Impact of the COVID-19 pandemic on the time to emergency endoscopy and clinical outcomes in patients with upper gastrointestinal bleeding.

Abstract

To investigate endoscopic management and clinical outcomes in patients with non-variceal upper gastrointestinal (GI) bleeding during the coronavirus disease 2019 pandemic. We retrospectively analyzed the data of 332 patients with non-variceal upper GI bleeding who underwent emergency upper GI endoscopy at three hospitals during the pandemic (April 2020-June 2021) and before the pandemic (January 2019-March 2020). The number of emergency upper GI endoscopies, time from hospital arrival to endoscopy, mortality within 30 days, rebleeding within 30 days, interventional radiology (IVR)/surgery requirement, composite outcome, rates of endoscopic hemostasis procedures, and second-look endoscopy were investigated using logistic regression. Overall, 152 and 180 patients underwent emergency upper GI endoscopies during and before the pandemic, respectively. The mean time from arrival to endoscopy was longer during the pandemic than before it (11.7 vs. 6.1h, p<0.01). Multivariate analysis revealed that mortality within 30 days (odds ratio [OR]: 2.27, p=0.26), rebleeding within 30 days (OR: 0.43, p=0.17), IVR/surgery requirement (OR: 1.79, p=0.33), and composite outcome (OR: 0.98, p=0.96) did not differ significantly between the periods; conversely, endoscopic hemostasis procedures (OR: 0.38, p<0.01) and second-look endoscopies (OR: 0.04, p<0.01) were less likely to be performed during the pandemic than before it. Although the time from arrival to endoscopy was significantly longer during the pandemic, it did not affect mortality and rebleeding.