Impact of the COVID-19 Pandemic on Utilization of EGD and Colonoscopy in the United States: An Analysis of the GIQuIC Registry

Audrey H Calderwood; Michael S Calderwood; J Lucas Williams; Jason A Dominitz

doi:10.1016/j.tige.2021.07.003

Impact of the COVID-19 Pandemic on Utilization of EGD and Colonoscopy in the United States: An Analysis of the GIQuIC Registry

Tech Innov Gastrointest Endosc. 2021;23(4):313-321. doi: 10.1016/j.tige.2021.07.003. Epub 2021 Jul 30.

Authors

Audrey H Calderwood^{1

2}, Michael S Calderwood^{1

2}, J Lucas Williams³, Jason A Dominitz^{4

5}

Affiliations

¹ Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
² Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
³ The GI Quality Improvement Consortium, Ltd., Bethesda, Maryland.
⁴ VA Puget Sound Health Care System, Seattle, Washington, D.C.
⁵ University of Washington, Seattle, Washington, D.C.

Abstract

Background and aims: The coronavirus disease 2019 (COVID-19) pandemic has limited the ability to perform endoscopy. The aim of this study was to quantify the impact of the pandemic on endoscopy volumes and indications in the United States.

Methods: We performed a retrospective analysis of data from the GI Quality Improvement Consortium (GIQuIC) registry. We compared volumes of colonoscopy and esophagogastroduodenoscopy (EGD) during the pandemic (March-September 2020) to before the pandemic (January 2019-February 2020). The primary outcome was change in monthly volumes. Secondary outcomes included changes in the distribution of procedure indications and in procedure volume by region of United States, patient characteristics, trainee involvement, and practice setting, as well as colorectal cancer diagnoses.

Results: Among 451 sites with 3514 endoscopists, the average monthly volume of colonoscopies and EGDs dropped by 38.5% and 33.4%, respectively. There was regional variation, with the greatest and least decline in procedures in the Northeast and South, respectively. There was a modest shift in procedure indications from prevention to diagnostic, an initial increase in performance in the hospital setting, and a decrease in procedures with trainees. The decline in volume of colonoscopy and EGD during the first 7 months of the pandemic was equivalent to approximately 2.7 and 2.4 months of prepandemic productivity, respectively. Thirty percent fewer colorectal cancers were diagnosed compared to expected.

Conclusion: These data on actual endoscopy utilization nationally during the pandemic can help in anticipating impact of delays in care on outcomes and planning for the recovery phase.

Keywords: ASA, American Society of Anesthesiologists; ASC, ambulatory surgical center; COVID-19; COVID-19, coronavirus disease 2019; Colonoscopy; EGD, esophagogastroduodenoscopy; ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasound; FIT, fecal immunochemical test; GERD, gastroesophageal reflux disease; GI, GI Quality Improvement Consortium; GI, gastroenterology; NPI, national provider identification; US, United States; Upper gastrointestinal endoscopy; Volume.

Abstract

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