P1301 - The Impact of the COVID-19 Pandemic on Endoscopy Procedure Volume and Cancer Detection Rate at a Large Academic Cancer Center

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Disha Kumar, MD

Baylor College of Medicine
Houston, TX, United States

Disha Kumar, MD¹, Lori Kohen, ², Anita Pappu, ³, Brian R. Weston, MD³, Denise Barringer, MS³, Phillip S. Ge, MD³, Jeffrey Lee, MD, MPH³, Mehnaz Shafi, MD³, William Ross, MD, MSCE³, Emmanuel Coronel, MD³
¹Baylor College of Medicine, Houston, TX; ²Syntropy Technologies LLC, Burlington, MA; ³University of Texas MD Anderson Cancer Center, Houston, TX

Introduction: The COVID-19 pandemic greatly affected the capacity to perform standard endoscopic procedures. Due to government mandate, practice shifted to performing only urgent procedures at the beginning of the pandemic followed by gradual resumption of elective procedures. We evaluated the impact of deferred colorectal cancer screening from March to December 2020 at a large academic cancer center.

Methods: We performed a retrospective cohort study among adults aged 18 years and older who had an endoscopy procedure performed between January 2019 to December 2020 at the University of Texas MD Anderson Cancer Center. In March 2020, elective procedures were suspended, then resumed in June 2020, with close to full capacity achieved by September 2020. There was no suspension during the 2020 winter COVID-19 surge. Clinical data were obtained via extraction of electronic health records. Data were aggregated and analyzed by the Syntropy platform: Palantir Foundry (Foundry). Basic statistics were performed, including student’s t-test and Chi-squared analysis.

Results: We identified 12444 endoscopy procedures performed on 9993 patients in 2019 and 9993 endoscopy procedures on 8138 patients in 2020 (table 1). Between March and December 2020, 8756 COVID tests were performed pre-endoscopy, with an average positivity rate of 4.8%. In Texas, the average COVID positivity rate was 8.9%. Total endoscopy volume declined by 19.7% in 2020 compared to 2019 (p-value = 0.02). The sharpest declines in endoscopy were in April 2020, with EGD volume falling by 76%, colonoscopy volume by 78%, and ERCP volume by 16% compared to respective averages in April 2019. By the end of 2020, case volume returned to 2019 levels. From March 2020 to December 2020, 850 colonoscopies were cancelled; average adenoma detection rates (ADR) were 27.0 and average carcinoma detection rates (CDR) were 10.7, compared to ADR of 34.5 (p-value = 0.004) and CDR of 12.6 (p=0.71) for the same time period in 2019. See Figure 1.

Discussion: Total endoscopy volume declined by 19.7% in 2020 due to the impact of COVID-19 related changes in endoscopy practice. This impacted elective procedures such as screening colonoscopy procedures. The ADR was significantly lower in 2020 compared to 2019. There was not a significant change in CDR. These findings highlight the importance of increased routine endoscopic procedures, as the burden of COVID-19 diminishes.

Figure: Endoscopic Procedures Performed and Adenoma and Carcinoma Detection Rates Over Time.

	2019		2020
	n	%	n	%
Sex
Male	5,022	51.2%	4,010	50.3%
Female	4,786	48.8%	3,957	49.7%
Unknown	0	0%	1	0%
Age
18-29	149	1.5%	136	1.7%
30-39	315	3.2%	301	3.8%
40-49	818	8.3%	752	9.4%
50-59	2,225	22.7%	1,964	24.6%
60-69	3,232	33%	2,570	32.3%
70-79	2,432	24.8%	1,816	22.8%
≥80	621	6.3%	411	5.2%
Unknown	16	0.2%	18	0.2%
Ethnicity
Hispanic/Latino	1,251	12.8%	1,025	12.9%
Not Hispanic/Latino	8,298	84.6%	6,741	84.6%
Unknown	259	2.6%	202	2.5%
Race
Black/African-American	946	9.6%	777	9.8%
White/Caucasian	7,312	74.6%	5,960	74.8%
Asian	668	6.8%	551	6.9%
Middle Eastern	0	0%	0	0%
American Indian or Alaska Native	34	0.3%	32	0.4%
Native Hawaiian or Other Pacific Islander	7	0.1%	6	0.1%
Unknown	98	1%	73	0.9%
Procedure
EGD	3,775	38.5%	3,098	38.9%
Colonoscopy	5,302	54.1%	4,164	52.3%
EUS	716	7.3%	661	8.3%
ERCP	439	4.4%	325	4.1%
Enteroscopy	27	0.3%	43	0.5%
Sigmoidoscopy	298	3%	254	3.2%

Table: Demographic Characteristics of Patients Who Received Endoscopic Procedures in 2019 and 2020

Disclosures:

Disha Kumar indicated no relevant financial relationships.

Lori Kohen indicated no relevant financial relationships.

Anita Pappu indicated no relevant financial relationships.

Brian Weston indicated no relevant financial relationships.

Denise Barringer indicated no relevant financial relationships.

Phillip Ge indicated no relevant financial relationships.

Jeffrey Lee indicated no relevant financial relationships.

Mehnaz Shafi indicated no relevant financial relationships.

William Ross indicated no relevant financial relationships.

Emmanuel Coronel: Boston Scientific – Consultant.

Disha Kumar, MD¹, Lori Kohen, ², Anita Pappu, ³, Brian R. Weston, MD³, Denise Barringer, MS³, Phillip S. Ge, MD³, Jeffrey Lee, MD, MPH³, Mehnaz Shafi, MD³, William Ross, MD, MSCE³, Emmanuel Coronel, MD³. P1301 - The Impact of the COVID-19 Pandemic on Endoscopy Procedure Volume and Cancer Detection Rate at a Large Academic Cancer Center, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.