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1. Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: An international multicentre study

Author

Vanella, G. Capurso, G. Burti, C. Fanti, L. Ricciardiello, L. Souza Lino, A. Boskoski, I. Bronswijk, M. Tyberg, A. Krishna Kumar Nair, G. Angeleti, S. Mauro, A. Zingone, F. Oppong, K.W. De La Iglesia-Garcia, D. Pouillon, L. Papanikolaou, I.S. Fracasso, P. Ciceri, F. Rovere-Querini, P. Tomba, C. Viale, E. Eusebi, L.H. Riccioni, M.E. Van Der Merwe, S. Shahid, H. Sarkar, A. Yoo, J.W.G. Dilaghi, E. Speight, R.A. Azzolini, F. Buttitta, F. Porcari, S. Petrone, M.C. Iglesias-Garcia, J. Savarino, E.V. Di Sabatino, A. Di Giulio, E. Farrell, J.J. Kahaleh, M. Roelandt, P. Costamagna, G. De Almeida Artifon, E.L. Bazzoli, F. Testoni, P.A. Greco, S. Arcidiacono, P.G.

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, χ 2 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). ©

Published
2021

3. Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study

Author

Avik Sarkar, Francesco Azzolini, James J. Farrell, Fabio Ciceri, Michiel Bronswijk, Francesco Buttitta, Stefano Angeletti, Per Alberto Testoni, Michel Kahaleh, Emilio Di Giulio, Amy Tyberg, Kofi Oppong, Franco Bazzoli, Emanuele Dilaghi, Serena Porcari, Carolina Tomba, Gabriele Capurso, Guido Costamagna, Salvatore Greco, Cesare Burti, Ioannis S. Papanikolaou, Aurelio Mauro, Fabiana Zingone, P. Fracasso, Julio Iglesias-Garcia, Paolo Giorgio Arcidiacono, Edi Viale, Maria Elena Riccioni, Haroon Shahid, Govind Nair, Edoardo Savarino, Ivo Boškoski, Giuseppe Vanella, Leonardo Henry Eusebi, Philip Roelandt, Jin Woo Gene Yoo, Patrizia Rovere-Querini, Lorella Fanti, Luigi Ricciardiello, Antonio Di Sabatino, Everson L.A. Artifon, Maria Chiara Petrone, Schalk Van der Merwe, R Alexander Speight, Lieven Pouillon, Andre Lino, Daniel De la Iglesia-García, Vanella, G., Capurso, G., Burti, C., Fanti, L., Ricciardiello, L., Souza Lino, A., Boskoski, I., Bronswijk, M., Tyberg, A., Krishna Kumar Nair, G., Angeleti, S., Mauro, A., Zingone, F., Oppong, K. W., De La Iglesia-Garcia, D., Pouillon, L., Papanikolaou, I. S., Fracasso, P., Ciceri, F., Rovere-Querini, P., Tomba, C., Viale, E., Eusebi, L. H., Riccioni, M. E., Van Der Merwe, S., Shahid, H., Sarkar, A., Yoo, J. W. G., Dilaghi, E., Speight, R. A., Azzolini, F., Buttitta, F., Porcari, S., Petrone, M. C., Iglesias-Garcia, J., Savarino, E. V., Di Sabatino, A., Di Giulio, E., Farrell, J. J., Kahaleh, M., Roelandt, P., Costamagna, G., De Almeida Artifon, E. L., Bazzoli, F., Testoni, P. A., Greco, S., Arcidiacono, P. G., Vanella, Giuseppe, Capurso, Gabriele, Burti, Cesare, Fanti, Lorella, Ricciardiello, Luigi, Souza Lino, Andre, Boskoski, Ivo, Bronswijk, Michiel, Tyberg, Amy, Krishna Kumar Nair, Govind, Angeleti, Stefano, Mauro, Aurelio, Zingone, Fabiana, Oppong, Kofi W., de la Iglesia-Garcia, Daniel, Pouillon, Lieven, Papanikolaou, Ioannis S., Fracasso, Pierluigi, Ciceri, Fabio, Rovere-Querini, Patrizia, Tomba, Carolina, Viale, Edi, Eusebi, Leonardo Henry, Riccioni, Maria Elena, van der Merwe, Schalk, Shahid, Haroon, Sarkar, Avik, Yoo, Jin Woo (Gene), Dilaghi, Emanuele, Speight, R. Alexander, Azzolini, Francesco, Buttitta, Francesco, Porcari, Serena, Petrone, Maria Chiara, Iglesias-Garcia, Julio, Savarino, Edoardo V., Di Sabatino, Antonio, Di Giulio, Emilio, Farrell, James J., Kahaleh, Michel, Roelandt, Philip, Costamagna, Guido, de Almeida Artifon, Everson Luiz, Bazzoli, Franco, Testoni, Per Alberto, Greco, Salvatore, and Arcidiacono, Paolo Giorgio

Subjects
covid-19, endoscopy, gastrointestinal tract, mucosal infection, aged, COVID-19, colitis, ischemic, cross-sectional studies, duodenum, female, gastric mucosa, gastrointestinal hemorrhage, humans, male, middle aged, pandemics, prospective studies, risk factors, SARS-CoV-2, stomach ulcer, endoscopy, gastrointestinal, Male, Cross-sectional study, colitis, RC799-869, Gastroenterology, Endoscopy, Gastrointestinal, law.invention, 0302 clinical medicine, law, Risk Factors, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, medicine.diagnostic_test, Diseases of the digestive system. Gastroenterology, Middle Aged, Intensive care unit, Exact test, medicine.anatomical_structure, Cohort, 030211 gastroenterology & hepatology, Female, Gastrointestinal Hemorrhage, Colitis, Ischemic, medicine.medical_specialty, Duodenum, Settore MED/12 - GASTROENTEROLOGIA, ischemic, COVID-19, Endoscopy, pandemic, ischemic lesions, 03 medical and health sciences, Internal medicine, medicine, Humans, Stomach Ulcer, Colitis, Pandemics, Aged, business.industry, medicine.disease, gastrointestinal, Endoscopy, Cross-Sectional Studies, Gastric Mucosa, business
Abstract

BackgroundAlthough evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported.AimsWe aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19.MethodsAll 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.ResultsBetween 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.ConclusionIn 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 numberClinicalTrial.gov (ID: NCT04318366).

Published
2021

4. Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study.

Author

Vanella G, Capurso G, Burti C, Fanti L, Ricciardiello L, Souza Lino A, Boskoski I, Bronswijk M, Tyberg A, Krishna Kumar Nair G, Angeletti S, Mauro A, Zingone F, Oppong KW, de la Iglesia-Garcia D, Pouillon L, Papanikolaou IS, Fracasso P, Ciceri F, Rovere-Querini P, Tomba C, Viale E, Eusebi LH, Riccioni ME, van der Merwe S, Shahid H, Sarkar A, Yoo JWG, Dilaghi E, Speight RA, Azzolini F, Buttitta F, Porcari S, Petrone MC, Iglesias-Garcia J, Savarino EV, Di Sabatino A, Di Giulio E, Farrell JJ, Kahaleh M, Roelandt P, Costamagna G, Artifon ELA, Bazzoli F, Testoni PA, Greco S, and Arcidiacono PG

Subjects
Aged, COVID-19 complications, Colitis, Ischemic etiology, Colitis, Ischemic pathology, Cross-Sectional Studies, Duodenum pathology, Female, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage pathology, Humans, Male, Middle Aged, Pandemics, Prospective Studies, Risk Factors, SARS-CoV-2, Stomach Ulcer etiology, Stomach Ulcer pathology, COVID-19 pathology, Endoscopy, Gastrointestinal, Gastric Mucosa pathology
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, χ 2 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)., Competing Interests: 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., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2021
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