ABSTRACT
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.
Subject(s)
Adenoma , COVID-19 , Colorectal Neoplasms , Humans , SARS-CoV-2 , Pandemics/prevention & control , Early Detection of Cancer , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Colonoscopy , Mass Screening , Adenoma/diagnosis , Adenoma/epidemiologyABSTRACT
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.