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COVID-19 and its impact on endoscopy services: what is the threshold for missed malignant diagnosis?
  1. Tony He1,
  2. Michael B MacIsaac1,
  3. Simon J Hume1,
  4. Alexander J Thompson1,2,
  5. Julien D Schulberg1,2
  1. 1 Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia
  2. 2 Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Julien D Schulberg, Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia; julien.schulberg{at}

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We read the study by Rutter et al 1 with interest. The substantial decrease in the cancer detection rate in the UK as a consequence of a reduction in endoscopy activity during the COVID-19 era is alarming. Early in the lockdown, UK endoscopy activity dropped to as low as 5% of pre-COVID levels, with activity only increasing to 20% after 10 weeks. More selective screening did significantly increase the per-procedure cancer detection rate (pre-COVID 1.91%; COVID-19 impacted 6.61%; p<0.001); however, despite this, endoscopic cancer detection reduced by 58% overall, with a concerning 72% detection reduction for colorectal cancer. Similarly, in the USA, a recent report found a 50% reduction in colorectal diagnosis as a result of the pandemic.2

COVID-19 remains an ongoing worldwide pandemic. Gastrointestinal (GI) endoscopy is considered an aerosol-generating procedure for SARS-CoV-2 transmission.3 There remain limited data to provide insight into creating a safe model for …

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  • Contributors TH: literature review, data collation, statistical analysis and drafting of manuscript. MM: data collation and statistical analysis. SJH: data collation. AT: manuscript review. JDS: literature review, data collation, statistical analysis and manuscript review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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.

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