Abstract
Background and aimsGastrointestinal manifestations in patients with COVID-19 are common but the role of endoscopy in this patient population remains unclear. We investigated the need for endoscopic procedures, their findings, and impact on patient care in a systematic and geographically diverse sample of patients hospitalized with COVID-19.MethodsAs part of the North American Alliance for the Study of Digestive Manifestations of COVID-19, we identified consecutive patients hospitalized with COVID-19 at 36 medical centers in the USA and Canada. We performed a secondary analysis of patients who underwent endoscopy, collecting information on endoscopic indications, findings, interventions, staffing, procedure location, anesthesia utilization, and adverse events.ResultsData were collected on 1992 patients; 24 (1.2%) underwent 27 endoscopic procedures (18 upper endoscopies, 7 colonoscopies, 2 endoscopic retrograde cholangiopancreatographies). The most common indications were: gastrointestinal bleeding (13) and enteral access (6). The most common findings were erosive or inflammatory changes. Ten patients underwent an endoscopic intervention for hemostatic therapy (2), enteral access (6), or biliary obstruction (2). Half of cases employed anesthesiology support; no sedation-related adverse events were reported. One-third of cases were performed in the intensive care setting and one quarter in the endoscopy unit.ConclusionsIn this large, systematic, geographically diverse cohort of patients hospitalized with COVID-19 in North America, very few patients underwent endoscopy despite a high prevalence of gastrointestinal manifestations. Almost all endoscopic findings and interventions were thought related to critical illness rather than direct viral injury. This systematic assessment of endoscopic necessity and outcomes may help guide resource allocation in the event of ongoing and future surges.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), the virus responsible for COVID-19, has causedKuftinec et al BMC Gastroenterol (2021) 21:205 a stool specimen [3]
All 24 patients who underwent endoscopy were admitted to the intensive care unit during their hospital course; 20 required mechanical ventilation and 16 required vasopressor support
Data on possible exposure and infection of endoscopy or anesthesia personnel during these procedures were not collected. In this consecutive sample of almost 2000 patients hospitalized with COVID-19 across a geographically diverse network of medical centers in North America, only 1.2% of patients underwent endoscopy despite a high prevalence of gastrointestinal symptoms and substantial burden of critical and/or prolonged illness
Summary
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), the virus responsible for COVID-19, has causedKuftinec et al BMC Gastroenterol (2021) 21:205 a stool specimen [3]. A case report early in the pandemic highlighted that gastrointestinal symptoms may be the presenting expression of COVID-19 and suggested the possibility of ischemic colitis as a direct consequence of SARS-CoV-2 infection [6]. Subsequent case series, have indicated that endoscopic findings in COVID-19 patients are likely to reflect critical illness rather than the direct effect of a GI-tropic virus. In a series from Lombardy, Italy of 38 patients who underwent endoscopic evaluation, 37% had esophagitis, peptic ulcer, or erosive gastritis, but notably 5 patients (13%) had ischemic or hemorrhagic colitis [8]. A recent analysis of COVID-19 patients with gastrointestinal bleeding largely observed lesions that were considered to be related to critical illness, such as gastroduodenal and rectal ulcers, rather than clear viral injury [10]. We investigated the need for endoscopic procedures, their findings, and impact on patient care in a systematic and geographically diverse sample of patients hospitalized with COVID-19
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