ABSTRACT
Introduction: In March 2020, Coronavirus Disease 2019 (COVID-19) was declared a pandemic. Elective healthcare services were reorganised worldwide. This study addresses the impact of measures taken in the early stages of the pandemic on diagnosing Upper Gastrointestinal (UGI) and Hepatopancreaticobiliary (HPB) malignancies in a university teaching hospital. Aims: To ascertain whether fewer cases of UGI/HPB cancers were detected, the differences in inpatient and outpatient diagnosis and whether there was an increased detection of later stage disease during the pandemic than in the preceding year. Methods: This was a retrospective cohort study conducted in Tallaght University Hospital in Ireland. All new diagnoses of UGI/HPB cancers, excluding hepatocellular carcinomas, are managed at a weekly Multidisciplinary Team (MDT) meeting. Data was retrieved from the MDT database and medical records and analysed using IBM SPSS Statistics V20. Results: 111 cases were detected. There was no significant difference in the proportion of cases detected in the overall post-COVID period (n=53, 47.7%) compared to the Pre-COVID period (n=58, 52.3%) (p=0.7884). When COVID-19 cases were at their highest levels in Ireland, we observed a significant drop in new UGI/HPB cases detected compared to the pre-COVID period. This was mitigated in the third quarter of 2020, when transmission was depressed and a sharp increase in detection of UGI/HPB cases was observed. The variance of distribution of cases per quarter in the two periods was statistically significant with a P-value of 0.0001. There was a non-significant trend towards fewer diagnoses of early cancer (stage ≤2) in the Post- COVID period (21% v 26%) (p=0.6416). The proportion of patients diagnosed as an inpatient did not differ between the two periods, p=.739. Discussion: As fears about aerosolization abated, endoscopy services quickly increased the number of scopes performed after the initial reduction at the start of the pandemic. There are several limitations to this study, however it does lead us to conclude that our fears regarding cancer diagnosis in the postpandemic period did not materialise. It also offers solace that when transmission of COVID- 19 is depressed, as it was in Ireland in Q3 2020 before the peak of the second wave in Q4 2020, that outpatient services can quickly escalate their level of activity and detect cancers that were missed with no significant change in stage. A further observation is that when lockdown measures in Ireland were reintroduced in winter 2020/2021 but outpatient services were kept open, a similar reduction in detections was observed compared to when they were closed. Therefore, the question may be posed if the primary driver of reduced detection of UGI/HPB cancers is primary care services being overwhelmed with pandemic work rather than a reduction in outpatient services . (Table Presented) (Figure Presented)
ABSTRACT
Introduction: UBT is the most accurate non-invasive test for H.pylori infection. The orally given urea, labelled with C13, is hydrolysed by the enzyme urease of H.pylori and C13O2 is measured expired in breath. UBT was our gold standard diagnostic test for H.pylori. This practice changed abruptly in March 2020, when our first wave of coronavirus -2 (SARS-CoV-2) started. UBT carries the risk of contamination by SARS-CoV-2 in the aerosol droplets generated by exhaled air. The British Society of Gastroenterology guideline at that time graded UBT as Aerosol Generating Procedure and therefore at high risk for transmission. Only emergency gastroenterology high risk procedures were recommended during restrictions which effectively terminated our standard UBT service. To maintain a non-invasive diagnostic option we developed a novel virtual test. C13 UBT At Home, is performed by patients at home with step by step instructions involving live video conference interaction between the patients and technicians. Aims & Methods: To determine the acceptability and the accuracy of the novel C13 UBT At Home service. Patients on a UBT waiting list were contacted and invited to undergo the alternative virtual breath test. Willing participants were pre assessed over phone to explain the process. Technical aspects (internet, smart phone or laptop requirements), navigation through the video call system attendanywhere and routine clinical parameters including PPI and antibiotic use were discussed. Suitable patients collected a Home UBT kit (Patient information sheet, test documentation, pre and post collection tubes, collection straw, urea tablet and feedback questionnaire) from a drop off point up to a week prior to their scheduled appointment. The test was performed as standard by the patient at home with live interaction for all active steps. The 20 minute rest between samples 1 and 2 collection was offline which allowed technicians to do concurrent cases. Patients were requested to fill in a feedback questionnaire after the test and to return it with the samples to the drop off point within 48 hours for analysis. The questionnaire included 6 questions covering pre procedure, procedure and post procedure domains. In addition to patient satisfaction, positivity rate, sample error rate and activity numbers were compared between UBT at home and a standard UBT cohort which was reinstated in 2021. Results: 300 patients were enrolled, mean age 41 years (range 7-85), 177 female (59%). Overall response rate was 96% (288), 96% (285) rated the entire UBT at home process as either excellent or good. All other parameters except connection to the hospital video call system, which was subject to external factors were also rated excellent/good by >90%. Accuracy between UBT tests was similar: positivity rate 23% (69/299) versus 22% (74/326), sample error rate 0.33% (1/300) versus 0.6% (2/326) for the UBT at home and standard tests respectively. Currently 3 of every 4 UBT's is now virtual despite reduced restrictions. Conclusion: UBT at home is possible and acceptable to patients with equivalent accuracy to standard UBT and should be continued to improve patient choice and satisfaction.
ABSTRACT
Aims The UK JAG on GI Endoscopy's minimum standard for polyp detection rates (PDR) in colonoscopy is 15 %. TheCOVID-19 pandemic precipitated the use of restrictive personal protective equipment (PPE) which might reduce dexterityand decrease PDRs. We audited our polyp excision rates both prior to and post the COVID-19 pandemic in order to assesswhether restrictive PPE led to a diminution therein. Methods Our endoscopy database was queried for all colonoscopies performed between 01/01/2014 and 29/02/2020 (Pre-COVID-19, n = 18,231) and between 01/03/2020 and 02/09/2020 (Post-COVID-19, n = 825) and subsequently irrevocablyanonymised. A polyp excision rate (PER) was calculated for each period as a proxy for PDR. A comparative odds ratio was calculated. An ordinary least squares (OLS) regression, using number of polyps excised as the dependent variable and procedure in thepost-COVID-19 period as a primary explanatory variable, was performed. The regression was controlled for age, malegender and procedure coded as therapeutic (as opposed to diagnostic). Results 4,346 and 209 patients had at least one polyp excised in the pre-COVID-19 (PER 23.8 %) and post-COVID-19 (PER25.3 %) periods respectively. Odds ratio 1.08 (95 %CIs: 0.92, 1.27). OLS regression established positive relationships between number of polyps excised and age (0.004, 95 %CIs: 0.003,0.005), male gender (0.10, 95 %CIs: 0.07, 0.13) and procedure coded as therapeutic (1.75, 95 %CIs: 1.71, 1.78). Itdemonstrated no significant relationship between procedure in the post-COVID-19 period (-0.003, 95 %CIs:-0.07, 0.07)and number of polyps excised. Conclusions Odds ratios comparing PERs and an OLS regression analysing number of polyps excised failed to demonstrateany significant difference between the pre-COVID-19 and post-COVID-19 eras.