Background

The COVID-19 pandemic has led to a substantial reduction in gastrointestinal endoscopies, creating a backlog of procedures. We aimed to quantify this backlog nationally for England and assess how various interventions might mitigate the backlog.

Methods

We did a national analysis of data for colonoscopies, flexible sigmoidoscopies, and gastroscopies from National Health Service (NHS) trusts in NHS England's Monthly Diagnostic Waiting Times and Activity dataset. Trusts were excluded if monthly data were incomplete. To estimate the potential backlog, we used linear logistic regression to project the cumulative deficit between actual procedures performed and expected procedures, based on historical pre-pandemic trends. We then made further estimations of the change to the backlog under three scenarios: recovery to a set level of capacity, ranging from 90% to 130%; further disruption to activity (eg, second pandemic wave); or introduction of faecal immunochemical testing (FIT) triaging.

Findings

We included data from Jan 1, 2018, to Oct 31, 2020, from 125 NHS trusts. 10 476 endoscopy procedures were done in April, 2020, representing 9·5% of those done in April, 2019 (n=110 584), before recovering to 105 716 by October, 2020 (84·5% of those done in October, 2019 [n=125 072]). Recovering to 100% capacity on the current trajectory would lead to a projected backlog of 162 735 (95% CI 143 775–181 695) colonoscopies, 119 025 (107 398–130 651) flexible sigmoidoscopies, and 194 087 (172 564–215 611) gastroscopies in January, 2021, attributable to the pandemic. Increasing capacity to 130% would still take up to June, 2022, to eliminate the backlog. A further 2-month interruption would add an extra 15·4%, a 4-month interruption would add an extra 43·8%, and a 6-month interruption would add an extra 82·5% to the potential backlog. FIT triaging of cases that are found to have greater than 10 μg haemoglobin per g would reduce colonoscopy referrals to around 75% of usual levels, with the backlog cleared in early 2022.

Interpretation

Our work highlights the impact of the pandemic on endoscopy services nationally. Even with mitigation measures, it could take much longer than a year to eliminate the pandemic-related backlog. Urgent action is required by key stakeholders (ie, individual NHS trusts, Clinical Commissioning Groups, British Society of Gastroenterology, and NHS England) to tackle the backlog and prevent delays to patient management.

Funding

Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) at University College London, National Institute for Health Research University College London Hospitals Biomedical Research Centre, and DATA-CAN, Health Data Research UK.

中文翻译：

---

预测 COVID-19 后英格兰的内窥镜活动恢复情况：全国分析

背景

COVID-19 大流行导致胃肠道内窥镜检查大幅减少，造成程序积压。我们旨在量化英格兰全国的积压情况，并评估各种干预措施如何减轻积压情况。

方法

我们在 NHS England 的月度诊断等待时间和活动数据集中对来自国家卫生服务 (NHS) 信托的结肠镜检查、柔性乙状结肠镜检查和胃镜检查的数据进行了全国分析。如果月度数据不完整，则不包括信托。为了估计潜在的积压，我们根据大流行前的历史趋势，使用线性逻辑回归来预测实际执行的程序与预期程序之间的累积赤字。然后，我们进一步估计了三种情况下积压的变化：恢复到设定的产能水平，范围从 90% 到 130%；活动进一步中断（例如，第二波大流行）；或引入粪便免疫化学检测 (FIT) 分类。

发现

我们纳入了 2018 年 1 月 1 日至 2020 年 10 月 31 日期间来自 125 个 NHS 信托基金的数据。2020 年 4 月完成了 10 476 例内窥镜检查手术，占 2019 年 4 月完成手术的 9·5% (n=110 584)，然后到 2020 年 10 月恢复到 105 716 例（占 10 月完成手术的 84·5%， 2019 [n=125 072]）。按照当前轨迹恢复到 100% 容量将导致预计积压 162 735 (95% CI 143 775–181 695) 次结肠镜检查、119 025 (107 398–130 651) 次灵活乙状结肠镜检查和 194 087 (172 564–215) 次结肠镜检查611) 2021 年 1 月的胃镜检查，归因于大流行。将产能提高到 130% 仍需要到 2022 年 6 月才能消除积压。再中断 2 个月将额外增加 15·4%，中断 4 个月将额外增加 43·8%，中断 6 个月将额外增加 82·5% 的潜在积压。

解释

我们的工作突出了大流行对全国内窥镜检查服务的影响。即使采取缓解措施，消除与流行病相关的积压也可能需要一年多的时间。关键利益相关者（即个人 NHS 信托、临床委托小组、英国胃肠病学会和 NHS England）需要采取紧急行动来解决积压问题并防止患者管理延误。

资金

伦敦大学学院 Wellcome/EPSRC 介入和外科科学中心 (WEISS)、伦敦大学学院医院生物医学研究中心国家健康研究所和英国健康数据研究中心 DATA-CAN。