ABSTRACT
Background and aims: Managing patients in a specialist cirrhosis clinic improves survival. The COVID-19 pandemic necessitated the transition to virtual clinics (VC). We aimed to evaluate the clinical impact of VC on survival, admission and decompensation rates in cirrhotic patients managed in a specialist service. Method: We retrospectively analysed cirrhotic patients who had a specialised VC from March to June 2020. Clinical parameters were collected at baseline and 6 months and compared with a cohort of patients reviewed face to face (F2F) in the same specialist cirrhosis clinics from March to June 2019. Patients with COVID-19 were excluded. Results: 143 patients attended for VC, 129 for F2F review. Groups were matched for age, sex, aetiology, and Child Pugh grade (CP). There was no difference at 6 months in survival, change in MELD/UKELD, decompensation or need for ambulatory reviewin all cirrhosis grades combined or CP BandC subgroup alone (p > 0.05) (Table 1). Fewer patients were admitted in the VC vs the F2F group (p = 0.01) but this was not validated in CP BandC subgroup (p = 0.28). Fewer blood tests were ordered for the VC group (p = 0.0001). The VC group had longer delays for ultrasound HCC surveillance (<0.0001) without an increase in new HCC cases.Table: Baseline Patient Demographics and 6 months’ outcome (*p < 0.05, **p < 0.01)(Table Presented)Conclusion: VC have not resulted in poorer clinical outcomes, even in patients with decompensated cirrhosis. Access to ambulatory care was still required. Fewer blood tests ordered and completed in the VC group did not result in adverse outcomes and this raises the possibility of cost-saving. urther studies need to confirm the longterm clinical impact and cost-effectiveness of specialist VC in management of cirrhotic patients.
ABSTRACT
Introduction 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. Methods 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. Results 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). Conclusions 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.