Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2021; 9(28): 8404-8412
Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8404
Comparison of the impact of endoscopic retrograde cholangiopancreatography between pre-COVID-19 and current COVID-19 outbreaks in South Korea: Retrospective survey
Kook Hyun Kim, Sung Bum Kim
Kook Hyun Kim, Sung Bum Kim, Division of Gastroenterology and HepatologyDepartment of Internal Medicine, Yeungnam University, College of Medicine, Daegu 42415, South Korea
Author contributions: Kim KH designed the research and wrote the paper; Kim SB analyzed the clinical data and reviewed the manuscript.
Supported by the 2020 Yeungnam University Research Grant, No. 220A480002.
Institutional review board statement: This study was approved by the Institutional Review Board of Yeungnam University Hospital (IRB No. 2020-12-042).
Informed consent statement: Written informed consent was waived owing to the retrospective nature of this study.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kook Hyun Kim, MD, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University, College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, South Korea. kimkh@yu.ac.kr
Received: June 22, 2021
Peer-review started: June 22, 2021
First decision: July 16, 2021
Revised: July 22, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: October 6, 2021
Research background

The coronavirus disease 2019 (COVID-19) outbreak has markedly influenced endoscopic patterns. Endoscopic retrograde cholangiopancreatography (ERCP) is an essential technique for pancreatobiliary disease but increases the risk of exposure to virus-containing body fluid; however, the impact of COVID-19 on ERCP is unknown.

Research motivation

Unlike upper endoscopy and colonoscopy, pancreatobiliary disorders such as bile duct obstruction or associated cholangitis usually require urgent treatment. However, endoscopy can cause human-to-human viral transmission by producing massive aerosol droplets throughout the procedure, particularly during therapeutic interventions such as ERCP. Due to the lack of experience and the highly contagious features of COVID-19, all measures to stop the viral spread in and outside the hospital were prioritized.

Research objectives

This study aimed to compare and to analyze the change in the number of ERCP procedures, causes, and clinical outcomes of emergency ERCP between pre-COVID-19 and during the COVID-19 outbreak in Daegu city, the worst-hit area in South Korea.

Research methods

This retrospective cohort study included patients aged ≥ 18 years who underwent ERCP between February 18 and March 28, 2020, at a tertiary hospital. Baseline demographics, causes of an ER visit, blood chemistry, ERCP indications, and endoscopic details relevant to ERCP were collected and compared with those from the same period in 2018 and 2019 as control groups.

Research results

The number of ERCP procedures in 2018 and 2019 decreased by 20.2% and 56.6%, respectively, compared with that in 2020 (P < 0.01); among the 113 emergency ERCPs, the observed numbers in 2018 (n = 42) and 2019 (n = 55) dramatically dropped by 61.9% and 70.9%, respectively, compared with that in 2020 (n = 16). No case of ERCP-related infection has been reported in medical providers or other patients.

Research conclusions

The COVID-19 outbreak significantly reduced the number of ERCPs; however, no difference was observed in the indications and endoscopic interventions before and during the COVID-19 outbreak.

Research perspectives

All emergency ERCP procedures were performed safely without causing any viral infection in our endoscopy center. However, a long-term follow-up is warranted to observe the clinical outcomes of ERCP procedures after the cessation of the COVID-19 outbreak.