The Impact of the COVID-19 Pandemic on Gastrointestinal Endoscopy Activity in a Tertiary Care Center from Northeastern Romania

Stefan Chiriac,Ana-Maria Singeap,Tudor Cuciureanu,Gheorghe G Balan,Laura Huiban,Diana David,Camelia Cojocariu,Sebastian Zenovia,Carol Stanciu,Anca Trifan,Catalin Sfarti,Irina Girleanu,Robert Nastasa

doi:10.3390/healthcare9010100

Abstract

Background: The outbreak of the coronavirus disease 2019 (COVID-19) has led to significant changes in endoscopy units worldwide, with potential impact on patients’ welfare as well as on endoscopy training. We aimed to assess the real-life impact of COVID-19 on the endoscopy unit in a tertiary care center from Romania. Methods: A 6.5-month period during the COVID-19 pandemic was compared to a similar period from 2019. Results: A 6.2-fold decrease of endoscopic procedures was noted. Colonoscopies were reduced from 916 to 42, p < 0.001; flexible sigmoidoscopies from 189 to 14, p = 0.009; upper gastrointestinal (GI) endoscopies from 2269 to 401, p = 0.006; and ERCP from 234 to 125, p < 0.001. The percentage of emergency procedures increased (38.8% vs. 26.2%, p < 0.001), as well as the rate of endoscopies performed for upper GI bleeding (42.5% vs. 24.4%, respectively, p < 0.001). The detection of cancers was considerably reduced (57 compared to 249, p = 0.001). There were fewer complications and higher success rates (7.6% vs. 19.2%, p < 0.001, and 94.2% vs. 90.7%, respectively). Fellows participation was also reduced from 90% to 40.9% (p < 0.001). Conclusions: The COVID-19 pandemic has significantly altered the workflow of the endoscopy unit, lowering the number of procedures performed and potentially compromising the early detection of cancers.

Highlights

Since the first detection of the SARS CoV-2 virus in patients with lower respiratory tract infection of unknown etiology in December 2019 in the Wuhan, Hubei Province, China [1], over 29 million patients have been diagnosed, resulting in over 900,000 deaths worldwide [2]
We aimed to assess the impact of the COVID-19 pandemic on GI endoscopy in a tertiary care center in northeastern Romania concerning the number of procedures performed, indications, complications, and results as well as trainee involvement
The general characteristics of endoscopies before and during COVID-19 period are described in Table 1 and Figure 1

Summary

Introduction

Since the first detection of the SARS CoV-2 virus in patients with lower respiratory tract infection of unknown etiology in December 2019 in the Wuhan, Hubei Province, China [1], over 29 million patients have been diagnosed, resulting in over 900,000 deaths worldwide [2]. In February 2020, the World Health Organization (WHO, Geneva, Switzerland) established the name of the disease caused by the SARS CoV-2 infection as the coronavirus disease 2019 (COVID-19), in March 2020, declared it a pandemic [3]. The significant impact of COVID-19 has been partly attributed to the high contagious potential of the SARS CoV-2 virus as well as the long incubation time. The potential for transmission is high during aerosol-generating procedures such as GI endoscopy. The prioritization of these procedures has been advocated by many international endoscopy organizations such as World Endoscopy Organization (WEO, Munich, Germany) [11], European Society of Gastrointestinal Endoscopy (ESGE, Munich, Germany), European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA, Munich, Germany) [12], Asian Pacific

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