Zhu L, Cai M Y, Shi Q, Wang P, Li Q L, Zhong Y S, Yao L Q, Zhou P H
Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Apr 25;23(4):327-331. doi: 10.3760/cma.j.issn.1671-0274.2020-0316-00147.
To explore the necessity and safety of selective endoscopy to detect gastrointestinal (GI) malignancy during the outbreak of coronavirus disease 2019 (COVID-19). A retrospective cohort study was carried out to analyze the clinical data of selective endoscopy performed at the Endoscopic Center, Zhongshan Hospital of Fudan University from February 20 to March 6, 2020. Clinical data included epidemiological questionnaire, chief complaints, endoscopic findings and biopsy pathology results, etc. All medical staff had blood test for IgM/IgG antibodies of COVID-19. Patients and their families were followed up by phone to determine whether they were infected with COVID-19. Meanwhile, the clinical data of selective endoscopy during the same period from February 20 to March 6, 2019 were collected as the control group to compare the overall results of endoscopy examinations during the epidemic and the detection rate of GI malignancy. A total of 911 patients underwent endoscopy in the epidemic period group, and a total of 5746 cases in the control group, which was 6.3 times over the epidemic period group. In the epidemic period group, 544 cases received gastroscopy and 367 cases received colonoscopy, while 3433 cases received gastroscopy and 2313 cases received colonoscopy in the control group, which were both 6.3 times of epidemic period group. Gastroscopy revealed that 39 patients (7.2%) were diagnosed with upper GI malignancies in the epidemic period group and 77 patients (2.2%) in the control group with significant difference (χ(2)=40.243, <0.001). The detection rate of gastric cancer in these two groups was 3.3% (=18) and 1.7% (=59) respectively with significant difference (χ(2)=6.254,=0.012). The detection rate of esophageal cancer was 3.7% (=20) and 0.5% (=18) respectively with significant difference (χ(2)=49.303,<0.001). Colonoscopy revealed that colorectal cancer was found in 32 cases (8.7%) of the epidemic period group and 88 cases (3.8%) of the control group with significant difference (χ(2)=17.888, <0.001). During the epidemic period, no infection of medical staff was found through the blood test of IgM/IgG antibodies on COVID-19. No patient and family members were infected with COVID-19 by phone follow-up. Compared with the same period in 2019, the number of selective endoscopy decreases sharply during the epidemic period, while the detection rate of various GI malignant tumors increases significantly, which indicates that patients with high-risk symptoms of GI malignancies should still receive endoscopy as soon as possible. Provided strict adherence to the epidemic prevention standards formulated by the state and professional societies, it is necessary to carry out clinical diagnosis and treatment as soon as possible.
探讨2019冠状病毒病（COVID-19）疫情期间选择性内镜检查对胃肠道恶性肿瘤的必要性及安全性。开展一项回顾性队列研究，分析2020年2月20日至3月6日在复旦大学附属中山医院内镜中心进行的选择性内镜检查的临床资料。临床资料包括流行病学调查问卷、主要症状、内镜检查结果及活检病理结果等。所有医护人员均进行了COVID-19 IgM/IgG抗体血液检测。通过电话随访患者及其家属，以确定他们是否感染COVID-19。同时，收集2019年2月20日至3月6日同期选择性内镜检查的临床资料作为对照组，比较疫情期间内镜检查的总体结果及胃肠道恶性肿瘤的检出率。疫情期间组共有911例患者接受内镜检查，对照组共有5746例，是疫情期间组的6.3倍。疫情期间组中，544例接受胃镜检查，367例接受结肠镜检查，而对照组中3433例接受胃镜检查，2313例接受结肠镜检查，均为疫情期间组的6.3倍。胃镜检查显示，疫情期间组39例（7.2%）被诊断为上消化道恶性肿瘤，对照组77例（2.2%），差异有统计学意义（χ(2)=40.243，<0.001）。两组胃癌检出率分别为3.3%（=18）和1.7%（=59），差异有统计学意义（χ(2)=6.254，=0.012）。食管癌检出率分别为3.7%（=20）和0.5%（=18），差异有统计学意义（χ(2)=49.303，<0.001）。结肠镜检查显示，疫情期间组32例（8.7%）发现结直肠癌，对照组88例（3.8%），差异有统计学意义（χ(2)=17.888，<0.001）。疫情期间，通过COVID-19 IgM/IgG抗体血液检测未发现医护人员感染。通过电话随访，未发现患者及其家属感染COVID-19。与2019年同期相比，疫情期间选择性内镜检查数量大幅减少，而各种胃肠道恶性肿瘤的检出率显著增加，这表明有胃肠道恶性肿瘤高危症状的患者仍应尽快接受内镜检查。只要严格遵守国家和专业学会制定的防疫标准，就有必要尽快开展临床诊治。
