In a review article on COVID-19 in gastrointestinal disease, Magro et al. discussed key aspects of gastroenterology and hepatology practice impacted by the ongoing COVID-19 pandemic.1 The authors summarized the gastrointestinal manifestations of COVID-19, the consequences for patients requiring immunosuppressive therapy, and subsequent vaccine strategies for these patients. In addition, the decrease in the availability of endoscopic resources, the digitization of patient contact and the threat of gastroenterology trainee education are discussed in detail. It is clear that the practice of our profession has changed and that we will face unique challenges over the next few years as we recover from this pandemic. The question remains how we will cope with these changes and how the practice will adapt to face the challenges ahead.
First, it will be critical to realize the true impact on the prognosis of patients who have been exposed to a delayed diagnostic evaluation and subsequent delay in starting treatment due to the COVID-19 pandemic and related measures. The Dutch experience demonstrating a significant drop in the absolute number of gastrointestinal cancers detected during endoscopy in 2020 is an illustration of this.2 In addition to postponing or canceling elective endoscopy, a decrease in patient referrals and a temporary pause in the colorectal cancer screening program have been suggested to be responsible for this decrease. The consequence of the COVID-19-induced delay in the diagnosis and treatment of gastrointestinal cancers is expected to result in a considerable loss of years of life and additional deaths.3 Consider not only the time it will take to resolve the backlog of patients awaiting endoscopic assessment, but also a potential increase in demand from patients who have waited to see their GP for their complaints, and have subsequently delayed their referral to a gastroenterologist. This increase in the number of patients will increase the workload even more for years to come, the so-called post-COVID recovery wave. Therefore, initiatives to improve patient selection for endoscopy will become even more imperative to address the imbalance between supply or “ability to serve” (resources available in endoscopy) and demand (patients referred for endoscopy). endoscopy). In addition, it also crystallized that endoscopy is often overused, illustrated by a prospective study from Portugal which found that only 62% of patients had an appropriate indication for esophagogastroduodenoscopy.4 One potential solution is the use of online patient education, which has been shown to be an effective tool in reducing the need for esophagogastroduodenoscopy in cases of unstudied dyspepsia.5
Second, who will diagnose and treat these patients when the COVID-19 pandemic subsides? For example, we see that in the UK gastroenterology trainees have reported a significant decrease in exposure to endoscopy procedures.6 It is assumed that the effects of reduced training, and therefore reduced certification, are expected to persist until 2022.6 Likewise, a survey of gastroenterology fellows in the United States showed that a third of fellows were referred to non-gastroenterology services during the pandemic and that COVID-19 had an impact on all aspects. of their training.7 Endoscopy is a practical specialty, which cannot be offset by the concept of the home office. Thus, initiatives among interns to tackle these challenges and create opportunities out of (future) challenges are of great value.8 Therefore, as the influx of patients will increase in the coming years, we must avoid a decrease in the available number of well-trained gastroenterologists. This puts us in a clinical conundrum, as resident training requires commitment, time, and guidance from trained professionals, who are needed more than ever to accomplish their clinical duties in order to alleviate waiting lists. post-COVID. This requires innovative planning and management of available resources by health care decision makers and practice administrators. We also believe that a renewed interest in the use of simulators for practical training is now more urgent than ever.
Ultimately, to meet the challenges ahead, we must answer the “simple” question “why do we do things the way we do?” The COVID-19 pandemic has shown us that there is great potential to optimize our communication with patients (telemedicine) and peers (digital conferences / meetings), to improve hygiene standards in our endoscopy units , to increase the efficiency of triage in the face of limited endoscopy services and improve international interdisciplinary collaborations (for example, the SECURE-IBD and COVID-Hep registries).9, 10 Time will tell if the changes to our clinical practice will be sustained when restrictive measures are released. Ultimately, the burden of responsibility falls on us, because in the long run it is we, the professionals, who must make full use of the lessons learned to ensure the best possible outcomes for patients.
CONFLICT OF INTEREST
Mönkemüller: Ovesco, Germany-Conferences, advice.