Time to Therapy May Not Impact Diagnosis Upstaging in Patients Referred for Management of Luminal Gastrointestinal Neoplasia.

Background: The COVID-19 pandemic dramatically impacted endoscopy practice. Recommendations were to postpone elective cases, including procedures for removal of luminal neoplasia. This provided a natural experiment to evaluate outcomes related to these decisions and the impact of time to procedure on change in histology.

Aims: The primary aim is to examine time to endoscopy for therapy of colorectal polyps and Barrett's esophagus with dysplasia and oncologic outcomes during the COVID-19 pandemic.

Methods: This was a retrospective cohort study of individuals referred for endoscopic therapy of advanced colorectal polyps and dysplastic Barrett's esophagus (BE) between July 2019 and January 2022. Multivariable logistic regression was used to evaluate whether time to therapeutic exam was associated with a change in histology. Time from index to therapeutic exam before versus after the start of the pandemic (March 20, 2020) was compared using a Cox regression.

Results: There were 310 patients (56% male, mean age 65) who were referred for colon polyps (n = 256) and BE-related neoplasia (n = 54). The median time to therapeutic exam was 78 days (range 4-718). Time to therapy was shorter for colon polyp cases completed after versus before the pandemic (HR: 1.49, 95% CI 1.14-1.96). The pandemic was not associated with a difference in time to exam for BE. Change in histology from index to therapeutic exam was noted in 51 cases (16.5%) and was mostly upstaging (70.6%). There was no association between time to therapeutic exam, sex, or timing related to the pandemic on the probability of being upstaged for colon polyps or BE.

Conclusions: Fewer than 1 in 5 cases had a change in histology from index to therapeutic exam, and there was no delay related to the COVID-19 pandemic. These findings suggest that procedures for removal of advanced colon polyps or dysplastic BE can potentially be postponed with minimal impact, helping guide triaging decisions going forward.