Backlog of Endoscopic Services Will Likely Persist Well Into 2022 in England

Endoscopy at the hospital.
Researchers assessed the change in the number of endoscopic procedures due to COVID-19 in England and proposed recovery scenarios based on waiting list volumes.

The backlog of endoscopy services across England caused by the coronavirus disease 2019 (COVID-19) pandemic will likely take more than 1 year to mitigate. These findings were published in The Lancet Gastroenterology and Hepatology.

The National Health Service (NHS) England’s Monthly Diagnostic Waiting Times and Activity Data were analyzed for this study. The change in the number of endoscopic procedures between January 2018 and October 2020 were assessed and recovery scenarios on the basis of current waiting list volumes were proposed.

In 2018, the average number of endoscopic procedures per month was 112,680 (standard deviation [SD], 6090). The number of procedures increased by 3.5% to 116,538 (SD, 5766) in 2019. The pandemic caused a great reduction in procedures to a low point in April of 2020 (10,476) corresponding with only 9.5% of the volume in April of 2019. In October 2020 there was a near recovery, performing 84.5% of the procedures as in the previous year.

Stratified by procedure type, compared with October of 2019, in 2020 there was 91.3% of the volume for colonoscopies, 89.6% of the volume for gastroscopy, and 62.2% for flexible sigmoidoscopy. The procedure types varied in recovery rate between January to October of 2020 (P =.015).

The number of patients who were on a waiting list for a procedure peaked in September of 2020 at 177,557 which corresponded with a 72.6% increase. The waiting list began to shorten in October when recovery commenced.

To predict when the accumulated backlog may be cleared, the investigators projected differing scenarios of operating over full capacity. In the scenario in which the NHS could perform 130% of procedures, in January of 2021 the backlog would be 163,709 (95% CI, 145,442-181,976) and be cleared by January of 2022. For the scenario of 120%, the backlog in January of 2021 would be 169,540 (95% CI, 150,163-188,917), in 2022 backlog would be 43,754 (95% CI, 35,060-52,447), and would be cleared in 2023. The scenario of operating at 110% found there would still be an excess of 53,640 (95% CI, 46,252-61,028) procedures in January of 2023.

This study may have been biased by assuming all patients who were on the waiting list still required a procedure, which may have caused over-estimations. Conversely, there were also assumptions made that no future peaks in infection would cause additional service disruptions, which if untrue, would cause these results to be under-estimations.

The study authors concluded the COVID-19 pandemic has caused enormous strain on the NHS endoscopic services in England, with little evidence the backlog can be cleared before 2022.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

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Ho KMA, Banerjee A, Lawler M, et al. Predicting endoscopic activity recovery in England after COVID-19: a national analysis. Lancet Gastroenterol Hepatol. Published online March 10, 2021. doi: 10.1016/S2468-1253(21)00058-3