ABSTRACT
Background: Although there is ongoing research into the effects of COVID-19 infection in patients with EoE, the non-infection-related impact of COVID-19 is not known. In particular, the impact of postponing endoscopy due to the pandemic has not been studied. Aim: To determine the impact of COVID-19-related endoscopy cancellations on clinical outcomes in EoE patients. Methods: In this retrospective cohort study, we identified adult patients with a diagnosis of EoE who had a routine endoscopy scheduled from mid-March 2020 to May 2020, the timeframe at the beginning of the pandemic when most procedures were stopped at our center. We determined if procedures were cancelled or proceeded, and if canceled, we determined which patients were rescheduled and returned. We extracted clinical, endoscopic, and histologic for the last procedure completed prior to the pandemic, and well as the next procedure performed during the pandemic, if a patient returned. Outcomes included histologic response (<15 eos/hpf), endoscopic severity (EREFS), and global symptoms response. Patients who had delayed care were compared to those who returned as scheduled. Results: Of 102 patients with an endoscopy scheduled within our time frame, 27 had the planned procedure and 75 were cancelled. Of these 75, 20 (27%) never returned for their EGD despite attempts to contact them. When compared to those who were cancelled, those who underwent their procedure had more severe fibrosis (predilation esophageal diameter 13.6 vs 15.1mm;p=0.04) and were more commonly treated with an elimination diet (56% vs 33%;p=0.04);the remainder of clinical features were similar (Table 1). For the 55 patients who were canceled but ultimately returned for their EGD, the mean time between procedures was 1.1±0.7 years. While treatment rates and endoscopic features were similar between the pre- and delayed post-COVID EGD, more patients required a dilation after their return (71% vs 58%;p=0.05) and their esophageal diameter had significantly decreased from the size achieved at the prior procedure (16.8mm to 15.0mm;p<0.001) (Table 2). Of 17 individuals who did not have stricture, narrowing, or dilation pre-pandemic, during their next endoscopy 5 (29%) had a stricture, 1 (6%) had a narrowing, and 7 (41%) required dilation. Conclusion: A large number of EoE patients had their endoscopies cancelled during the initial part of the COVID-19 pandemic. Those who were not cancelled had more severe fibrostenosis. Greater than 25% of those cancelled never returned for care, which is an unmeasured impact of the pandemic, and it is uncertain whether EoE findings have worsened in this group. Of those who returned, there was a delay of greater than one year, associated with progression of some fibrotic features and an increased need for esophageal dilation. (Table Presented) (Table Presented)