PTU-43 Impact of the COVID-19 pandemic on endoscopic cancer detection at a single-centre in the UK

Abstract

<h3>Introduction</h3> Endoscopy services were paused during the first wave of the COVID-19 pandemic between March – April 2020. Endoscopy resumed in May 2020 at a reduced productivity alongside early clinical triage in an effort to use resources responsibly. We assessed whether our reduced service led to reductions in gastrointestinal (GI) cancer detection. We assessed differences in the choice of initial investigation, clinical triage and referral to endoscopy time among GI cancers diagnosed via the suspected GI cancer referral pathway. <h3>Methods</h3> GI cancer diagnoses were reviewed retrospectively over a seven month period (Mar-Oct 2020). Inclusion criteria were patients coded with a new diagnosis of GI cancer. The volume of endoscopic procedures performed was assessed using our endoscopy reporting software. Results were compared to the equivalent time period in 2019. Differences in time to endoscopy (days) were evaluated with a two-sample unpaired t-test. <h3>Results</h3> There was a 28.5% reduction in GI cancer diagnoses in 2020 (Mar-Oct) compared to 2019 (191 vs 267), with a 27.1% reduction in GI cancers diagnosed via endoscopic procedures (132 vs 181). There was a 42.7% reduction in endoscopic procedures in 2020 (Mar-Oct) compared to 2019 (6977 vs 12186). In terms of referrals for suspected GI cancers from GPs, there was a 30% reduction (3188 vs 4579). In 2020 (Mar-Oct), among cancers diagnosed via endoscopic procedures on the suspected GI cancer pathway, 40 of 68 (58.8%) patients had imaging as their first investigation (n=5 Barium swallow, n=13 CT abdomen, n=22 CT colonography) compared to 21 of 81 (25.9%) patients in 2019 (n=11 CT abdomen, n=9 CT colonography). Following the start of clinical triage (May-Oct 2020), 36 of 54 (67%) patients were triaged as ‘very urgent’. 17 of 54 (31%) patients were triaged as ‘urgent’. 1 patient was not prioritised as their barium swallow suggested a diagnosis of achalasia which was later found to be an oesophageal malignancy (referral to endoscopy 95 days). There was no significant difference in referral to endoscopy time in 2020 (Mar-Oct) [mean 45 days, SD 40.2] compared to 2019 [mean 41.6 days, SD 26.7] (mean difference 3.4 days p=0.55). <h3>Conclusions</h3> The COVID-19 pandemic has led to a 28.5% reduction in GI cancer diagnoses. This worrying reduction in cancer detection will need to be ameliorated by an increase in endoscopy capacity. Radiological investigations were utilised more during this period to assess suspected GI cancer referrals. 98% of cancer patients were appropriately prioritised as very urgent or urgent based on clinical triage, and radiological investigations aided in triage. There was no significant difference in referral to endoscopy time. We highlight that achalasia diagnosed on barium swallow should always visualised directly, even with curtailed endoscopy capacity.