Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Gut. 2021 Mar;70(3):537-543. doi: 10.1136/gutjnl-2020-322179. Epub 2020 Jul 20.
The COVID-19 pandemic has had a major global impact on endoscopic services. This reduced capacity, along with public reluctance to undergo endoscopy during the pandemic, might result in excess mortality from delayed cancer diagnosis. Using the UK's National Endoscopy Database (NED), we performed the first national analysis of the impact of the pandemic on endoscopy services and endoscopic cancer diagnosis.
We developed a NED COVID-19 module incorporating procedure-level data on all endoscopic procedures. Three periods were designated: pre-COVID (6 January 2020 to 15 March), transition (16-22 March) and COVID-impacted (23 March-31 May). National, regional and procedure-specific analyses were performed. The average weekly number of cancers, proportion of missing cancers and cancer detection rates were calculated.
A weekly average of 35 478 endoscopy procedures were performed in the pre-COVID period. Activity in the COVID-impacted period reduced to 12% of pre-COVID levels; at its low point, activity was only 5%, recovering to 20% of pre-COVID activity by study end. Although more selective vetting significantly increased the per-procedure cancer detection rate (pre-COVID 1.91%; COVID-impacted 6.61%; p<0.001), the weekly number of cancers detected decreased by 58%. The proportion of missing cancers ranged from 19% (pancreatobiliary) to 72% (colorectal).
This national analysis demonstrates the remarkable impact that the pandemic has had on endoscopic services, which has resulted in a substantial and concerning reduction in cancer detection. Major, urgent efforts are required to restore endoscopy capacity to prevent an impending cancer healthcare crisis.
COVID-19 大流行对内镜服务产生了重大的全球性影响。这种服务能力的下降，加上公众在大流行期间不愿意接受内镜检查，可能导致癌症诊断延误导致的超额死亡率。利用英国国家内镜数据库（NED），我们首次对大流行对内镜服务和内镜癌症诊断的影响进行了全国性分析。
我们开发了一个 NED COVID-19 模块，其中包含所有内镜程序的程序级别数据。指定了三个时期：COVID-19 前（2020 年 1 月 6 日至 3 月 15 日）、过渡期（3 月 16 日至 22 日）和 COVID-19 影响期（3 月 23 日至 5 月 31 日）。进行了全国、地区和程序特异性分析。计算了每周癌症的平均数量、缺失癌症的比例和癌症检出率。
COVID-19 前期间每周平均进行 35478 次内镜检查。COVID-19 影响期的活动减少到 COVID-19 前水平的 12%；在最低点，活动仅为 5%，到研究结束时恢复到 COVID-19 前活动的 20%。虽然更有选择性的审查显著提高了每例检查的癌症检出率（COVID-19 前为 1.91%；COVID-19 影响期为 6.61%；p<0.001），但每周检出的癌症数量减少了 58%。缺失癌症的比例范围从 19%（肝胆）到 72%（结直肠）。
这项全国性分析表明，大流行对内镜服务产生了显著影响，导致癌症检测率大幅下降，令人担忧。需要做出重大、紧迫的努力来恢复内镜服务能力，以防止即将到来的癌症医疗保健危机。
