New York-Presbyterian/Columbia University Medical Center New York, NY
Award: Presidential Poster Award
Vasantham Annadurai, MD1, John W. Blackett, MD2, Daniel E. Freedberg, MD, MS2, Chin Hur, MD, MPH1, Peter H. Green, MD2, Benjamin Lebwohl, MD, MS1; 1New York-Presbyterian/Columbia University Medical Center, New York, NY; 2Columbia University Medical Center, New York, NY
Introduction: The SARS-CoV-2 pandemic caused drastic shifts in hospital workflows internationally. In an effort to limit viral spread and to preserve equipment and staffing availability, many hospitals lowered procedure capacity, prioritizing urgent and emergent cases. The purpose of this study was to characterize the numbers, indications, and diagnostic yield of gastrointestinal endoscopies across three affiliated hospitals in the New York metropolitan area before and after the outbreak. Methods: We compared characteristics and outcomes of inpatient (IP) and outpatient (OP) endoscopies on adults (≥18 years) during the six months before and the nine weeks following March 16, 2020, the date on which elective procedures were cancelled at these institutions. Results: A total of 9,105 procedures before and 332 procedures after the start of the outbreak were performed (350 vs. 37 per week on average). The mean age was 60 and 62 years in the pre-pandemic and pandemic periods. Females comprised 57% and 44% of patients respectively (p < 0.01). There were significant differences in the distribution of procedures in the OP setting, with a decline in the proportion of EGDs (38% vs. 23%, p < 0.001) and colonoscopies (49% vs. 18%, p < 0.001) and a rise in the proportion of EUSs (6% vs. 19%, p < 0.001) and ERCPs (3% vs. 29%, p < 0.001). Procedure indications changed, with a marked rise in the proportion of all EGDs to evaluate bleeding (18% vs. 66%, p < 0.001), and in the proportion of ERCPs to evaluate jaundice (21% vs. 43%, p < 0.001). Patients undergoing IP ERCP for evaluation of jaundice had higher levels of total bilirubin prior to procedure (mean 11 vs. 17 mg/dl, p = 0.02). There was a significant increase in the diagnostic yield of combined IP and OP EGDs for bleeding (47% vs. 63%, p < 0.01). While not statistically significant, there were also increases in diagnostic yield of EUS and ERCPs for diagnosis of malignancy, and OP colonoscopy for bleeding (Table 1). Discussion: In this comparative series of endoscopies before and during the SARS-CoV-2 pandemic, we observed an increase in the proportion of endoscopies done for urgent indications such as bleeding or biliary obstruction. EGDs done for bleeding had a higher diagnostic yield during the pandemic, likely reflecting the restriction of endoscopies to patients with a high level of suspicion for active bleed. The trend towards higher likelihood of diagnosing malignancy on EUS similarly suggests that providers had a higher threshold to perform endoscopy.
Table 1. Diagnostic or therapeutic yield of the most common indication for inpatient procedures during the pandemic period, compared with yield during the pre-pandemic period.
Disclosures: Vasantham Annadurai indicated no relevant financial relationships. John Blackett indicated no relevant financial relationships. Daniel Freedberg indicated no relevant financial relationships. Chin Hur indicated no relevant financial relationships. Peter Green indicated no relevant financial relationships. Benjamin Lebwohl indicated no relevant financial relationships.