ABSTRACT
DDW 2022 Author Disclosures: Sachin Wani: NO financial relationship with a commercial interest ;Jeffrey Williams: NO financial relationship with a commercial interest ;Jennifer Holub: NO financial relationship with a commercial interest ;Audrey Calderwood: YES financial relationship with a commercial interest;Dark Canyon Laboratoties:Advisory Committees or Review Panels ;Jason Dominitz: NO financial relationship with a commercial interest ;Prasad Iyer: YES financial relationship with a commercial interest;Exact Sciences:Consulting;Exact Sciences:Grant/Research Support;Pentax:Grant/Research Support;Pentax:Consulting;Ambu:Consulting;Symple Surgical:Consulting;Medtronic:Consulting ;Nicholas Shaheen: YES financial relationship with a commercial interest;Lucid:Grant/Research Support;Medtronic:Grant/Research Support;Steris:Grant/Research Support;Pentax:Grant/Research Support;CDx Medical:Consulting;Cernostics:Consulting;Interpace Diagnostics:Grant/Research Support;Phathom Pharmaceuticals:Consulting;Exact Sciences:Consulting;Aqua Medical:Consulting;Cook Medical:Consulting Background: The COVID-19 pandemic has disrupted endoscopy practices with significant reductions in procedural capacity creating unprecedented decreases in cancer screening and surveillance services. Using a national registry with matched endoscopy and pathology data, we aimed to assess the impact of the pandemic on the proportion of patients diagnosed with BE and BE-related dysplasia and adherence to established quality indicators in BE. Methods: We analyzed data from the GI Quality Improvement Consortium (GIQuIC) Registry, a national repository of endoscopy data. Procedure data from all EGDs in the registry during the study period, including procedure indication, demographics, endoscopy findings, pathology results and recommendations were assessed from 1/2018 – 5/2021. Three cohorts based on date of EGD performance were created: Pre-pandemic (1/2018-2/2020), Early Pandemic (3/2020-7/2020) and Late-pandemic (8/2020-5/2021). Observed and expected number of BE and dysplasia cases/month were calculated. Adherence to Seattle protocol was assessed by dividing the BE length by number of pathology jars submitted;a ratio of ≤2.0 with rounding down was considered adherent. Adherence to recommended surveillance for non-dysplastic BE (NDBE) was calculated by assessing the proportion recommended to undergo an EGD between 3-5 years. Results: Among 1,619,684 EGDs assessed, 94,081 (5.8%) met inclusion criteria (Table 1). These cases were largely performed by GIs and represented 394 practices and 2666 endoscopists nationwide with geographic distribution within the U.S. as follows: West 24%, Midwest 13%, South 40%, and Northeast 23%. Fewer endoscopies were performed by non-GIs during the early (1.5%) and late pandemic (1.5%) compared to pre-pandemic period (9.3%, p<0.001). The mean BE length was 2.3 (2.5) cm and distribution based on histology was NDBE 87.5%, low-grade dysplasia (LGD) 2.2%, indefinite for dysplasia (IND) 2.9%, high-grade dysplasia (HGD) 1.5%, and unknown 5.8%. Table and Figure highlight the significant reduction in the number of patients diagnosed with BE (47.9% and 24.1%) and BE-related dysplasia (HGD: 38.5% and 25.3%;LGD: 45% and 34%, any dysplasia: 43.9% and 31.3%) per month during the early and late pandemic periods. Over the pandemic, there was no decline in adherence rates to quality indicators in BE with an overall adherence rate to the Seattle protocol and appropriate recommended surveillance interval in NDBE of 83% and 68.4%, respectively. Conclusions: Results of this study demonstrate a significant decline in EGD volume with an associated reduction in the number of patients diagnosed with BE and related dysplasia during the COVID-19 pandemic. The absence of a compensatory increase in diagnoses in the late pandemic period is concerning with likely long-term deleterious downstream effects on esophageal adenocarcinoma morbidity and mortality. [Formula presented] [Formula presented]