key: cord-0289164-zcgx07ga authors: Mohyud Din, F.; Gul, M. A.; Hameed, N.; Hameed, R.; Zaidi, Y.; Kanju, S.; Tameez-ud-din, A.; Altaf, S. M.; Tameez Ud Din, A. title: Comparison of endoscopic activity before and during the covid pandemic at a tertiary care hospital in South Punjab date: 2021-10-14 journal: nan DOI: 10.1101/2021.10.11.21264820 sha: 39b239f7c4d0ba9804d033fbba3175cb4efef61b doc_id: 289164 cord_uid: zcgx07ga Introduction: Coronavirus disease 2019 (COVID-19) has resulted in dramatic changes to healthcare delivery. Endoscopic activity has had frequent disruptions during this pandemic. The objective of the study was to see the influence of pandemic over the endoscopic activity. Methods: This retrospective analysis of endoscopic activity was undertaken at Nishtar Hospital Multan. Procedural analysis was done in the three months immediately after covid lockdown (1st April till 30th June 2020) and was compared to a similar period one year back. Results: Five hundred and fifty-four (68.5%) patients underwent endoscopic procedures during the three months of pre-COVID era, while this number reduced to half (n=255, 31.5%) patients during the covid pandemic. Even though the absolute number of Esophagogastroduodenoscopies (EGDs) reduced during the pandemic, patients were more likely to undergo EGDs during the COVID pandemic in contrast to the era before the pandemic (79% versus 66%, p = 0.002). The most common indication for EGD was upper gastrointestinal bleeding (UGIB). The percentage of EGDs done for UGIB rose from almost 60% to 80% during the covid pandemic (p < 0.001). The most common findings were esophageal varices and portal gastropathy (non-significant difference during and before the pandemic). Percentage of ERCPs done for obstructive jaundice doubled during the COVID pandemic (33% versus 65%, p = 0.002).The most common indication for sigmoidoscopy or colonoscopy was lower gastrointestinal bleeding. However, no significant difference was found before and during the covid pandemic (41.7% and 45.8% respectively, p=0.72). Internal hemorrhoids were the most common endoscopic finding. Colon cancer diagnosis reduced from 10% to undetected during the pandemic period. Conclusion: COVID pandemic resulted in a considerable reduction in all types of endoscopic procedures. The majority of procedures were done for emergency indications like gastrointestinal bleeding. Rates of cancer detection were significantly reduced. MeSH: Endoscopy, COVID-19, Gastroenterology 3 during this pandemic. The objective of the study was to see the influence of pandemic over the endoscopic activity. Methods: This retrospective analysis of endoscopic activity was undertaken at Nishtar Hospital Multan. Procedural analysis was done in the three months immediately after covid lockdown (1st April till 30th June 2020) and was compared to a similar period one year back. Results: Five hundred and fifty-four (68.5%) patients underwent endoscopic procedures during the three months of pre-COVID era, while this number reduced to half (n=255, 31.5%) patients during the covid pandemic. Even though the absolute number of Esophagogastroduodenoscopies (EGDs) reduced during the pandemic, patients were more likely to undergo EGDs during the COVID pandemic in contrast to the era before the pandemic (79% versus 66%, p = 0.002). The most common indication for EGD was upper gastrointestinal bleeding (UGIB). The percentage of EGDs done for UGIB rose from almost 60% to 80% during the covid pandemic (p < 0.001). The most common findings were esophageal varices and portal gastropathy (non-significant difference during and before the pandemic). Percentage of ERCPs done for obstructive jaundice doubled during the COVID pandemic (33% versus 65%, p = 0.002).The most common indication for sigmoidoscopy or colonoscopy was lower gastrointestinal bleeding. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Within a short span of time, the disastrous impact of this pandemic has reached unprecedented levels, affecting countries all over the world with more than 206 million reported cases and more than 4.3 million deaths as of 8th August 2021 [1] . COVID-19 has greatly impacted medical practices of health-care centers including private clinics and tertiary care hospitals. The field of Gastroenterology has been especially affected and to meet the challenges posed by this pandemic, guidelines on safe endoscopy have been published by esteemed United States, European, Asian and Japanese societies [2] [3] [4] [5] . It is a well-recognized fact that COVID-19 is primarily transmitted via the respiratory route. However, endoscopists face the risk of transmission via the oral and fecal routes as well [6] [7] [8] [9] .All over the world gastrointestinal (GI) departments were affected severely. In most centers elective procedures were postponed which led to an unprecedented decrease in the endoscopic activity [10-13]. The first known case of COVID-19 in Pakistan was reported on 26th February 2020, with lockdown imposed by the Government of Pakistan in March 2020 [14] . The provision of essential and non-essential health services in the country have been severely affected by the pandemic but few studies regarding the impact of this pandemic over the endoscopic activity have been reported in Pakistan. We aimed . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint 6 to investigate how the COVID pandemic has influenced the endoscopic procedures at Nishtar Hospital Multan, which is the largest tertiary care center in the region. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint 7 This retrospective study was carried out at the Department of Gastroenterology, Nishtar Hospital Multan. Ethical approval for the study was issued by the Institutional Review Board (IRB) of Nishtar Medical University, Multan (Reference No. 17997). To see the effects of pandemic, a comparison between two time periods was considered, namely 1st of April-30th June 2020 during the pandemic, and a similar period between 1st of April-30th June 2019 before the pandemic. All the patients who underwent endoscopic procedures during this time period were included in our study. From the endoscopy record register patient's age, gender, type of procedure, indication of procedure and findings of endoscopy were noted. Confidentiality of patients was ensured. Data were entered and evaluated in Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp, Armonk, US). Comparison of endoscopic activity was done between the two time periods. The results were reported as frequencies, . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint 8 percentages, and tables. Chi-square test was used for the analysis of qualitative variables. We considered a p-value of less than 0.05 to be significant. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint 9 A total of 809 (males 56.7%, females 43.3%) patients were included in the study who underwent endoscopic procedures during the specified time periods. There were 554 (68.5%) patients who underwent procedures during the three months of pre-COVID era. During the COVID era this number became less than half i.e., only 255 (31.5%) patients. The mean age of the study population was 46.86 years with a standard deviation of 16.6 years and age range of 12 to 90 years. The mean age of patients undergoing procedures during the pre-COVID era was 46.07 + 16.4 years, while mean age of patients during the COVID-19 pandemic was 48.57 + 16.9 years (p < 0.05). There was no significant difference with regards to gender distribution between the pre-COVID and COVID pandemic (p = 0.76). Table 1 shows the different procedures and their frequency before and during the COVID pandemic. Overall EGDs were the most common procedure. Patients were more likely to undergo EGDs during the COVID pandemic as compared to the era before the pandemic (79% versus 66%, p = 0.002). Table 2 shows the indications and findings of EGDs before and during the covid pandemic. The most common indication for EGD was upper gastrointestinal bleeding (UGIB). The percentage of EGDs done for UGIB rose from almost 60% to 80% during the covid pandemic (p < 0.001). Percentage of EGDs done for . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint 1 0 persistent pain epigastrium decreased significantly to half (10% to 5%, p < 0.001) during the pandemic. Similarly, EGDs done for variceal screening reduced significantly from 10% to 1% during the pandemic (p< 0.001). Not much change was seen in other indications for which EGD was performed. As for the findings, the two most common seen in almost of EGDs were esophageal varices and portal gastropathy. Table 3 shows the different indications for which ERCP was performed. Obstructive jaundice was the most common indication. Percentage of ERCPs done for obstructive jaundice doubled during the COVID pandemic (33% versus 65%, p = 0.002). Table 4 shows the indications and findings of lower GI endoscopy procedures performed. The most common indication for sigmoidoscopy or colonoscopy was lower gastrointestinal bleeding. However, no significant difference before and during the covid pandemic (41.7% during the pre-COVID era, 45.8% during the COVID pandemic, p = 0.72). Internal hemorrhoids were the most common endoscopic finding in patients who underwent lower GI endoscopy (38% in pre-COVID era, 50% during the pandemic). . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint 1 2 In our setting, it was found that although the overall absolute number of procedures reduced to almost half during the covid pandemic, there were some interesting findings with regards to the indications for these procedures. There was an increase in the percentage of EGDs and the proportion ERCP procedures for obstructive jaundice doubled during this period (p = 0.002). These changes occurred due to precautionary restrictions adopted by the government and our institute, limiting the . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint 1 3 This study is one of the first in this region to evaluate the effect of covid pandemic over endoscopy practice but it has certain limitations. Our study was single centered and the database contained no information regarding complications of different procedures. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint 1 4 The covid pandemic has had a profound impact on the endoscopic activity, which is evident by a considerable reduction in all types of procedures. Most procedures were carried out in emergency settings and cancer detection was reduced during these times. Only time will tell the full impact of covid pandemic and further studies are required to delineate the long-term effect of this health disaster over the well-being of the patients. Efforts should be done to safely return to pre-covid situation so that the patients in need of essential health services can be evaluated and treated in the way which suits their health needs. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint 2 0 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint 2 1 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint 2 4 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint Coronavirus Update (Live) Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements) Dinis-Ribeiro M. 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CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted October 14, 2021. ; https://doi.org/10.1101/2021.10.11.21264820 doi: medRxiv preprint