key: cord-1033192-xsy1asya
authors: Bhat, Praveen Kumar R.; Santosh Kumar K Y; Sorake, Chandrashekar; Kulamarva, Ganaraj
title: Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery
date: 2020-09-15
journal: J Gastrointest Surg
DOI: 10.1007/s11605-020-04796-z
sha: 76dc7b34c2a9f054d249e395c214034cff4de453
doc_id: 1033192
cord_uid: xsy1asya

nan

imaging. A multicentre survey suggested that the number of endoscopic and colonoscopy procedures have drastically reduced to 10% of the pre-COVID era (in more than 75% of the centres surveyed) 2 . Guidelines issued by international bodies/ consensus groups are difficult to implement in a country like India with limited resources. Peripheral endoscopy centres, catering majority of the population lack of negative pressure units, have limited access to PPE; hence, many have completely stopped endoscopic procedures. Escalating cost of the procedure due to pre-procedure COVID test, PPE coupled with loss of jobs and livelihood, travel restrictions also have a cascading effect on the drastic reduction in number of procedures.

We being a tertiary care centre for gastrointestinal services cater to a huge demographic area with patients travelling 300-400 km to avail our services. Since the onset of the pandemic, the centre is geared up to perform all scheduled surgeries for gastrointestinal malignancies without undue delay. The real issues are the economic disruption and the travel restrictions taking a toll on early diagnosis and optimal care. The patients are delaying/postponing the hospital visit which we feel might have a catastrophic affect with many presenting with advanced stage of disease. We are presenting our data (Table 1 ) on the number of screening/diagnostic procedures undertaken during the period of COVID-19 pandemic (2020) compared with the corresponding period in the previous year (2019). The procedures reduced to less than 10% of the corresponding period of previous year in the months of April-May 2020. The number of procedures are gradually showing an increasing trend over the last 2 months(June-July 2020) but still are at 30-35% compared with that of the corresponding period of the past year. Various studies and observations published worldwide also have shown similar trends in screening and diagnostic procedures.

The results of a recently published UK endoscopy database analysis have revealed that endoscopic activity reduced to 12% of pre-COVID levels, and at its low point, activity was only 5%. 3 The weekly number of cancers detected decreased by 58% and the proportion of missing cancers ranged from 19% (pancreatobiliary) to 72% (colorectal) according to the database analysis. 3 A multicentre survey in Italy conducted at the peak of the pandemic also revealed that majority of the units (60.5%) which had normal endoscopic activities reduced by 75-99%. 4 The results of web-based survey of gastroenterologists across North America also suggest that at the time of response (April 2020), most centres (46/71, 65%) were operating at ≤ 10% of their normal endoscopy volume. 5 The published surveys and our observations suggest that there is a major disruption in endoscopic/screening activity due to COVID-19 pandemic which may lead to delay in gastrointestinal cancer diagnosis. This may result in a perilous situation where in many patients could present with advanced gastrointestinal cancers leading to adverse outcomes.

Conflict of Interest The authors declare that they have no conflict of interest. 

Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery

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