key: cord-308730-mv3ttl1e authors: Bujanda, Luis; Arratibel, Paula; Gil, Ines; Torrente, Silvia; Martos, Maider; Navascues, Jose M Enriquez - title: Surgery and emergency gastrointestinal endoscopy during the Covid-19 pandemic date: 2020-09-16 journal: Gastroenterol Hepatol DOI: 10.1016/j.gastrohep.2020.07.002 sha: doc_id: 308730 cord_uid: mv3ttl1e nan Urgent gastrointestinal endoscopy (UGE) is a worldwide extended medical procedure, being the most frequent the upper and lower gastrointestinal bleeding and impaction of a foreign body the most common emergencies that require this technique 1, 2 . The activity in endoscopy units has been deeply affected by Covid-19 pandemic. In order to decrease the risk of infection, elective endoscopy has been stopped since "State of Alarm" was declared. However this restriction does not apply to UGE. We analyzed the UGE performed from March 1st 2020 to April 30th 2020 (Covid period) and we compared it with those underwent during the same period of the previous year, 2019 (pre-Covid period). The UGE It Works in our Hospital (Donostia Universitary Hospital, San Sebastian, Spain) Monday to Friday from 3 p.m. to 8 a.m. and Saturday and Sunday during 24 hours. UGE They are usually requested by the Emergency Department and less frequently from hospitalization rooms or intensive care unit. Regarding to our protocol, we perform UGE within 12 hours since admission to patients with gastrointestinal bleeding and within 6 hours to those with impaction of foreign bodies. In total 126 UGE were included of which 107 (85%) were upper endoscopy. Upper bleeding was the most common clinical indication in 56 patients (44%), while impaction of a foreign body was the second most common reason for indication reported by 47 (37%) ( Table 1) . By the other hand, lower gastrointestinal bleeding was the main indication for urgent colonoscopy, performed in 11 (9%) cases, followed by 6 patients (5%) who needed stenting due to colonic obstruction in relation to colorectal cancer. 64 UGE procedures (51%) were performed in Saturday or Sunday (Table 1) . Comparing two periods, 44% less UGE procedures were performed in the Covid period (45 Covid period vs 81 pre-Covid). In addition, upper endoscopy was significantly more common in proportion than colonoscopy in the Covid period, 89% (40/45) vs 83% (67/81). The number of UGE by upper gastrointestinal bleeding fell from 33 patients in the pre-Covid period to 23 patients in the Covid period, that is, a 30% less. In impaction of foreign bodies, a 58% decrease was observed: from 33 in the pre-Covid period to 14 in the Covid one. The percentage of emergency endoscopies that required some therapeutic procedure went from 47% (40/85) in the preCovid period to 47% (21/45) in the Covid period ( Table 1 ). The number of colonoscopies needed for colonic stents in obstructive colorectal cancer decreased by half in Covid period. It is to be noted that the decrease in the number of procedures was higher from Monday to Friday than on weekends (53% vs 40%) ( Table 1) . As a result of the collapse of emergency departments and hospitals Healthcare Authorities made a call to the population to stay at home and to avoid going to primary healthcare centers or to emergency departments, if not essential. The number of hospital admission and elective surgery decreased a 36% and 48%, respectively (Table 2) . This fact is one of the main reasons to explain the decreased of the demand for UGE in hospitals. We assume that, in our environment, many UGE don't necessary any therapeutic maneuver, they are just diagnostic explorations. More of the half emergency endoscopy was diagnostic without changes in both periods (53%). It could be that many of these patients, presenting with melena or rectal bleeding in the current "State of Alarm," minimize their symptoms and wait longer before demanding healthcare attention. Probably, some cases could stop spontaneously. In emergency general surgery happened something similar, the number of appendectomy, abscess, or cholecystectomy decreased between 38% and 41%. It's possible that antibiotics were used more frequently in the Covid period. Another consequence of this may be the increase in gastrointestinal perforations (Table 2) . Similarly, people suffering from impaction of foreign bodies could also have waited a longer time to ask for medical attention or could have tried different attempts to solve the impaction for example drink carbonated beverages. Stay at home having more time to eat could be another reason to explain the reduction of impactions. Probably related to the former reasons the percentage decrease of UGE due to impaction of foreign bodies was higher than the observed for GI bleeding. By the other hand, decreased demand from hospitalization rooms may be another explanation for the reduction in the number of UGE performed. In fact, during COVID19 period, non-urgent surgical activity was lower, therefore the number of post-surgical complications were less ( Table 2) . There is no obvious explanation for the decrease in the treatment of colonic obstruction or volvulus, but it could be related to the probable increase of acute abdomen and peritonitis. According to our experience, the decrease in UGE was lower on weekdays than on weekends. Perhaps the endoscopy was delayed until the next morning trying to avoid coronavirus infections. In summary during Covid period had a decreased important in the emergency endoscopy and surgery. Emergency upper gastrointestinal endoscopy at the Emergency Department of Izzet Baysal Hospital: analysis of 263 patients Foreign bodies in the gastrointestinal tract and anorectal emergencies Acknowledgements; We thank Arantza Zubizarreta, Javier Basterrechea and Nieves Gonzalez-García for his kind collaboration in this study.