Delaying endoscopies due to COVID-19 safe in IBD patients

Delays in endoscopies due to the coronavirus disease 2019 (COVID-19) pandemic does not seem to worsen clinical outcomes in patients with inflammatory bowel diseases (IBD), though healthcare utilization patterns appear to be affected, according to a study reported at the recently concluded 2022 Crohn’s & Colitis Congress (CCC 2022).

Due to the aerosolizing nature of endoscopies, “professional gastroenterology organizations recommended delaying nonurgent endoscopic procedures in the IBD population until 3–6 months after a decrease in COVID-19 infection rates,” the researchers said.

“Controlled delay in colonoscopies in patients with IBD with closely monitored rescheduling efforts is safe and can be utilized in times of emergencies without compromising patient outcomes,” they added.

The retrospective chart review included 250 IBD patients who had had their scheduled endoscopies cancelled due to COVID-19. Of the participants, 150 were promptly rescheduled and constituted the on-time group (mean age 42.8 years, 59 percent women), while the remaining 100 were further postponed for at least three months (delayed group; mean age 47.5 years, 47 percent women).

In the on-time group, 14 patients (9.3 percent) needed further IBD-related hospitalizations after endoscopy, as opposed to only three patients (3 percent) in the delayed group (p=0.03). [CCC 2022, Young et al]

Moreover, there were significantly more surgeries related to IBD postendoscopy in the on-time vs delayed group (16 vs 4; p=0.03). Additional IBD therapy after the procedure was likewise more common in the on-time arm (45 vs 14; p=0.002).

According to the researchers, such patterns do not necessarily mean worse operative outcomes in the on-time group. “Increased hospitalizations and surgeries in the on-time group could represent over-utilization of health resources, or [it] could be too early in the course to see worse outcomes in the delayed group.”

While IBD-related hospitalizations (p=0.49), surgeries (p=0.32), and additional therapies (p=0.22) during the delay, as well as postendoscopy emergency visits (p=0.17), were comparable between the delayed and on-time group, further delaying endoscopy might carry a slight risk of cancer.

There was a “trend towards increased malignancies in the delayed group, but higher number of admissions and operations in the on-time group, despite similar degrees of inflammation on endoscopy,” the researchers said.

Nevertheless, the current data suggest that “patients with delayed endoscopies due to COVID-19 did not experience worse outcomes compared to patients with on-time endoscopies,” the researchers said. Delaying such procedures, particularly in nonurgent cases, may thus be more beneficial than harmful to the patient as it helps lower the risk of infection.

Notable limitations of the study included its retrospective nature, which prevented the complete evaluation of all factors that could have influenced IBD-related admissions, additional procedures, and medication. Its single-centre design and relatively short data collection period were likewise key methodological weaknesses.

“Only 1-year postendoscopy data [were] collected,” the researchers said. Future studies “may need longer follow-up times to evaluate true effect on colorectal cancer risk.”