Should the Endoscopic Restrictions during COVID-19 Pandemic Remain Unchanged?

Emilio Bresky,Sebastian Licuime,Maria Jose Rojas,Luis Seijas,Juan Madariaga,Gustavo Bresky,Fabian Saez,Paulette Palma,Domingo Lancellotti

doi:10.3390/gastroent12030034

Abstract

(Background) Endoscopic procedures are interventions that have been defined as carrying a high-risk of infection with COVID-19. Most endoscopy units restrict their activity based on pre-endoscopic diagnosis. (Objective) To determine the consequences of endoscopic restrictions as a result of the COVID-19 pandemic and their impact on digestive cancer diagnosis. (Design) A comparison of upper digestive endoscopies and colonoscopies with gastrointestinal cancers diagnosed between three endoscopic centers, two of which restricted their procedures and one that did not but performed the procedures under a strict protocol. (Setting) A retrospective analysis was performed collecting data between 15 March 2019 and 15 August 2020. Two-factor ANOVA and a Tukey’s a posteriori test were used as statistical tests. (Main outcome measures) There was variation in gastrointestinal cancer diagnosis between 2019 and 2020, considering the endoscopic procedures performed each year. (Result) There was a significant decrease in the total endoscopic procedures performed between 2019 and 2020 (p < 0.001), the result of reduced testing at the two centers (p < 0.001) with pre-endoscopic restrictions, which was not compensated for by a slight increase in procedures at the center without restrictions (p = 0.139). Regarding the total cancers diagnosed, while a significant decrease was observed for the two centers with pre-endoscopic restrictions (p = 0.007), a significant increase was registered in the center that maintained its endoscopic productivity (p < 0.001). After 851 procedures (537 upper digestive endoscopies and 314 colonoscopies) there was no evidence of COVID-19 infection in the endoscopic staff. (Conclusion) Endoscopic restrictions based on pre-endoscopic diagnosis should be reassessed in consideration of local pandemic situations, and a balance should be sought between COVID-19 infection risk and the detrimental delay of potential cancer diagnosis.

Highlights

The COVID-19 pandemic produced a radical change in various aspects of our lives.This virus can be transmitted directly from both symptomatic and asymptomatic patients [1] from less than one meter [2] through respiratory droplets, establish contact with the oral mucosa or nasal or conjunctiva [3]
Endoscopic digestivecancer cancerdiagnosis diagnosis data were studied in three centers: two public hospitals, Hospital de Coquimbo centers: two public hospitals, Hospital de La Serena (HLS) and Hospital de Coquimbo (HC), and in the CCM, whose endoscopic unit is private and outpatient only
The overall number of digestive cancers registered during P19 and P20 showed significant decreases (p < 0.001) in the hospitals (19 to 9 diagnoses at HLS and 26 to 13 at HC), while a significant increase was observed at CCM, from 3 to 22 (p < 0.001) (Figure 4)

Summary

Introduction

The COVID-19 pandemic produced a radical change in various aspects of our lives This virus can be transmitted directly from both symptomatic and asymptomatic patients [1] from less than one meter [2] through respiratory droplets, establish contact with the oral mucosa or nasal or conjunctiva [3]. The airborne spread of the virus is especially important in certain procedures that can generate aerosols, such as intubation, bronchoscopy, and upper gastrointestinal endoscopy [6,7]. This has led to the definition of all endoscopic procedures as high risk for COVID-19 infection. Both health authorities and most gastroenterological scientific societies worldwide have recommended cancelling endoscopic procedures, except in cases of emergency [6]

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