ABSTRACT
Aims The outbreak of the corona-virus disease 2019 (COVID-19) has led to significant changes in endoscopy unitsworldwide, with potential impact on patients' welfare as well as on endoscopy training. We aimed to assess the real-lifeimpact of COVID-19 on the endoscopy unit in a tertiary care center from Romania. Methods We performed a service evaluation using the local endoscopy database. Two time periods were analyzed, namelyfrom the 1 of March to 15 September 2020, during the COVID-19 pandemic and a similar period between 1 of March -15 September 2019. Results There was a 6.2 fold decrease of the number of endoscopic procedures as a result of COVID-19. The mostimportant reduction was found in colonoscopy, from 916 to 42 procedures, P < 0.001, followed by flexible sigmoidoscopy, from 189 to 14 procedures, P = 0.009, upper gastrointestinal endoscopy, from 2269 to 401 procedures, P = 0.006, and ERCP, from 234 to 125 procedures, 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). Thedetection of cancers was considerably reduced (57 compared to 249, P = 0.001). Surprisingly the rate of complications waslower and the success of the procedures higher (7.6 % vs 19.2 %, P < 0.001, and 94.2 % vs 90.7 %, respectively). Fellowparticipation was also reduced from 90 % before the pandemic to 40.9 % during COVID-19 time (P < 0.001). Conclusions The COVID-19 pandemic has significantly altered the workflow of the endoscopy unit, lowering the number ofprocedures performed and potentially compromising the early detection of cancers.