TY - JOUR T1 - COVID-19 and its impact on endoscopy services: what is the threshold for missed malignant diagnosis? JF - Gut JO - Gut SP - 1414 LP - 1415 DO - 10.1136/gutjnl-2020-322769 VL - 70 IS - 7 AU - Tony He AU - Michael B MacIsaac AU - Simon J Hume AU - Alexander J Thompson AU - Julien D Schulberg Y1 - 2021/07/01 UR - http://gut.bmj.com/content/70/7/1414.abstract N2 - 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 … ER -