ID: 3526466 THE EFFECT OF SARS-COV-2 ON ENDOSCOPY TRAINING IN A TERTIARY REFERRAL CENTER

Conlon, Caroline; Farrelly, Niamh Mehigan; Ring, Eabha; Dunne, Talulla; Gorman, Dora; Kelleher, Barry; Leyden, Jan; Lahiff, Conor

Introduction: In Spring 2020, guidelines for the safe practice of endoscopy during the SARS-CoV-2 pandemic were introduced. Endoscopy units transformed to comply with guidelines in order to prevent the spread of COVID-19 and to protect patients and staff. Many units experienced a marked decrease in case volume. Aims/Background: The aim of this study was to assess the effect of the pandemic on the colonoscopy performance in our endoscopy unit;focusing primarily on case volume, pathology identified and training. Methods: This was a single center, retrospective, observational study comparing colonoscopies performed at a high-volume endoscopy center in Ireland during the SARS-CoV-2 pandemic with colonoscopies performed during a similar time frame pre-pandemic (March-June 2020 versus 2019). Data was collected using electronic patient records. Results: During the reference period (March to June 2019), 981 colonoscopies were performed in our unit. In the same period in 2020, there was a 4.5-fold reduction in colonoscopies performed (n=217). Baseline patient characteristics, colonoscopy comfort scores, sedation rates and quality of bowel preparation were similar in both groups. 53% were male (2019, n=522;2020, n=115). The median age in 2019 was 61 years compared with 66 years in 2020. The indications for endoscopy differed between the two time periods. The main indications pre-pandemic were previous polyps (19.47%), colorectal cancer (CRC) screening via the national CRC screening programme in Ireland (17.33%), and diarrhoea or alternating bowel habits (11.62%). In 2020, the main indications included CRC screening (33.64%), anaemia (15.67%) and rectal bleeding (13.36%). With regards to pathology identified, the overall adenoma detection rate (ADR) in 2019 was 27.83%. In 2020, the ADR was 37.33%. There was a 2.4-fold reduction in the number of malignancies detected in 2020 compared with 2019 (2019, n=24;2020, n=10). There was an 8-fold reduction in the number of colonoscopies performed by GI trainees (2019, n=367;2020, n=44). Although the total number of polyps identified reduced greatly (2019, n=331;2020, n=62), the ADR for GI trainees remained acceptable (2019 = 32.21%;2020 = 40.91%). The average number of polyps detected per procedure was equal in 2019 to 2020 (n=2). Cecal intubation rates (91.0% vs 90.9%) and withdrawal times (15.9 vs 17.3 minutes) were comparable for 2019 versus 2020. Conclusion: The SARS-CoV-2 pandemic impacted greatly on our endoscopy unit in terms of case volume and pathology identified. Endoscopy training in our unit was also adversely affected. A marked decrease in the number of colonoscopies and polypectomies performed by GI trainees was observed in 2020. At present, many countries worldwide are experiencing a second wave of the virus. Strategies will need to be created to safeguard endoscopy training for our trainees.