P396 COVID-19 pandemic-related endoscopy delays did not translate to deleterious outcomes for patients with Inflammatory Bowel Disease: A retrospective cohort study

Abstract

BackgroundInflammatory Bowel Disease (IBD) patients require frequent endoscopies for disease assessment and confirmation of remission, making it a crucial component in their management. It is unknown if measures put in place to reduce the spread of the virus SARS-CoV-2, including the delay of non-urgent IBD patient endoscopy, resulted in more deleterious outcomes for patients with IBD. Therefore, we aimed to determine if delays in endoscopy during the COVID-19 pandemic were associated with an increased risk of adverse IBD outcomes (emergency room, ER presentation, hospitalization, surgery or escalation of drug therapy).MethodsA retrospective cohort study was performed in IBD patients receiving outpatient endoscopies between March and August, 2019 (pre-COVID-19 pandemic) and, 2020 (during the COVID-19 pandemic) at two tertiary care centers affiliated with Western University, London, Canada. Data pertaining to endoscopy timing, IBD drug prescription, ER attendance, hospitalization, and surgery were collected.ResultsA total of, 1160 endoscopies (2019, n=718;, 2020, n=442) occurred across, 1083 patients (2019, n=669;, 2020, n=414). More endoscopies were delayed in, 2020 than, 2019 (26.7% vs., 9.7% respectively, p<0.0001) and for longer, 56 days (IQR=63) in, 2020 vs., 30 days (IQR=42) in, 2019. No differences were seen in the baseline demographic characteristics based on cohort year or occurrence of endoscopy delay. Also, rurality, sex, IBD type, and age were not associated with a delay in endoscopy. It was found that endoscopy delay was not associated with an increased risk of an adverse IBD outcome (composite outcome of emergency room presentation, ER presentation, hospitalization, surgery or escalation of drug therapy) (RR, 1.23, p=0.20).ConclusionA greater proportion of delays in endoscopy were observed during the COVID-19 pandemic; however, delays in general were not associated with more adverse IBD outcomes, and were found to be associated with less deleterious IBD outcomes. This may reflect the accurate and preferential triage of more severe IBD patients to endoscopic assessments.