Study data published in Gastroenterology outlining the effects of the coronavirus disease 2019 (COVID-19) pandemic on health care provision for patients with inflammatory bowel disease (IBD) showed that during the height of the pandemic in the Netherlands, nearly 60% of all IBD-related procedures were canceled or postponed. Incomplete recovery of missed endoscopies and surgical procedures may lead to increased morbidity or mortality in patients with IBD, particularly those who have undiagnosed dysplasia at risk of progression to colorectal cancer (CRC), the study authors said.
Investigators of the retrospective cohort study used PALGA, the nationwide network and registry of histopathology and cytopathology in the Netherlands to identify IBD-related endoscopies or surgery and new diagnoses of IBD or IBD-related dysplasia and CRC that occurred during the COVID-19 pandemic, defined as the period from February 7, 2020 to August 9, 2020. The investigators compared incidence rates of IBD-related procedures and diagnoses during this period to mean incidence data from 2018 to 2019.
The PALGA search identified a total of 61,097 eligible IBD-related procedures. The total incidence of IBD-related procedures was significantly lower during the COVID-19 pandemic. At the national peak of the pandemic in April 2020, a maximum decrease of 59.7% (310 procedures) was observed compared with the mean incidence from April 2018 to 2019.
Although there was a “relative increase” in the number of IBD procedures in subsequent weeks, the investigators observed an overall decrease of 14.2% (1476 procedures) during the total COVID-19 pandemic period compared with the mean incidence from April 2018 to 2019. The net decrease in endoscopic and surgical procedures was 14.7% (1443 procedures) and 5.5% (33 procedures), respectively.
“In this nationwide retrospective cohort study we found a large reduction in IBD health care during the COVID-19 pandemic. At the height of the pandemic, almost 6 out of 10 IBD-related procedures were cancelled or postponed,” the investigators said.
New IBD diagnoses made during the COVID-19 pandemic decreased by 6.5% compared with the rates of new diagnoses made between 2018 and 2019. High-grade dysplasia and CRC diagnoses were not found to decrease, but indefinite and low-grade dysplasia diagnoses decreased by 25.5%. Investigators hypothesized that gastroenterology clinics’ prioritization of high-grade dysplasia and CRC screening prevented a decline in diagnostic numbers.
Study limitations included the procedures where histology was acquired and the lack of data on the type of endoscopy (surveillance or not), therapy, or modality available.
“The true consequences of the COVID-19 pandemic on effective surveillance, therapy, and mortality are likely not measurable yet,” investigators wrote. “[However, these] data may help…providers and hospitals in planning health care during a second peak of [COVID-19] in the near future,” they concluded.
Groen MT, Derks MEW, Kuijpers CCHJ, Nagtegaal ID, Hoentjen F. Reduction of IBD healthcare during the COVID-19 pandemic: a nationwide retrospective cohort study. Gastroenterology. Published online October 22, 2020. doi: 10.1053/j.gastro.2020.10.032