Emergency endoscopy in children during sars-cov-2 pandemic in a tertiary center-a changing pattern

ABSTRACT

Introduction: At pediatric age, an emergency endoscopic procedure is required in a limited number of circumstances, mainly due to accidental foreign body ingestion (FBI), gastrointestinal bleeding and caustic ingestion. FBI may represent most of the procedures, occurring typically in young children (6 months to 3 years of age) at home. Although most FBIs in the gastrointestinal tract pass spontaneously without complications, endoscopic or surgical removal may be required in a few cases. SARS-CoV2 pandemic has led to significant family lifestyle changes, which forced children to stay at home for prolonged periods of time. It has been suggested that pandemic contingency may have increased the frequency of domestic accidents during lockdown period (namely FBI and caustic ingestion) and consequently the risk of potentially fatal episodes, as compared with non-pandemic periods. Aims & Methods: A retrospective analysis of the overall admissions to the pediatric emergency department of a tertiary referral hospital center with need of emergency endoscopy was performed. Children and adolescents aged between 0 and 18 years were included in the study. We compared the first 6 months of the pandemic (peak months April to September 2020-Group A) with the homologous period of the previous year (2019-Group B). The aim of the study was to evaluate if the changes in the lifestyle and hospital practices imposed by the pandemic had an impact on the frequency and profile of the emergency endoscopy. Chi-square and Mann-Whitney U tests were used for statistical analysis using IBM-SPSS®. Statistically significance was considered when p-value was under 0.05. Results: A total of 89 cases were analyzed (54% of the admissions in group A). Median age of admissions was 4.5 years. Groups did not differ for gender (p = 0.399) or age (p = 0.242). Concerning overall emergency endoscopies, 28% (25/89) occurred in children under the age of two, with most of these episodes occurring in Group A (19/89;p = 0.009). Groups did not differ considering the endoscopy indication (foreign body ingestion, caustic ingestion, food impaction and digestive hemorrhage) (p=0.899), nor about the presence of associated lesions (p = 0.597). The most frequent ingestions were caustics (18%, 16/89), coins (17%, 15/89), food impaction (12%, 11/89) and batteries (10%, 9/89). However, battery ingestions and food impactions were more frequent in 2020, respectively 67% (9/89;p = 0.419) and 64% (7/89;p = 0.49). There were no statistically significant differences on the time delay to reach the emergency department (p = 0.934) or on the time delay since emergency room admission until the endoscopic procedure (p = 0.266). More foreign bodies were removed in Group A (p = 0.026) and when lesions were present, they were more frequently seen on the esophagus (p = 0.007). Most of the patients (84%) were discharged home, after a brief recovery time after the procedure, with no difference between groups (p = 0.397). Conclusion: This study shows that there were no significant differences between both groups on the number and type of emergency endoscopies, on the time to reach the emergency room or to the performance of the endoscopy. Children under the age of 2 had more episodes with need of emergency endoscopy during the pandemic as compared to the homologous period. Overall, the pandemic did not seem to affect the quality of healthcare practice concerning emergency endoscopic procedures.