ABSTRACT
BackgroundBritish Society of Gastroenterology (BSG) recommended that the endoscopy units to perform ERCP during the COVID-19 pandemic for obstructive biliary pathologies in an emergency. We aim to assess the local performance of ERCP during the COVID-19 first wave at our local endoscopy centre.MethodsAll ERCP procedures performed from January 2020 to Jun 2020 were retrospectively assessed and compared with procedures performed between January-Jun 2019 at Royal Lancaster Infirmary. Indications of ERCP, success rate, and complications were studied separately. Correlation analysis was conducted using Spearman’s rank correlation coefficient. The binary logistic regression model was carried out to compute factors associated with successful ERCP. The significance is established when the two-sides P-value < 0.05. Statistical analysis was performed using SPSS software version 25 for Windows (SPSS Inc., Chicago, IL, USA) (Corporation, 2017).ResultsFrom 281 patients, 60.14% and 38.14% patients were presented for ERCP procedures before and after COVID-19 period respectively. Higher proportion of patients was presented with liver dysfunction before pandemic period as compared to pandemic period (P<0.005) and use of antibiotics was significantly higher in pandemic period (P<0.05). the success rate of ERCP procedure was higher before emergence of the pandemic and lesser during the COVID-19 first wave as 86.39% and 77.67% respectively but the results were insignificant (P=0.07). A statistically significant but negative correlation was observed between cholangitis and stent insertion with ERCP success and positive correlation between sphincterotomy and ERCP success as (r=-0.129, P=0.030), (r= -0.172, P=0.004) and (r= 0.232, P<0.001) respectively. In binary logistic regression analysis, sphincterotomy (β =2.800, P=0.028) and stent insertion (β =0.852, P=0.046) were statistically significant predictors of ERCP outcomes. There was no statistically significant impact of cholangitis in the success of ERCP (β =1.672, P=0.109).ConclusionCOVID-19 pandemic significantly reduced ERCP procedures and success rate was also lowered due to restriction on endoscopic services in UK and all over the world. The endoscopic services can be resumed subject to specific SOPs to be followed in endoscopic units without affecting the safety of staff and patients.
ABSTRACT
Background The British Society of Gastroenterology (BSG) recommended that during the COVID-19 pandemic, endoscopy units perform endoscopic retrograde cholangiopancreatography (ERCP) for obstructive biliary pathologies in an emergency. We assessed the local performance of ERCP during the first wave of COVID-19 at our local endoscopy center, in particular the technique to common bile duct (CBD) cannulation. Methodology All ERCP procedures performed from January to June 2020 were retrospectively assessed and compared with procedures performed between January and June 2019 at the Royal Lancaster Infirmary. The indications for ERCP, success rate, and complications were studied separately. Correlation analysis was conducted using Spearman's rank correlation coefficient. The binary logistic regression model was used to compute the factors associated with successful ERCP. Significance was established when the two-sided P-value < 0.05. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 25 for Windows (SPSS Inc., Chicago, IL, USA, 2017). Results A total of 281 ERCP were included in this study, with 169 and 112 performed during the first six months of 2019 and 2020, respectively. A statistically significant (0.0087) higher proportion of cases with liver dysfunction presented for ERCP before the COVID-19 outbreak (152, 89.94%). All patients before COVID-19 underwent wire control-assisted ERCP, while 82 (73.21%) received assisted ERCP during the first wave (P < 0.001). There was no statistically significant difference (P = 0.10) in the number of patients who underwent sphincterotomy before and during the first wave of COVID-19, with 97 (57.39%) and 76 (67.85%), respectively. The success rate of ERCP before COVID-19 was relatively high, accounting for 146 (86.39%) patients in contrast to 87 (77.67%) patients during the first wave (P = 0.074). Sphincterotomy (ß = 2.800, P = 0.028) and stent insertion (ß = 0.852, P = 0.046) were statistically significant predictors of ERCP outcomes. There was no statistically significant impact of cholangitis on the success of ERCP (ß = 1.672, P = 0.109). Conclusion The first wave of COVID-19 had a statistically proven negative impact on the expected standards of ERCP performance. Although the complication rate was significantly higher during the first wave case difficulty, the American Society of Anesthesia (ASA) status was not assessed on an individual basis. Both ASA status and case difficulty are now included in our endoscopy selection process. We recommend adding the complexity of cases and ASA to the local and national recording databases. This is a rare study on UK-based hospitals.