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COVID-19 prompts U of U Health, VA to re-evaluate use of endoscopy

A drop in endoscopy procedures due to COVID-19 precautions prompts a second look at when the procedures are most needed and most effective.

Today, endoscopy is one of the most common outpatient procedures conducted in the United States with nearly 18 million procedures performed annually. To do it, a doctor inserts a flexible tube with a light and camera attached to it into your digestive system.

But as important as these examinations are in detecting cancer, ulcers and other digestive diseases, they were ground to a halt by the emergence of COVID-19. In April, for instance, gastrointestinal endoscopy procedures plunged 93% below normal volume in the Veterans Administration Healthcare System, which serves more than 6 million veterans nationwide. Similarly, University of Utah Health performed 80% fewer endoscopies in April than normal.

Yet, while this presents a serious concern, it is also an opportunity for doctors to evaluate how and when these procedures should be done, according to Andrew Gawron, an associate professor of gastroenterology at U of U Health and lead author of a recent commentary of the impact of COVID-19 on access to endoscopic procedures via the VA Healthcare System.

“Losing access to most endoscopies as a result of the COVID-19 pandemic has severely hampered our ability to detect, diagnose and treat many digestive diseases,” says Gawron, who is also a staff physician at the Salt Lake City VA. “On the other hand, this unexpected pause in doing these procedures has given us an unprecedented opportunity to step back to reconsider if and when endoscopies are necessary and explore whether there may be effective alternatives to their use.”

The commentary appears in Gastroenterology.

Within the VA, estimates suggest that about 64,000 endoscopic examinations have been postponed or deferred since the onset of COVID-19. Gawron and colleagues suspect that this figure will continue to surge as the pandemic continues, potentially affecting up to 400,000 veterans who undergo it annually. This drop could also affect the U of U Health gastroenterology program since many of its medical students receive endoscopy training at the Salt Lake VA Hospital, Gawron says

But, as Gawron and his colleagues point out in their commentary, the VA has adopted several strategic approaches to mitigate the disruption of endoscopic procedures; similar strategies were adopted by U of U Health and serve as a model for other medical institutions:

Offering patients non-invasive substitutes: Instead of endoscopy, VA doctors have turned to non-invasive ways to screen colon cancer such as fecal immunochemical testing, which detects hidden blood in the stool (an early warning sign of cancer), and is another recommended test for colon cancer screening.

Finetuning triage: The VA has prioritized who receives an endoscopy. These range from Priority 1 patients, who have trouble swallowing, rectal bleeding or other symptoms and need immediate examination, to priority 4 patients who are healthy but are due for a cancer-screening endoscopy this year.

Curbing overuse: Previous research has shown that up to 30% of colonoscopies conducted in the VA and non-VA Healthcare systems may be done too early or may not be necessary, Gawron says. As a result, the VA is aggressively adopting new colon polyp surveillance guidelines for when and how often procedures are actually needed.

However, if you do have gastrointestinal symptoms it is vital that you consult a physician as soon as possible, Gawron says.

“Patients, whether they are coming to the VA or U of U Health should feel safe to seek necessary care if you have concerning signs or symptoms,” he says. “The longer you delay, the more potential for harm.”