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Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis
  1. Matthew D Rutter1,2,
  2. Matthew Brookes3,4,
  3. Thomas J Lee5,
  4. Peter Rogers6,
  5. Linda Sharp2
  1. 1 Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
  2. 2 Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
  3. 3 Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
  4. 4 Research Institute in Healthcare Science (RIHS), University of Wolverhampton, Wolverhampton, UK
  5. 5 Gastroenterology Research, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
  6. 6 Weblogik, Ipswich, UK
  1. Correspondence to Professor Matthew D Rutter, Gastroenterology, University Hospital of North Tees, Stockton-on-Tees TS19 8PE, UK; matt.rutter{at}


Objective The COVID-19 pandemic has had a major global impact on endoscopic services. This reduced capacity, along with public reluctance to undergo endoscopy during the pandemic, might result in excess mortality from delayed cancer diagnosis. Using the UK’s National Endoscopy Database (NED), we performed the first national analysis of the impact of the pandemic on endoscopy services and endoscopic cancer diagnosis.

Design We developed a NED COVID-19 module incorporating procedure-level data on all endoscopic procedures. Three periods were designated: pre-COVID (6 January 2020 to 15 March), transition (16–22 March) and COVID-impacted (23 March–31 May). National, regional and procedure-specific analyses were performed. The average weekly number of cancers, proportion of missing cancers and cancer detection rates were calculated.

Results A weekly average of 35 478 endoscopy procedures were performed in the pre-COVID period. Activity in the COVID-impacted period reduced to 12% of pre-COVID levels; at its low point, activity was only 5%, recovering to 20% of pre-COVID activity by study end. Although more selective vetting significantly increased the per-procedure cancer detection rate (pre-COVID 1.91%; COVID-impacted 6.61%; p<0.001), the weekly number of cancers detected decreased by 58%. The proportion of missing cancers ranged from 19% (pancreatobiliary) to 72% (colorectal).

Conclusion This national analysis demonstrates the remarkable impact that the pandemic has had on endoscopic services, which has resulted in a substantial and concerning reduction in cancer detection. Major, urgent efforts are required to restore endoscopy capacity to prevent an impending cancer healthcare crisis.

  • gastrointesinal endoscopy
  • gastrointestinal cancer
  • health service research

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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  • Contributors All authors conceived, wrote and reviewed the paper. PR provided IT input. LS analysed the data. MDR was responsible for overall content as guarantor.

  • Funding The authors wish to acknowledge a grant from The Health Foundation for the NED-APRIQOT project.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data were derived from the National Endoscopy Database. Data relevant to the study are included in the article or uploaded as supplementary information.