Nishizawa T, Toyoshima O. Real‐world clinical data of endoscopy‐based cancer detection during the emergency declaration for COVID‐19 in Japan. World J Gastrointest Endosc 2020; 12: 401‐403.
  • 5. Devereaux B, Kaffes A, Strasser S. Guide for triage of endoscopic procedures during the COVID‐19 pandemic. Gastroenterological Society of Australia, 26 Mar 2020. https://www.gesa.org.au/public/13/files/Education%20&%20Resources/COVID‐19/Triage_Guide_Endoscopic_Procedure_26032020.pdf (viewed July 2021).

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