Reduction in endoscopic upper gastrointestinal malignancy detection during COVID-19-enforced lockdown

Abstract

Background: The COVID-19 pandemic had an unprecedented impact on healthcare worldwide, greatly affecting patients’ access to healthcare services. In international studies, rates of oesophagogastroduodenoscopy (EGD) decreased, while the malignant yield increased proportionally. This study describes changes in endoscopy rates and in the detection of malignancy at a single South African tertiary hospital.

Methods: Records from a pre-existing registry of an upper gastrointestinal (UGI) endoscopy service were accessed and retrospectively analysed after ethical approval. Study periods were the 18-month, government-enforced COVID-19 lockdown (“lockdown”, 27 March 2020 to 30 September 2021) and a matched 18-month period preceding lockdown for comparison (“prelockdown”, 20 September 2018 to 26 March 2020). All patients presenting to the upper endoscopy service at Groote Schuur Hospital (“the service”) for index EGD were evaluated for potential inclusion in the study. Patient demographics, date, and indication for endoscopy were recorded, and histologically proven malignancy was documented.

Results: During lockdown, 2 428 index EGDs were performed, compared with 4 448 in the pre-lockdown period, indicating a 45.41% decrease. Similar biopsy rates were observed: 24.10% EGDs in pre-lockdown and 23.19% EGDs in lockdown. Malignancy was proven in 119 patients during lockdown, compared with 131 in pre-lockdown – an absolute decrease of 9.16% (p < 0.001), but with a higher yield (4.90% vs. 2.95%). The profile of the malignancy type remained similar between the two periods, except for a decrease in squamous cell carcinoma, attributed to changing referral patterns during lockdown, which did not reach statistical significance. Dyspepsia, as the most common indication for EGD, decreased significantly during lockdown (24.23% to 13.53%; p < 0.001). Endoscopy for epigastric pain, atypical chest pain, and reflux decreased, while alarm symptom referrals, including gastrointestinal bleeding (11.70% to 16.75%; p < 0.001), dysphagia (12.62% to 14.07%; p = 0.0927), and anaemia (11.97% to 18.03%; p < 0.001), increased.

Conclusion: This study showed findings similar to international studies, with a substantial decrease in endoscopies and a proportional increase in malignancy detection. Further studies of other significant pathologies, such as peptic ulcer disease, would provide additional information on the pandemic’s residual effects on this population.