Improvement in appropriateness and diagnostic yield of fast-track endoscopy during the COVID-19 pandemic in Northern Italy

Abstract

Background During the COVID-19 outbreak in Italy, only fast-track endoscopic procedures have been performed; nevertheless, a significant drop in their number has been reported. We evaluated whether the pandemic has impacted the appropriateness and diagnostic yield of fast-track endoscopic procedures compared with those performed in 2019.

Methods This retrospective study involved endoscopy services in Northern Italy. We compared data regarding endoscopic procedures performed in March and April 2020 with those performed during the same period in 2019.

Results In 2020, there was a 53.6 % reduction in the number of fast-track endoscopic procedures compared with 2019. Patients undergoing endoscopy in 2020 were younger than in 2019. Both appropriate referral and diagnostic yield increased in 2020 for both upper and lower endoscopy. A higher rate of cancer was diagnosed in 2020 by upper endoscopy (3.6 % vs. 6.6 %; P = 0.04).

Conclusions The high level of inappropriate endoscopy referrals registered in 2019 significantly improved during the COVID-19 outbreak of 2020, with an increase in the diagnostic yield.

Publication History

Received: 24 June 2020

Accepted: 17 September 2020

Accepted Manuscript online:
17 September 2020

Article published online:
04 November 2020

• References

• 1 Hassan C, Bersani G, Buri L. et al. Appropriateness of upper-GI endoscopy: an Italian survey on behalf of the Italian Society of Digestive Endoscopy. Gastrointest Endosc 2007; 65: 767-774
• 2 Minoli G, Meucci G, Bortoli A. et al. The ASGE guidelines for the appropriate use of colonoscopy in an open access system. Gastrointest Endosc 2000; 52: 39-44
• 3 Di Giulio E, Hassan C, Pickhardt PJ. et al. Cost-effectiveness of upper gastrointestinal endoscopy according to the appropriateness of the indication. Scand J Gastroenterol 2009; 44: 491-498
• 4 Parente F, Bargiggia S, Bianchi Porro G. Prospective audit of gastroscopy under the ‘three-day rule’: a regional initiative in Italy to reduce waiting time for suspected malignancy. Aliment Pharmacol Ther 2002; 16: 1011-1014
• 5 Little P, Dorward M, Warner G. et al. Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral and prescribing in primary care: nested observational study. BMJ 2004; 328: 444-446
• 6 Repici A, Pace F, Gabbiadini R. et al. Endoscopy units and the COVID-19 outbreak: a multicenter experience from Italy. Gastroenterology 2020; 159: 363-366
• 7 Armellini E, Repici A, Alvisi C. et al. Analysis of patients attitude to undergo urgent endoscopic procedures during COVID-19 outbreak in Italy. Dig Liv Dis 2020; 52: 695-699
• 8 ASGE Standards of Practice Committee. Appropriate use of GI endoscopy. Gastrointest Endosc 2012; 75: 1127-1131
• 9 Levy RL, Olden KW, Naliboff BD. et al. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology 2006; 130: 1447-1458
• 10 Cardin F, Andreotti A, Zorzi M. et al. Usefulness of a fast track list for anxious patients in a upper GI endoscopy. BMC Surgery 2012; 12 (Suppl. 01) S11
• 11 Rex DK, Vemulapalli KC, Kane MJ. et al. Most patients are willing to undergo elective endoscopic procedures during the reopening period of the COVID-19 pandemic. Gastroenterology 2020; 159: 1173-1175
• 12 Poletti P, Ajelli M, Merler M. Risk perception and effectiveness of uncoordinated behavioral responses in an emerging epidemic. Math Biosci 2012; 238: 80-89
• 13 Cori L, Bianchi F, Cadum E. et al. Risk perception and COVID-19. Int J Environ Res Public Health 2020; 17: 3114
• 14 Lui TK, Leung K, Guo CG. et al. Impacts of COVID-19 pandemic on gastrointestinal endoscopy volume and diagnosis of gastric and colorectal cancers: a population-based study. Gastroenterology 2020; 159: 1164-1166
• 15 Kapoor N, Bassi A, Sturgess S. et al. Predictive value of alarm features in a rapid access upper gastrointestinal cancer service. Gut 2005; 54: 40-45