Endoscopic treatments of pancreatic cancer during COVID-19: a global review

The results discussed in the following article were extracted from data obtained in March through June of 2020.

In the early months of onset, the COVID-19 pandemic forced significant changes and challenges upon healthcare industries around the world, affecting endoscopic procedures that aid in the diagnosis and management of pancreatic cancer.

Impact
Because endoscopic procedures can be considered aerosol-generating procedures, many national and international professional organizations have issued guidance to postpone elective procedures and nonurgent examinations.¹

A recent survey of 252 endoscopy units from 55 countries “reported an average 83% reduction in total endoscopy volumes during the COVID-19 pandemic” in comparison to baseline procedure volumes. Results also showed an “82% reduction in upper endoscopy procedures (esophagogastroduodenoscopy, endoscopic ultrasonography, and endoscopic retrograde cholangiopancreatography) and an 85% reduction in lower endoscopy (flexible sigmoidoscopy and colonoscopy).”²

Another global survey took aim at identifying the impact of COVID-19 on pancreatic surgery. Results gathered from 337 respondents from seven international pancreatic-associated and study groups showed that 62.2% of centers “performed less pancreatic surgery because of the COVID-19 pandemic, reducing the weekly pancreatic resection rate from 3 … to 1.”³

Closing
A summary of seven recommendations provided by professional organizations from four continents shows that all but one recommends that endoscopy units postpone nonurgent cases.⁴ Specific guidelines vary by region, but many note that procedures relating to the endoscopic treatment and management of symptoms associated with pancreatic cancer should be considered high priority but managed on a case-by-case basis.^5,6,7,8

COVID-19 has dramatically impacted the volume of procedures and treatment options for physicians around the world. A global expert response study determined that “if countries increase their normal surgical volume by 20% post-pandemic, it would take a median 45 weeks to clear the backlog of operations resulting from COVID-19 disruption.”⁹ In the meantime, professional organizations urge endoscopy units to consider alternative methods of care, such as remote visits via telemedicine when possible, “in order to decrease the office density of patients, and provide needed care to patients who are less willing or unable to travel.”⁸

Research shows us that physicians are adapting to the COVID-19 environment with changes in treatment methods for symptoms of pancreatic cancer or postponement of procedures. How have your treatment philosophies changed in the COVID-19 era? Join the conversation on Twitter #PancChat.

References

1. Castro Filho EC, Castro R, Fernandes FF, et al. Gastrointestinal endoscopy during the COVID-19 pandemic: an updated review of guidelines and statements from international and national societies. Gastrointest Endosc. 2020;92(2):440.e6-445.e6. doi:10.1016/j.gie.2020.03.3854.
2. Parasa S, Reddy N, Faigel DO, et al. Global impact of the COVID-19 pandemic on endoscopy: an international survey of 252 centers from 55 countries. Gastroenterology. 2020;159(4):1579.e5-1581.e5. doi:10.1053/j.gastro.2020.06.009.
3. Oba A, Stoop TF, Löhr M, et al. Global survey on pancreatic surgery during the COVID-19 pandemic. Ann Surg. 2020;272(2):e87–e93. doi:10.1097/SLA.0000000000004006.
4. Lui RN, Wong SH, Sánchez‐Luna SA, et al. Overview of guidance for endoscopy during the coronavirus disease 2019 pandemic. J Gastroenterol Hepatol. 2020;35(5):749-759. doi:10.1111/jgh.15053.
5. Aguila EJT, Cua IHY, Dumagpi JEL, et al. COVID-19 and its effects on the digestive system and endoscopy practice. JGH Open. 2020;4(3):324-331. doi:10.1002/jgh3.12358.
6. Gastroenterological Society of Australia. Guide for triage of endoscopic procedures during the COVID-19 pandemic. GESA Web site. https://www.gesa.org.au/public/13/files/COVID-19/Triage_Guide_Endoscopic_Procedure_26032020.pdf. Published March 26, 2020. Accessed October 19, 2020.
7. Gralnek IM, Hassan C, Beilenhoff U, et al. ESGE and ESGENA position statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy. 2020;52(6):483-490. doi:10.1055/a-1155-6229.
8. ACG News Team. Joint GI society message on COVID‐19. American College of Gastroenterology Web site. https://gi.org/2020/03/15/joint‐gi‐society‐message‐on‐covid‐19/. Published March 15, 2020. Accessed October 19, 2020.
9. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans [published online ahead of print May 12, 2020]. Br J Surg. 2020;10.1002/bjs.11746. doi:10.1002/bjs.11746.