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Urgent upper gastrointestinal endoscopy referrals cancelled due to the COVID-19 pandemic

Perminder S Phull
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DOI: https://doi.org/10.7861/clinmed.Let.20.6.1
Clin Med November 2020
Perminder S Phull
Aberdeen Royal Infirmary, Aberdeen, UK
Roles: Consultant gastroenterologist
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Editor – The British Society of Gastroenterology have done a superb job in providing timely and well thought-out guidance for endoscopy services following the COVID-19 pandemic.1 One of the points highlighted is the critical role of senior clinical decision-making for triaging and prioritisation of referrals for endoscopy while capacity is restricted. The curtailment of elective outpatient endoscopy services at the peak of the COVID-19 pandemic resulted in the cancellation of endoscopy appointments. At our institution, virtual clinic review was undertaken by a consultant gastroenterologist for all patients who had their appointment for urgent upper gastrointestinal (GI) endoscopy cancelled. A total of 117 patients were reviewed (mean age 57.5 years; range 19–89 years; 62.4% female), of whom 75 (64.1%) had been originally vetted as direct-to-test referrals from primary care; 34 (29.1%) patients had been previously seen in clinic, and the remaining eight (6.8%) had the endoscopy requested following hospital admission. The indications for endoscopy were suspected upper GI cancer alarm features in 109 (93.2%) cases. Following clinic review, four (3.4%) patients underwent immediate endoscopy due to severe high-risk symptoms. It was possible to remove 35 (29.9%) patients from the waiting list as they did not require an endoscopy any longer. Thirty-two (91.4%) of these patients had either been originally vetted as direct-to-test or had been referred following an inpatient episode. These results demonstrate that clinic review of patients listed for urgent endoscopy can reduce the demand by around one-third. While direct-to-test diagnostics have been advocated for patients with suspected upper GI cancer in order to provide a timely diagnosis, only about 4% of such patients will have a cancer confirmed.2 When endoscopy capacity is restricted, as during the COVID-19 pandemic, a strategy of clinic review first would help to target those patients most likely to benefit from endoscopy.

  • © Royal College of Physicians 2020. All rights reserved.

References

  1. ↵
    1. Rees CJ
    , East J, Oppong K, et al. Restarting gastrointestinal endoscopy in the deceleration and early recovery phases of COVID-19 pandemic: Guidance from the British Society of Gastroenterology. Clin Med 2020;20:352–8.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Kapoor N
    , Bassi A, Sturgess R, et al. Predictive value of alarm features in a rapid access upper gastrointestinal cancer service. Gut 2005;54:40–5.
    OpenUrlAbstract/FREE Full Text
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Urgent upper gastrointestinal endoscopy referrals cancelled due to the COVID-19 pandemic
Perminder S Phull
Clinical Medicine Nov 2020, 20 (6) e278; DOI: 10.7861/clinmed.Let.20.6.1

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Urgent upper gastrointestinal endoscopy referrals cancelled due to the COVID-19 pandemic
Perminder S Phull
Clinical Medicine Nov 2020, 20 (6) e278; DOI: 10.7861/clinmed.Let.20.6.1
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