Re-initiation of CT colonography services during the COVID-19 pandemic: Preliminary evaluation of safety.

David Peprah,Kathryn Smith,Janice Muckian,Andrew Plumb,Jia Ying Kuah,James Stephenson,Antoni Sergot,Alison Corr

doi:10.1259/bjr.20201316

Abstract

Objective:The COVID-19 pandemic has led to cancellation and deferral of many cancer investigations, including CT colonography (CTC). In May 2020, BSGAR and SCoR issued guidelines outlining steps for conduct of CTC in the early recovery phase. We evaluated the implementation of these in four English hospital trusts.Methods:Ethical permission was not required for this multicentre service evaluation. We identified patients undergoing CTC over a 2-month period from May to July 2020 at four Trusts. We recorded demographics, scan indications, colonic findings, and incidental lung base changes compatible with COVID-19. A subset of patients were contacted via telephone to document new symptoms 2 weeks following their scan. Staff were contacted to determine if any acquired COVID-19 during the period.Results:224 patients (118 male, 52.7%) were scanned during the period. In 55 patients (24.6%), CTC showed a ≥6 mm polyp. 33 of 224 (14.7%) scans showed incidental lung base changes felt unrelated to COVID-19, and only one patient had changes indeterminate for COVID-19; no classic COVID-19 pulmonary changes were found. Of 169 patients with telephone follow-up, none reported any new symptoms of COVID-19 (cough, fever, anosmia, ageusia) within 14 days of CTC. None of the 86 staff contacted developed COVID-19.Conclusion:We found no cases of patients or staff acquiring COVID-19 infection following CTC; and no evidence of significant asymptomatic COVID-19 patients attending for CTC appointments based on lung base changes.Advances in knowledge:Our findings suggest that current practice is unlikely to contribute significantly to spread of SARS-nCOV2. Cancer and significant polyp detection rates were high, underlining the importance of maintaining service provision.

Highlights

The current COVID-19 pandemic has affected all aspects of world affairs in an extraordinary and unexpected manner
We found no cases of patients or staff acquiring COVID-19 infection following CT colonography (CTC); and no evidence of significant asymptomatic COVID-19 patients attending for CTC appointments based on lung base changes
Our results provide encouraging preliminary data characterising the risk of COVID-19 in patients receiving CTC at four UK centres in the early post-peak phase

Summary

Introduction

The current COVID-19 pandemic has affected all aspects of world affairs in an extraordinary and unexpected manner. Remote consultations have become the norm, and (at least initially) patients were encouraged to access medical advice via 111 rather than visiting GP practices.[2] there has been significant disruption to service provision that has necessarily affected clinically urgent activity, including outpatient cancer investigations This includes the 2 week-w ait (2WW) referral pathway, which saw activity reductions of up to 80% during the pandemic peak in March and April.[3] According to the National Endoscopy Database (NED), which captures a large proportion of endoscopic activity in England in near real-time, during April and May 2020, endoscopic activity was only 12% of pre-COVID levels.[4] Such delayed diagnosis is predicted to lead to substantial increases in cancer deaths, ranging from 4.8 to 5.3% increase for lung cancer to a 15.3–16.6% increase for colorectal cancer (CRC), causing around 1500 extra deaths within 5 years for CRC alone.[3]

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Conclusion