Fall in colonoscopy completion rates is short lived after a break in performing colonoscopy: a study of how the COVID-19-impacted period affected colonoscopy performance

• Introduction
• Methods
• Results
• Discussion
• References

Introduction

During the first COVID-19 outbreak, UK endoscopy activity fell to 12 % during the COVID-impacted period between March and June 2020 [1]. Consequently, the majority of endoscopists had a simultaneous hiatus in colonoscopy activity, which may have affected performance measures. In this study, the effect of the 3-month COVID-impacted period on key performance indicators of colonoscopists was assessed.

Methods

A total of 15 endoscopists who performed both upper and lower gastrointestinal endoscopies, and a minimum of 50 colonoscopies in the year prior to March 2020, were included in the study. Baseline frequency, cecal intubation rate (CIR), and polyp detection rate (PDR) for the year prior to the COVID-19 pandemic (1 March 2019 – 29 February 2020) were compared with the year after (1 June 2020 – 31 May 2021) the 3-month COVID-impacted period (1 March – 31 May 2020) for each endoscopist.

Results

Of the 15 endoscopists, 3 were accredited bowel cancer screening colonoscopists. In the year prior to the COVID-impacted period, 2898 colonoscopies, representing 38 % of all colonoscopies performed at the study center, were performed by the 15 participating endoscopists. During this period, participants performed between 80 and 565 colonoscopies, with CIR ranging between 83.8 % and 98.6 %, and PDR ranging between 18.9 % and 64.2 %. Compared with the year prior, after the 3-month COVID-impacted period, there was a 51 % decrease in colonoscopies performed by the 15 participants (n = 1488) in the following year, which represented 24.1 % of all colonoscopies performed at the study center.

There was a fall in the overall CIR (mean difference –2.3 %, P = 0.04) in the first 3 months of restarting procedures (June – August 2021) compared with the pre-COVID baseline, but this had recovered by 6 months and was sustained at 1 year. There was an increase in PDR in the year after the COVID-impacted period (mean difference + 5.9 %, P  < 0.001). Comparisons of number of procedures, CIR, and PDR in the year before and in the 3 months, 6 months, and year after the COVID-impacted period, overall and by each of the 15 endoscopists, are detailed in [Table 1].

Discussion

During the initial stages of the pandemic, our center had taken the approach to pause outpatient endoscopy activity for 3 months between March and May 2020. We hypothesized that a sustained break from endoscopy might negatively affect key performance indicators. Examining the performance of endoscopists in the period immediately after this pause offered a unique opportunity to assess how endoscopists were affected by the 3-month hiatus. Our results suggest that a break in endoscopy is associated with a brief and small fall in colonoscopy completion rates in the first 3 months following the break, but most endoscopists returned to their baseline performance by 6 months and all by 1 year. Regression of technical skill is one of the concerns among female gastroenterologists who are considering a break to start a family [2], and this study supports the notion that regression of performance is short lived. In conclusion, we show that after a break from colonoscopy, a small fall in completion rates occurs but this recovers with time.

Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Rutter MD, Brookes M, Lee TJ. et al. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis. Gut 2021; 70: 537-543
  CrossrefPubMedSearch in Google Scholar
• 2 David YN, Dixon RE, Kakked G. et al. Pregnancy and the working gastroenterologist: perceptions, realities, and systemic challenges. Gastroenterology 2021; 161: 756-760
  CrossrefPubMedSearch in Google Scholar

Corresponding author

Publication History

Received: 05 April 2022

Accepted: 26 April 2022

Article published online:
12 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Rutter MD, Brookes M, Lee TJ. et al. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis. Gut 2021; 70: 537-543
  CrossrefPubMedSearch in Google Scholar
• 2 David YN, Dixon RE, Kakked G. et al. Pregnancy and the working gastroenterologist: perceptions, realities, and systemic challenges. Gastroenterology 2021; 161: 756-760
  CrossrefPubMedSearch in Google Scholar