Professor El-Omar has chosen Professor Matt Rutter, Professor of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK to do the next #GUTBlog.

The #GUTBlog focusses on the latest paper “Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis” which is due to be published in paper copy in GUT in March 2021. Professor Rutter is the first author on this paper.

“We all know what a major impact the pandemic has had on hospital services, and of course this includes endoscopy services. Almost a year ago at the start of the pandemic, there was much fear about whether endoscopy units might be an environment for superspreading of COVID-19 and we were fearful that staff would contract the disease or would have to be redeployed to general medical wards and intensive care units to help manage a tidal wave of patients being admitted with COVID-19. This resulted in the BSG producing important guidance advising endoscopy units that they should be minimising all endoscopic activity until a clearer picture emerged and issues of PPE were resolved, essentially only performing emergency or near-emergency procedures. Clearly there was a concern that this would have a major impact on the ability to diagnose gastrointestinal diseases including cancer.

In April our team felt it important to understand exactly what was happening in endoscopy units and it occurred to us that the National Endoscopy Database (NED) would be the perfect way to do this.

Many of you will be familiar with the United Kingdom’s National Endoscopy Database; for those who aren’t, essentially it is a national database that automatically captures real time endoscopic data from hospitals in the United Kingdom. Our intention is to capture from every hospital and currently over 80% of all the UK’s endoscopy units upload to the NED. One of the advantages of NED is that the data is collated in real time, whereas traditional means to count the number of endoscopy procedures takes several months to be validated and even then, is often inaccurate.

So, we decided to analyse NED data to see what impact the pandemic was having on endoscopy activity and endoscopic cancer detection. We developed a specific NED COVID-19 module incorporating procedure level data on all endoscopic procedures. We calculated baseline pre-pandemic and endoscopic activity using the 10 weeks prior to the onset of the pandemic. We then compared this to the 10 weeks after the BSG had issued its guidance.

In summary, as published in this paper we saw that from a pre pandemic weekly average of 35,000 endoscopic procedures, the activity reduced to a low of 5% of normal activity and over the entire 10 weeks averaged at only 12% of normal activity. Alarmingly the weekly number of cancers detected decreased by 58%, ranging from a 19% reduction in pancreato-biliary cancers to a 72% reduction in colorectal cancers. Undoubtedly the scale of the impact of the pandemic on endoscopic services was concerning and was important for us to know. This study influenced national policy and instilled a sense of urgency in actions to facilitate recovery of endoscopic activity.

After the publication of the paper, we were able to work closely with NHS England to provide up to date information as the recovery continued. Now that we’re in our third lockdown, our data is again proving invaluable (having recovered to 83% of pre-pandemic levels by November 2020, weekly endoscopic activity has dropped again to 66%) and we are developing additional NED outputs specifically for regions across the UK to help them manage recovery. We have also been able to do some preliminary work looking at the recovery of weekly cancer detection. It has been interesting to see what impact the tighter gatekeeping on endoscopic referrals has had, and in many hospitals, we can see an early indication of full recovery of weekly cancer detection rates despite lower endoscopic workload: this needs fuller analysis but suggests that one of the positive outcomes from the pandemic may be better patient selection for endoscopy.

Our study illustrates how valuable a resource the National Endoscopy Database is, and we hope to exploit its potential further in service evaluation/intelligence, audit, quality assurance and improvement, and in research. NED is in the process of moving to an updated version which we hope will start roll out to hospitals in mid-2021. This will provide us with an even richer endoscopy dataset. We are always happy to discuss potential projects using NED data and I would be delighted to hear from anybody who wishes to explore this further.”

Professor Matt Rutter

Twitter: @Rutter_Matt