Endoscopic Utilization and Outcomes of Upper Gastrointestinal Bleeding in COVID-19: A Global Real-World Database Analysis

Abstract

Introduction: Upper gastrointestinal bleeding (UGIB) events are increasingly recognized in the Coronavirus Disease-2019 (COVID-19) patients. The data about the rates of utilization of endoscopy and outcomes among these patients are scarce.Methods: All hospitalized COVID-19 patients with UGIB (hematemesis or melena or both) were studied from January 1, 2020, to September 1, 2020, from the TriNetX multicenter research network database. Patients were divided into two groups- patients who underwent any endoscopies (endoscopy group) and did not undergo endoscopy (non-endoscopy group). A subgroup analysis was performed for patients with variceal (V-UGIB) and non-variceal UGIB (NV-UGIB). Mortality and development of acute respiratory distress syndrome were the primary outcomes of the study. Secondary outcomes were cross-section imaging (CT scan of the abdomen) and mechanical ventilation.Results: A total of 3466 hospitalized COVID-19 had UGIB events from January 1, 2020, to September 1, 2020. 3.1% (3466/112,158). Only 51.1% of patients (1773/3446) underwent an endoscopy. The endoscopy group had a lower risk of mortality (risk ratio [RR] 0.63, 95%CI:0.52–0.77), and ARDS (RR 0.39, 95%CI:0.22–0.71). Rates of mechanical ventilation (RR 0.66, 95%CI:0.47–0.91) were lower, and the rate of CT scan utilization (RR 1.20, 95%CI:1.01–1.42) were higher in the endoscopy group. No differences in the outcomes were noted in V-UGIB and NV-UGIB groups.Conclusion: UGIB events in hospitalized adult COVID-19 patients was 3.1%. Endoscopy utilization in this cohort was associated with a significantly lower risk of mortality (37%) and ARDS (61%). Future prospective studies are needed to validate these findings.Funding Statement: None.Declaration of Interests: The authors have no commercial associations or sources of support that might pose a conflict of interest.Ethics Approval Statement: TriNetX has received a waiver from IRB since it does not contain any protected health information (PHI) or the HCO Information, and only includes aggregated counts and statistical summaries of de-identified information.