ABSTRACT
Objective: Endoscopy departments have experienced considerable challenges in the provision of endoscopy services since the start of the COVID-19 pandemic. Several studies have reported a reduction of procedures performed by trainee endoscopists during the pandemic. The aim of this study was to assess the impact on colonoscopy training and quality in an academic centre throughout successive waves of the pandemic. Methods: This was a single-centre, retrospective, observational study comparing colonoscopies performed at a tertiary endoscopy centre in Ireland at different stages of the pandemic with those performed during a similar time frame prepandemic. Data were collected using electronic patient records. Primary outcomes were procedure volumes, adenoma detection rate and mean adenoma per procedure. Results: In the prepandemic period, 798 colonoscopies were performed. During the same period in 2020, 172 colonoscopies were performed. In 2021, during the third wave of the pandemic, 538 colonoscopies were performed. Percentages of colonoscopies performed by trainees were 46.0% (n=367) in 2019, 25.6% (n=44) in 2020 and 45.2% (n=243) in 2021. Adenoma detection rate was 21.3% in 2019, 38.6% in 2020 and 23.9% in 2021. Mean adenoma per procedure was 0.45 in 2019, 0.86 in 2020 and 0.49 in 2021. Caecal intubation rate was 90.74% in 2019, 90.9% in 2020 and 95.88% in 2021. Conclusion: The COVID-19 pandemic initially had a negative impact on overall colonoscopy volumes and training. Despite a reduction in procedural volume, key performance standards were maintained by trainees. Maintenance of hands-on training is essential to allow trainees achieve and retain competency in endoscopy.
ABSTRACT
Introduction: In Spring 2020, guidelines for the safe practice of endoscopy during the SARS-CoV-2 pandemic were introduced. Endoscopy units transformed to comply with guidelines in order to prevent the spread of COVID-19 and to protect patients and staff. Many units experienced a marked decrease in case volume. Aims/Background: The aim of this study was to assess the effect of the pandemic on the colonoscopy performance in our endoscopy unit;focusing primarily on case volume, pathology identified and training. Methods: This was a single center, retrospective, observational study comparing colonoscopies performed at a high-volume endoscopy center in Ireland during the SARS-CoV-2 pandemic with colonoscopies performed during a similar time frame pre-pandemic (March-June 2020 versus 2019). Data was collected using electronic patient records. Results: During the reference period (March to June 2019), 981 colonoscopies were performed in our unit. In the same period in 2020, there was a 4.5-fold reduction in colonoscopies performed (n=217). Baseline patient characteristics, colonoscopy comfort scores, sedation rates and quality of bowel preparation were similar in both groups. 53% were male (2019, n=522;2020, n=115). The median age in 2019 was 61 years compared with 66 years in 2020. The indications for endoscopy differed between the two time periods. The main indications pre-pandemic were previous polyps (19.47%), colorectal cancer (CRC) screening via the national CRC screening programme in Ireland (17.33%), and diarrhoea or alternating bowel habits (11.62%). In 2020, the main indications included CRC screening (33.64%), anaemia (15.67%) and rectal bleeding (13.36%). With regards to pathology identified, the overall adenoma detection rate (ADR) in 2019 was 27.83%. In 2020, the ADR was 37.33%. There was a 2.4-fold reduction in the number of malignancies detected in 2020 compared with 2019 (2019, n=24;2020, n=10). There was an 8-fold reduction in the number of colonoscopies performed by GI trainees (2019, n=367;2020, n=44). Although the total number of polyps identified reduced greatly (2019, n=331;2020, n=62), the ADR for GI trainees remained acceptable (2019 = 32.21%;2020 = 40.91%). The average number of polyps detected per procedure was equal in 2019 to 2020 (n=2). Cecal intubation rates (91.0% vs 90.9%) and withdrawal times (15.9 vs 17.3 minutes) were comparable for 2019 versus 2020. Conclusion: The SARS-CoV-2 pandemic impacted greatly on our endoscopy unit in terms of case volume and pathology identified. Endoscopy training in our unit was also adversely affected. A marked decrease in the number of colonoscopies and polypectomies performed by GI trainees was observed in 2020. At present, many countries worldwide are experiencing a second wave of the virus. Strategies will need to be created to safeguard endoscopy training for our trainees.
ABSTRACT
BACKGROUND: Radical changes to clinical and endoscopy practice have been rapidly introduced following the spread of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Urgent endoscopies are, however, intended to proceed as normal with additional personal protective procedures. A perceived reduction in hospital attendances may suggest a number of urgently indicated endoscopic retrograde cholangio-pancreatographies (ERCPs) are being missed. Objectives and Methods: A review of all ERCPs carried out in a large tertiary referral endoscopy unit under healthcare restrictions was compared to the same time period in previous years. The intention was to determine if ERCPs are proceeding as normal or if there is a difference in referral characteristics. RESULTS: Under service restrictions (13 March to the end of April 2020), 55 ERCPs were performed compared with 87 ERCPs in 2019. Similar numbers to 2019 were also recorded in the preceding years. One case of coronavirus disease 2019 (COVID-19) was reported in a patient in the days following ERCP, with no cases notified among staff related to endoscopy. CONCLUSIONS: A reduction in ERCP referrals raises concern that a cohort of patients with significant biliary disease remain undetected. Whether this results in later, and more severe, presentation remains to be seen but a potential surge in such cases could significantly burden all future endoscopy planning services.