Healthcare professionals / Gastroenterology / Clinical Considerations

Making the shift from surgery to Endoscopic Tissue Resection 

As Covid-19 spreads through, many non-coronavirus patients have been avoiding or postponing hospital screenings and procedures out of fear, potentially leading to long-lasting health consequences. 

Failing to detect non-malignant colorectal polyps and cancers means
these patients are more likely to undergo surgery later, instead of being
treated timely and safely with less invasive Endoscopic Tissue Resection (ETR)


The introduction of lockdowns and "stay at home" messages, along with daily news about hospitals inundated with serious COVID-19 cases, has made the public reluctant to seek advice from general practitioners and attend hospital appointments, both from fear of catching COVID-19 and from a desire not to overburden hospital services.

As a result, the pandemic has had a major impact on endoscopy services, resulting in a considerable — and concerning — reduction in cancer detection.  

 COVID-19 has impacted the way hospital operate and reduced the number of patients being treated due to:

  • Social distancing 
  • Enforced downtime & additional cleaning between procedures
  • PPE donning and doffing 

In the Netherlands, COVID-19 has reduced overall cancer diagnostics and led to reductions in cancer diagnoses by between 26%.1


statistics of cancer during endoscopic procedure

Endoscopic therapy vs surgery

Failing to detect non-malignant colorectal polyps and cancers means patients are more likely to undergo surgery at a later stage, despite the availability of endoscopic therapy.  

Even before Covid-19, many patients with benign polyps were advised towards surgery.  

Between 2000 and 2014, there were over 1.2 million surgeries for non-malignant colorectal polyps and colorectal cancer in the US.

clinical data

Physicians tend to view some of the colorectal polyps as "too complex for endoscopic removal" and therefore opt to have them surgically resected. However, surgical resection is associated with higher morbidity and mortality. Today, there are various advanced endoscopic techniques available today for removing benign polyps, even if they are complex. 4

Improvements in screening techniques have resulted in the potential to resect larger lesions with endoscopy, while ensuring patient safety and limiting cross-contamination after the procedure. Despite the procedural challenges entailed by ETR, procedures that can be carried out without a hospital stay are more efficient and productive.5

Our Endoscopic Tissue Resection Solutions

1. Dinmohamed AG, Visser O, Verhoeven RHA, et al. Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands. Lancet Oncology, 2020;21:750–1.   

2. Rutter Matthew D. et al. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis. BMJ, 2020;0:1–7. doi:10.1136/gutjnl-2020-322179. 

 3.Peery Anne F. et al. Increasing Rates of Surgery for Patients With Non-Malignant Colorectal Polyps in the United States. Gastroenterology. 2018 April;154(5):13521360.e3.doi:10.1053/j.gastro.2018.01.003.   

4. Zwager Liselotte W et al. Unnecessary surgery for benign colorectal polyps. Ned Tijdschr Geneeskd 2019 Oct 10;163:D4241.   

5. BSC Tissue Resection Procedure Brochure.