Fewer High-Risk Lesions Detected Due to Delayed Endoscopy During the COVID-19 Pandemic

Doctor holding endoscope before gastroscopy.
Researchers assessed the decline in high-risk GI and pancreato-biliary lesions detected during the COVID-19 pandemic due to reduced numbers of endoscopic procedures performed.

The COVID-19 pandemic has caused a reduction in endoscopy procedures and consequently detection of high-risk gastrointestinal (GI) and pancreato-biliary lesions. These findings, from a retrospective, multicenter, cross-sectional study, were published in Gut.

Medical records from 8 tertiary centers in Italy were reviewed. The total number of endoscopic procedures and detection of high-risk lesions were compared during the pandemic (March 9 to May 4, 2020) against the same time period from 2017 to 2019.

A total of 13,293 procedures (median, 1912 per center) were performed during 2019. The rates decreased to 3799 procedures (median, 408 per center) during the pandemic, corresponding with a 71.4% reduction.

Elective procedures decreased by 72.9% (12,632 vs 3475). Lower-GI endoscopies had a larger decrease compared with upper-GI procedures (P <.001). Hepato-pancreato-biliary endoscopies were more modestly reduced (45.7%; P <.001). Cancer-related procedures were less likely to be reduced (18.3%) compared with endoscopic retrograde cholangiopancreatography (52.2%; P =.009).

Diagnoses of cancer and upper GI high-grade dysplasia were decreased by 62.4% and 84.2%, respectively. High-grade dysplasia detected during routine colonoscopy decreased by 69.8% and neoplastic lesions by 67.8%. Globally, the rate of hepato-pancreato-biliary malignancies decreased from 22.0% to 15.7% (relative risk, 1.43; 95% CI, 1.04-1.95; P =.034).

Overall, the study authors detected a 57.9% reduction in diagnosed lesions. The authors noted that emergency department endoscopic examinations decreased by 48.2%, despite a maintenance of admissions.

Trends in the number of endoscopic procedures performed and lesions detected between 2017 and 2019 did not differ significantly.

During the pandemic, endoscopy was reported to be one of the most affected medical examinations. This may have occurred due to a combination of fears of SARS-CoV-2 in-hospital transmission, reductions in elective procedures, and the decline in non-severe conditions which had previously been overtreated.

This study was limited by its short duration and retrospective design.

These data indicated the COVID-19 pandemic caused drastic reductions in endoscopy procedures, causing fewer numbers of cancers or high-risk lesions to be detected. Clinicians should now focus on designing endoscopy programs which target patients at high risk for lesions, such that diagnoses are not further delayed.

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


Furnari M, Eusebi LH, Savarino E, et al. Effects of SARS-CoV-2 emergency measures on high-risk lesions detection: a multicentre cross-sectional study. Gut. 2021;70(7):1241-1243. doi:10.1136/gutjnl-2020-323116