The impact of COVID-19 on the volume and outcomes of routine and emergency endoscopy within an NHS Trust

Abstract

Objective: COVID-19 has resulted in increased restrictions around the practice of routine endoscopy. This has had an impact on the number of endoscopies performed and access to training. However, gaps remain in our understanding. Methods: Patients referred for inpatient endoscopies from March to May 2019 and February to May 2020 were identified. Their electronic notes and endoscopy reports were examined for referral details, endoscopic findings, complications and 30-day mortality. Additional information was collected on patients with upper gastrointestinal bleeds (UGIB) to enable the calculation of pre-oesophagogastroduodenoscopy (OGD) Blatchford scores and post-OGD Rockall scores. Comparisons were made between data obtained from March to May 2019 and 2020 (inter-year comparisons) and between February 2020 (immediately before the British Society of Gastroenterology published advice to restrict routine endoscopies) and March to May 2020 period (intra-year comparisons). Results: 398 endoscopies were performed from March to May 2019 compared to 183 over the same period in 2020, a 54% reduction. 103 endoscopies were performed in February 2020 compared to the mean monthly value of 61 for the period from March to May 2020, a reduction of 41%. 12% of patients died in 2019 compared to 16% in 2020. For UGIB, 11% of patients died in 2019 compared to 15% in 2020. In 2019, 17% of UGIB OGDs were performed by gastroenterology trainees compared to 26% in 2020. Conclusion: COVID-19 has led to a marked decrease in the number of endoscopies performed. Despite this trainee endoscopy exposure concerning emergency, UGIB OGDs have been preserved.