Beating bowel cancer together

New guidance for endoscopy procedures to remain open is issued

Friday 15 January 2021

Endoscopy services across the UK should continue to go ahead throughout the second wave of the pandemic, and patients who are high risk of COVID-19 should be prioritised for the vaccination before their endoscopy takes place, according to the UK's leading endoscopy organisations who have updated their information and guidance for health professionals.

The two key tests to diagnose bowel cancer are colonoscopy and flexible sigmoidoscopy – a camera on a thin, flexible cable inserted through the anus to look at different parts of the bowel. These tests are known as endoscopy procedures.

These tests are the gold standard of detecting bowel cancer, especially at the earliest stage of the disease, when it's more treatable. Endoscopy may even prevent the disease through the removal of pre-cancerous growths (polyps) discovered during the procedures. Nearly everyone diagnosed at the earliest stage of bowel cancer will survive but this drops significantly as the disease develops, so getting timely access to these tests is vital.

In March and April 2020 all endoscopy procedures, except for emergencies, were paused to reduce the spread of COVID-19. New research from the University of Oxford suggests that the number of colonoscopies performed in England alone fell by 92%, compared with an average month in 2019, suggesting that thousands of people may have undiagnosed and untreated bowel cancer.

The British Society of Gastroentrology, Joint Advisory Group on Gastrointestinal (GI) Endoscopy, and other professional stakeholder groups have issued key strategies of endoscopy services and to ensure patient safety. Below are a few of their main points:

  • endoscopy departments should be preserved as a priority and not be used for COVID-19 work, and teams should be preserved and not redeployed
  • existing additional endoscopy facilities should continue where possible, particularly where they are not in a hospital setting and COVID-19 safe
  • ongoing communication is needed to reassure GPs and patients that endoscopy units are open and that urgent referrals should continue
  • patients should be reassured that it is safe to come into hospitals for endoscopy procedures and that these can be performed safely with minimal risk of infection
  • enhanced PPE should be used when performing any endoscopic procedures
  • selected patients should be prioritised for a COVID-19 vaccination before their endoscopy procedure who in the lower at-risk vaccination priority groups (5-9). These include:
    • patients who have been diagnosed with bowel cancer through an urgent referral for endoscopy
    • patients with newly diagnosed moderate-severe inflammatory bowel disease (IBD), or worsening IBD requiring treatment
    • patients treated for variceal bleeding who enter or are in a banding programme
  • all other patient-facing endoscopy staff should be vaccinated

Genevieve Edwards, Chief Executive at Bowel Cancer UK, says: "We warmly welcome the joint guidance from British Society of Gastroenterology and the Joint Advisory Group on GI endoscopy, which will ensure that life-saving endoscopy procedures are able to continue. We're delighted to see the care and thought that has gone into developing this updated guidance that will keep people safe at this challenging time.

"Many endoscopy units were struggling to cope with demand pre COVID-19 and it's vital to preserve capacity and expertise to allow endoscopy to carry on. They urgently need additional resources and recovery plans to tackle the growing backlog of people waiting for an endoscopy procedure.

"Losing staff to isolation and redeployment whilst having to hand over wards for use for COVID-19 patients demonstrates the depth of this problem. We recognise the strain that the NHS is under at the current time, but urge Trusts to implement this guidance as far as possible."

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