Navigating Care Amid Crisis: The Impact of the COVID-19 Pandemic on Eosinophilic Esophagitis Management in Canada

TL;DR

The study examines how the COVID-19 pandemic affected the management of Eosinophilic Esophagitis and foreign body impactions in Canadian emergency care.

Contribution

The study provides new insights into the impact of the pandemic on EoE diagnosis and emergency endoscopic procedures in a Canadian city.

Findings

New EoE diagnoses in emergency departments declined during the pandemic.

Non-EoE causes of foreign body impactions increased in the second year of the pandemic.

Endoscopic resolution rates remained high despite pandemic-related challenges.

Abstract

Background and Objectives: The COVID-19 pandemic caused significant disruptions in healthcare services. Foreign body impactions (FBIs), with Eosinophilic Esophagitis (EoE) being one of the leading underlying causes in adults, are some of the most common emergencies and often require endoscopy. The study assesses the impact of COVID-19 on the incidence and outcomes of foreign body impactions (FBIs) requiring endoscopy at Canadian tertiary centres in a single city. Methods: Patients presenting to tertiary care hospital emergency departments in Calgary (March 2019–Feb 2022) for FBI were identified using the AACRS (Alberta Ambulatory Care Reporting System) database using International Classification of Disease (ICD-9 and ICD-10) codes (T178, T181) and provincial diagnostic codes (935.1, 530.4) for a foreign body in the esophagus (530.13 and K20.0). One-way ANOVA (SPSS® 27.0) analyzed incidence and disease progression across Pre-COVID-19 and COVID-19 years. Results: 759 patients were included in the analysis (274 Pre-COVID-19 (PC: March 2019–Feb 2020), 234 COVID-19 Year 1 (CY1: March 2020–Feb 2021), and 251 COVID-19 Year 2 (CY2: March 2021–Feb 2022)). The mean age remained consistent, with two-thirds being male. Food was the predominant type of FBI (>90%). The incidence of new EoE in EDs declined from PC (60.9%) to CY1 (47.4%) (p < 0.001), while endoscopic resolution remained >96%. Follow-up endoscopies in outpatient settings remained stable (~60%). Non-EoE causes of FBI, including esophagitis and cancer, increased in CY2. The mean ED length of stay rose in CY2, but this was not statistically significant (p = 0.06). Conclusions: This study highlights the resilience of emergent endoscopic care in Calgary during COVID, despite a decline in new EoE diagnoses, which might be due to access barriers.