The Impact of SARS-COV-2 on two Colorectal Cancer screening centres.

BowelScreen paused activity in March 2020 to prioritise the response to the COVID-19 pandemic. The aim of this study was to examine the impact of this delay. Cases affected by the pause and subsequently completed were compared to the same period in 2019. Endoscopy and histology data were obtained from the BowelScreen database and patient records. One-hundred and seven colonoscopies were performed during the study period. This compared with 224 colonoscopies during the same period in 2019. Median lead time to colonoscopy in 2020 was 74 days compared to 34 days in 2019. Adenoma detection rate was 59% for both periods. Advanced adenoma and cancer detection rates were similar in both periods. While there was a marked reduction in activity and significant delays for BowelScreen patients during the first wave of the COVID-19 pandemic, this does not appear to have impacted on clinical outcomes for patients who attended for screening colonoscopy.

The impact of sars-cov-2 on the irish national colorectal cancer screening programme: A report from two high-volume endoscopy centres

Aims The Irish National BowelScreen programme paused activities in March 2020 to prioritise the emergency response tothe SARS-CoV-2 pandemic. As a result, patients with positive fecal immunochemical test (FIT) results that had already beenreturned, experienced delays in time to colonoscopy. The standard lead time in BowelScreen is 20 working days. The aim ofthis study was to examine the impact of this delay on time to colonoscopy for index FIT positive cases in two tertiaryendoscopy units. Methods Index cases affected by the pause which were subsequently completed (up to July 2020) were analyzed andcompared to the same period in 2019. All colonoscopy's were performed by a BowelScreen accredited consultantendoscopist. Endoscopy and histology data was obtained from the BowelScreen database and patient records. Results In total, 111 colonoscopies were performed during the study period. During the same period in 2019, 226 indexcolonoscopies were completed. The median lead time in 2020 was 38 working days, or almost double the recommendedlead time. The median age in 2020 was 66.5 years (IQR 60-70) and in 2019 63 years (IQR 60-70). Men accounted for 55 %of patients in 2020 and 66 % in 2019. A total of 191 polyps were detected in the 2020 group, 16 % of which were advanced adenomas (adenoma ≥ 10mm). There were 394 polyps identified in the 2019 group, 16 % of which were advancedadenomas. The majority of these advanced adenomas (77 % in 2020 and 90 % in 2019) were left sided. High gradedysplasia was detected in one polyp in 2020 and in five in 2019. There were 3 cancers detected in 2020 and 11 in 2019. Conclusions There was a significant delay in lead time to index colonoscopy for FIT positive patients in BowelScreen.Despite this, the two groups had comparable advanced adenoma and cancer pathology detection rates.

Keeping the endoscopy ship afloat against the first wave of covid-19-the utilisation of a private institution to bolster mmuh gi services during covid-19

Aims During COVID-19, guidelines for performance of endoscopy meant procedure numbers were significantly curtailed.From April-June 2020, the Health Authorities in Ireland procured private hospitals for public use. The aims of this study were 1. to determine if additional private hospital capacity was utilised effectively for endoscopy, as this model is oftenemployed to deal with long waiting lists in Ireland. 2. to compare pathology and follow up rates between the two institutions. Methods We analysed all documentation relating to 242 endoscopy procedures outsourced to the private institution (MPH). For the period of June 2020 we compared indications, follow up rates and pathology for outpatient endoscopy proceduresperformed in our public institution, MMUH (n = 111) and MPH (n = 104). Results 197/242 (81.4 %) procedures in 167 patients were completed. Non-completion was due to refusal or failure toattend (32) and illness (6). 102 patients (61 %) were subsequently discharged to the GP and 39 % of patients requiredhospital follow up. There was no significant difference between indications in both institutions (p = 0.843). As shown in Table 1, rates ofsignificant pathology in MPH vs MMUH were not statistically significant, 4 % vs 7 %;p = 0.315. There was no difference infollow up rates in MPH vs MMUH, 62 % vs 51 %, p = 0.849. Conclusions The use of private capacity in MPH during the first wave of COVID19 significantly reduced the burden on thepublic system for GI procedures. However arranging the necessary follow up for the 39 % of patients from the MPHgenerated a substantial clinical and administrative workload on the public system. Although the endoscopy procedures performed in both institutions were deemed 'urgent', significant pathology was rare, between 4-7 %, suggesting more stringent criteria for endoscopy should be considered in the future.

Improving adherence to endoscopy guidelines for triage and surveillance in a singleendoscopy unit

Aims Encouraging adherence to agreed triage guidelines is a critical facet of endoscopy waiting list management,particularly in the current climate of COVID-19. Unfortunately, few such guidelines exist and there is considerable variabilityin their application. The aim of this study was to determine if the use of locally developed flowsheets, created using existing guidelines, couldaid in standardisation of endoscopy triage and surveillance in a single endoscopy unit. Methods Existing international (BSG) and national (NICE, NCSS and HIQA) guidelines were reviewed. Simple flowsheetswere devised to address upper and lower GI endoscopy triage, polyp and Barretts surveillance, family history of colorectalcancer. A baseline quiz involving clinical scenarios was devised and endoscopy users were invited to participate. The quizwas then retaken after reviewing the relevant flowsheets. Results 20 endoscopy users took part. The mean number of correct answers increased significantly after reviewingflowsheets (45±11 % v 71±12 %;p=<0.0001). Similar improvements were noted across both the triage and surveillancesections (25±15 % v 25±18 %;p=0.8368), and between nursing and medical staff (24±18 % v 27±15 %;p=0.7075).Consultants had more correct answers than nurses at initial assessment (56±5 % v 42±12 %;p=0.054) but there was nosignificant difference after reviewing the flowsheets (71±10 % v 66±14 %;p=0.5566). Conclusions We have shown a significant improvement in triage accuracy after reviewing appropriate guideline flowsheets among medical and nursing staff. While medical staff performed better at initial assessment, there was no significant difference between medical and nursing staff scores after reviewing the guidelines. We conclude that all staff should refer to guidelines when triaging clinical requests. In addition it reassures us that nurses, with appropriate guidelines as reference, can be utilised to support or replace doctor-led triage. (Table Presented).