C0286 - Impact Analysis of an Endoscopic Triage Algorithm Implemented During the Early Stages of the COVID-19 Pandemic

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ritodhi Chatterjee, MD

Baylor College of Medicine
Houston, TX

Ritodhi Chatterjee, MD, David Szafron, MD, Gyanprakash A. Ketwaroo, MD, MSc
Baylor College of Medicine, Houston, TX

Introduction: Early in the COVID-19 pandemic, gastroenterology practices were forced to cancel or reschedule procedures to preserve personal protective equipment (PPE) and minimize viral spread. Such prolonged disruption in endoscopic activity was unprecedented. ACG and other societies released triage guidelines, but these could not account for regional or institutional idiosyncrasies. The GI section of our veterans affairs (VA) hospital created an internal triage protocol based on expert review. Our aim was to gauge appropriateness of this algorithm by evaluating the resulting case load and outcomes. This analysis will help inform future endoscopy planning and resource management.

Methods: We assessed the number of endoscopic cases—including EGD, colonoscopy, EUS, enteroscopy, flexible sigmoidoscopy, and ERCP—performed during the study period (3/15/20-4/30/20) after launch of the new protocol. We tabulated procedures completed in the preceding nine months, divided into six-week windows, to estimate historical case volume. Each urgent case was reviewed for diagnostic and therapeutic yield, complications, and COVID-19 status. Procedures were deemed “high-yield” if associated with an intervention, change in management, or time-sensitive diagnosis such as malignancy.

Results: 6,730 endoscopic cases were completed in the nine months prior to study period, an average of 1,122 per six-week block. Over an equivalent period in the COVID-19 era, 158 endoscopic procedures were deemed “urgent” via our triage protocol and performed—14% of the usual case load. Colonoscopy volume fell most significantly to 8% of baseline, with EGD volume following at 18%. Of 158 urgent cases, 54% were categorized as high-yield and < 2% produced complications. No patients or staff tested positive for COVID-19 within two weeks.

Discussion: Our analysis suggests that the endoscopic triage protocol deployed during the first wave of COVID-19 was safe and effective. The algorithm selected for procedures that were high-yield over half the time. In addition, administrative policies enacted (e.g., screening, PPE) were effective in limiting spread of COVID-19. Notably, advanced endoscopic procedure volume was less affected by adoption of the triage protocol and thus scheduling and staffing should facilitate such cases. Creative strategies will be necessary to reduce queues resulting from marked decline in colonoscopy volume, such as use of FIT testing, re-triage based on new surveillance guidelines, and emphasis on optimizing bowel prep.

Figure: Figure 1. Endoscopic case load over nine months prior to implementation of triage protocol, separated into total and high-volume procedures (A), and low-volume procedures (B)

Procedure	Case Count	% Outpatient	% Inpatient	% High-Yield	Complications
Colonoscopy	54	46%	54%	24%	0
EGD	71	41%	59%	68%	0
ERCP	8	25%	75%	100%	1
Flex Sig	8	25%	75%	50%	1
EUS	10	90%	10%	60%	0
Enteroscopy	7	14%	86%	86%	0
Total	158	43%	57%	54%	2

Table: Table 1. Comparison of relative utility and complication rate for urgent cases performed during the study period by procedure type

Disclosures:

Ritodhi Chatterjee indicated no relevant financial relationships.

David Szafron indicated no relevant financial relationships.

Gyanprakash Ketwaroo indicated no relevant financial relationships.

Ritodhi Chatterjee, MD, David Szafron, MD, Gyanprakash A. Ketwaroo, MD, MSc. C0286 - Impact Analysis of an Endoscopic Triage Algorithm Implemented During the Early Stages of the COVID-19 Pandemic, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.