Triage policy to postpone endoscopy for patients with low-risk varices is safe during the COVID-19 pandemic

Abstract During the COVID-19 pandemic, most of the endoscopic services were electively postponed or suspended. We aimed to assess the safety of a triage policy in patients receiving esophageal variceal ligation during the COVID-19 pandemic. Triage policy of endoscopic variceal ligation (EVL) was implemented in our hospital during the lockdown period from 15th May 2021 to 26th July 2021. We compared the clinical characteristics and outcomes with those receiving endoscopy due to esophageal varices from 17th May 2020 to 28th July 2020. Of the 124 patients receiving EVL, a higher percentage of esophageal variceal bleeding (EVB) was noted (9/32, 28.1% vs. 8/92, 8.7%, p = 0.006) during the lockdown period, with a higher percentage of EVB in the referrals (7/9, 77.8% vs. 2/14, 14.2%, p = 0.007). Twenty-three patients whose endoscopies were postponed by triage policy due to low-risk or eradicated varices did not experience EVB during the lockdown period. Child-Pughs class C was independent factor predictive of EVB (relative risk 7.674, P = 0.004), entering the program of prophylactic EVL was the protective factor of EVB (relative risk 0.158, P = 0.004). Entrance into the prophylaxis program does not only decrease risk of EVB but also fosters comprehensive triage to postpone endoscopy during the lockdown period.