Assessment of The Clinical Impact of Postponing Endoscopic Procedures Using Risk Stratification During Covid-19 Pandemic: a Prospective Systematic Multicentric Study

Abstract

Aims During the COVID-19 outbreak, we adopted in March 2020 our own risk stratification triage policy facing massivecancellation/postponing of all endoscopic procedures not considered urgent or immediately necessary. At the end of the firstwave endoscopy activity resumed progressively. We aimed to assess the impact of procedure postponing on patientoutcome. Methods Six weeks after cancellation policy initiation, the endoscopic reporting system of two tertiary hospitals wasmodified to allow prospective completion of our electronic database. From 01/05/2020 to 30/08/2020, for each procedure,endoscopists were asked to precise whether: 1) the examination was postponed due to the COVID-19 outbreak;2) theexamination revealed a significant diagnosis (SD, e.g: neoplasia diagnosis and management, diagnosis and management ofgastrointestinal bleeding lesion, stricture management, cyst and abdominal collection drainage, resection of large(pre)neoplastic lesions, gastrointestinal leak management, etc) and 3) if postponing the examination had a significantimpact on patient s management. Results During this period, among 5283 procedures performed, 476 (9 %) had been tagged as postponed procedures (PP)[esophagogastroduodenoscopy 50.8 %, colonoscopy 43.5 %, ERCP 2.5 %, EUS 2.7 %, enteroscopy: 0.4 %;medianpostponing delay 71 (52-91) days]. 8.1 % were postponed by the patient and 91.9 % by the hospital. Examinations revealeda SD in 70 cases in the PP group (14.7 %) and in 672 (14 %) in the non-PP group during the same period (p = 0.72). In 14cases (2.9 %) postponing the examination had a significant impact on patient management;4 patients received a delayeddiagnosis on management of cancer, 3 patients developed biliopancreatic complications and appropriate management wasprovided with delay in 2 and 3 patients with severe functional and inflammatory bowel diseases, respectively and 2 hadsevere esophagitis worsening. Conclusions Based on the analysis of PP procedures, the triage policy adopted during first wave COVID outbreak appearedadequate in terms of proportion of SD and impact on patient management.