Urgent upper gastrointestinal endoscopy referrals cancelled due to the COVID-19 pandemic

Editor – The British Society of Gastroenterology have done a superb job in providing timely and well thought-out guidance for endoscopy services following the COVID-19 pandemic.¹ One of the points highlighted is the critical role of senior clinical decision-making for triaging and prioritisation of referrals for endoscopy while capacity is restricted. The curtailment of elective outpatient endoscopy services at the peak of the COVID-19 pandemic resulted in the cancellation of endoscopy appointments. At our institution, virtual clinic review was undertaken by a consultant gastroenterologist for all patients who had their appointment for urgent upper gastrointestinal (GI) endoscopy cancelled. A total of 117 patients were reviewed (mean age 57.5 years; range 19–89 years; 62.4% female), of whom 75 (64.1%) had been originally vetted as direct-to-test referrals from primary care; 34 (29.1%) patients had been previously seen in clinic, and the remaining eight (6.8%) had the endoscopy requested following hospital admission. The indications for endoscopy were suspected upper GI cancer alarm features in 109 (93.2%) cases. Following clinic review, four (3.4%) patients underwent immediate endoscopy due to severe high-risk symptoms. It was possible to remove 35 (29.9%) patients from the waiting list as they did not require an endoscopy any longer. Thirty-two (91.4%) of these patients had either been originally vetted as direct-to-test or had been referred following an inpatient episode. These results demonstrate that clinic review of patients listed for urgent endoscopy can reduce the demand by around one-third. While direct-to-test diagnostics have been advocated for patients with suspected upper GI cancer in order to provide a timely diagnosis, only about 4% of such patients will have a cancer confirmed.² When endoscopy capacity is restricted, as during the COVID-19 pandemic, a strategy of clinic review first would help to target those patients most likely to benefit from endoscopy.