Article Text
Abstract
Background Although evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported.
Aims We aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19.
Methods All consecutive patients with COVID-19 undergoing endoscopy in 16 institutions from high-prevalence regions were enrolled. Mann-Whitney U, χ2 or Fisher’s exact test were used to compare patients with major abnormalities to those with negative procedures, and multivariate logistic regression to identify independent predictors.
Results Between February and May 2020, during the first pandemic outbreak with severely restricted endoscopy activity, 114 endoscopies on 106 patients with COVID-19 were performed in 16 institutions (men=70.8%, median age=68 (58–74); 33% admitted in intensive care unit; 44.4% reporting GI symptoms). 66.7% endoscopies were urgent, mainly for overt GI bleeding. 52 (45.6%) patients had major abnormalities, whereas 13 bled from previous conditions. The most prevalent upper GI abnormalities were ulcers (25.3%), erosive/ulcerative gastro-duodenopathy (16.1%) and petechial/haemorrhagic gastropathy (9.2%). Among lower GI endoscopies, 33.3% showed an ischaemic-like colitis.
Receiver operating curve analysis identified D-dimers >1850 ng/mL as predicting major abnormalities. Only D-dimers >1850 ng/mL (OR=12.12 (1.69–86.87)) and presence of GI symptoms (OR=6.17 (1.13–33.67)) were independently associated with major abnormalities at multivariate analysis.
Conclusion In this highly selected cohort of hospitalised patients with COVID-19 requiring endoscopy, almost half showed acute mucosal injuries and more than one-third of lower GI endoscopies had features of ischaemic colitis. Among the hospitalisation-related and patient-related variables evaluated in this study, D-dimers above 1850 ng/mL was the most useful at predicting major mucosal abnormalities at endoscopy.
Trial registration number ClinicalTrial.gov (ID: NCT04318366).
- endoscopy
- mucosal infection
- gastrointestinal tract
- covid-19
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Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Twitter @pigifracasso
Contributors PGA and GC were involved in study concept and design. SG, JF, ELDAA, ADS, MK, PR, CB, LF, LR, ASL, IB, MB, AT, GKKN, SA, AM, FZ, KWO, DdllG, LP, ISP, PF, CT, EV, LHE, MER, SWVdM, HS, AS, JWY, ED, RAS, FA, FB, SP, MCP and PRQ were involved in acquisition of data. GV and GC were involved in statistical analysis. GV, GC and PGA were involved in analysis and interpretation of data and in drafting of the manuscript. MB, SWvdM, KWO, ES, ADS, JF, MK, GC, JIG, EDG, ELDAA, FB, PAT, SG, FC and PGA were involved in critical revision of the manuscript for important intellectual content. All authors revised the manuscript, approved the final version to be published and agree to be accountable for accuracy and integrity of any part of the work. Guarantor of the article: PGA.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests GV received travel grants from Mylan and Alfasigma. GC is a consultant for Mylan. IB is consultant for Apollo Endosurgery, Cook Medical and Boston Scientific; board member for Endo Tools; research grant recipient from Apollo Endosurgery; had food and beverage compensation from Apollo Endosurgery, Cook Medical, Boston Scientific and Endo Tools. LR is a consultant for Cancer Prevention Pharmaceuticals; has received research grants from SLA Pharma AG and Takeda and receives funds from the Italian Association for Cancer Research (IG21723). MB received travel grants from Takeda, Taewoong Medical and Prion Medical. KWO has received lecture fees from Olympus, Medtronic and Mylan. He has received a research grant from Medtronic. LP received advisory board fees from Janssen and Takeda; presentation fees from AbbVie and Ferring; and personal fees from AbbVie, Ferring, Norgine and Takeda. SWVdM holds the Cook chair in interventional endoscopy and holds consultancy agreements with Boston Scientific, Cook, Pentax and Olympus. ES has received lecture or consultancy fees from Medtronic, Reckitt Benckiser, Takeda, Merck & Co, Bristol Myers Squibb, AbbVie, Amgen, Novartis, Fresenius Kabi, Sandoz, Sofar, Malesci, Janssen, Grifols, Aurora Pharma, Innovamedica, Johnson & Johnson, SILA, Unifarco, Alfasigma, Shire, EG Stada Group. MK has done consulting work for Boston Scientific, Interscope Med and AbbVie. He has received research grants from Boston Scientific, Emcision, Conmed, Pinnacle, Cook, Gore, Merit and Olympus. PR is supported by Clinical Mandate from Belgian Foundation against Cancer (Stichting tegen Kanker) and receives speaking and consultancy fees from MSD Belgium. GC is consultant for and had food and beverage compensation from Cook Medical, Boston Scientific and Olympus.
Patient consent for publication Not required.
Ethics approval IRCCS San Raffaele Institute promoted the study and obtained local Institutional Review Board (IRB) approval under the code COVID-BioB (n.34/int/2020) as part of a general protocol registered in ClinicalTrial.gov. Each participating centre obtained approval in keeping with local IRB policy.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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