The coronavirus disease 2019 (COVID-19) pandemic has caused a substantial decrease in endoscopy services in Hong Kong, which has been associated with significant delays in the diagnosis of gastrointestinal (GI) cancer, according to a report published in Gastroenterology.

The COVID-19 pandemic has led to serious disruptions in the healthcare systems of many countries. However, the practical implications of service reductions remain unclear. In this study, researchers quantified the short-term disruption brought on by the COVID-19 pandemic on the delivery of GI endoscopy and its effect on cancer diagnosis and staging at a population level in Hong Kong.

Between January 23 and March 8, a total of 1045 COVID-19 cases were reported. Researchers determined the total number of upper and lower endoscopies performed in public hospitals in Hong Kong between October and March for the past 4 years using the Clinical Data Analysis and Reporting System (CDARS). Statistical measures such as Autoregressive integrated moving average (ARIMA) model, Buishand U test, linear regression model and state-transition Markov model were used to: predict the trend of patients newly diagnosed with gastrointestinal cancers; determine the week of turning point of the sudden changes; assess the relationship between the number of cancers diagnosed and the volume of endoscopy; and the potential stage shifting of these cancers with delayed diagnosis were estimated, respectively.


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During the first week of diagnosing new COVID-19 cases, The Buishand U test showed a turning point in the number of upper and lower endoscopies performed (P <0.001) and the number of gastric and colorectal cancers diagnosed (P <0.001). Subsequently, the average number of upper and lower endoscopies performed per week fell by 51.0% (from 1813 to 887, P <0.001) and 58.8% (from 1190 to 491, P <0.001), respectively. Additionally, the average number of gastrointestinal cancers diagnosed per week also dropped by 46.2% (from 22.9 to 12.3, P <0.001) and 37.0% (from 92.1 to 58, P <0.001), respectively. The ARIMA prediction and Markov model estimate that 4.6% and 6.4% of gastric and colorectal patients would have cancer stage upshifting at 6 months.

The authors state that, “the delay and subsequent cancer stage upshifting will be amplified if the COVID-19 pandemic lengthens further. Gradual resumption of non-emergency endoscopy services should be considered as early as feasible and practical, balancing the risks of delayed cancer diagnosis and personal safety of patients and staff.”

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Reference

Lui, TKL, Leung K, Guo C, Tsui VWM, Wu JT, Leung WK. Impacts of COVID-19 pandemic on gastrointestinal endoscopy volume and diagnosis of gastric and colorectal cancers: A population-based study [available online May 17, 2020]. Gastroenterology. doi: 10.1053/j.gastro.2020.05.037