Effect of using personal protective equipment during the COVID-19 pandemic on the quality indicators of screening colonoscopies

Background and Aims: Coronavirus Disease 2019 (COVID-19) has affected many facets of the practice of medicine including screening colonoscopies. Our study looks to observe if there has been an effect on the quality of colonoscopies, as indicated by quality measures such as cecal intubation rate (CIR), cecal intubation time (CIT), scope withdrawal time (SWT) and adenoma detection rate (ADR) with the adoption of standard COVID-19 precautions. Methods: We conducted a retrospective chart review to analyze the effects of the COVID-19 pandemic on screening colonoscopies. The study utilized data on CIR, CIT, SWT and ADR from outpatient, non-emergent procedures conducted at 3 endoscopy suites of St Lukes University Health Network. All inpatient and emergent procedures were excluded. Data was obtained by performing chart review on EPIC electronic health record. Results: Our study demonstrated that the total number of screening colonoscopies was decreased between 2019 to 2020 (318 in 2019 vs 157 in 2020, p= 0.005). CIT (320+/-105 seconds in 2019 vs 392+/-107 seconds in 2020, p=0.001) and SWT (706+/-232 seconds in 2019 vs 830+/-241 seconds in 2020, p=0.001) were increased while CIR (98.2% in 2019 vs 96.6% in 2020, p=0.04) was decreased between 2019 and 2020 likely due to PPE introduction. ADR was similar between the two groups (38.23 (12.50-66.66) in 2019 vs 38.18(16.66-66.00) in 2020, p=0.8). Conclusion: Our study showed that quality indices for screening colonoscopies like cecal intubation rate, cecal intubation time and scope withdrawal time were negatively impacted during the initial COVID time period compared to pre-COVID time. The study also displayed that though there was a significant decline in both screening and diagnostic colonoscopies during pandemic, adenoma detection rates were comparable. Thus, the efficiency of the procedures was affected by the use of PPE but it did not affect the colonoscopies clinical benefits.