BMJ Open Gastroenterology (Sep 2021)
Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study
- Lieven Pouillon,
- Fabiana Zingone,
- Emilio Di Giulio,
- Daniel de la Iglesia-Garcia,
- Philip Roelandt,
- Paolo Giorgio Arcidiacono,
- Julio Iglesias-Garcia,
- Antonio Di Sabatino,
- Fabio Ciceri,
- Patrizia Rovere-Querini,
- Giuseppe Vanella,
- Gabriele Capurso,
- Cesare Burti,
- Lorella Fanti,
- Luigi Ricciardiello,
- Andre Souza Lino,
- Michiel Bronswijk,
- Amy Tyberg,
- Govind Krishna Kumar Nair,
- Aurelio Mauro,
- Kofi W. Oppong,
- Ioannis S. Papanikolaou,
- Pierluigi Fracasso,
- Carolina Tomba,
- Edi Viale,
- Maria Elena Riccioni,
- Schalk van der Merwe,
- Haroon Shahid,
- Avik Sarkar,
- Jin Woo (Gene) Yoo,
- Emanuele Dilaghi,
- R. Alexander Speight,
- Francesco Azzolini,
- Francesco Buttitta,
- Serena Porcari,
- Maria Chiara Petrone,
- Edoardo V. Savarino,
- James J. Farrell,
- Michel Kahaleh,
- Franco Bazzoli,
- Per Alberto Testoni,
- Salvatore Greco,
- Stefano Angeletti,
- Everson Luiz de Almeida Artifon
Affiliations
- Lieven Pouillon
- Imelda GI Clinical Research Center, Imeldaziekenhuis, Bonheiden, Belgium
- Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Emilio Di Giulio
- Digestive Endoscopy Unit, Sant`Andrea Hospital, Sapienza University, Rome, Italy
- Daniel de la Iglesia-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela. Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Philip Roelandt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela. Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
- Fabio Ciceri
- Department of Hematology and Stem Cell Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Patrizia Rovere-Querini
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Gabriele Capurso
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Cesare Burti
- Digestive Endoscopy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Lorella Fanti
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Luigi Ricciardiello
- Department of Medical and Surgical Sciences, University of Bologna and Sant’Orsola Malpighi Hospital, Bologna, Italy
- Andre Souza Lino
- GI Endoscopy Service, Hospital Casa de Saude de Santos, Santos, Brazil
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Amy Tyberg
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
- Govind Krishna Kumar Nair
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Aurelio Mauro
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
- Kofi W. Oppong
- Department of Gastroenterology, Newcastle upon Tyne hospitals NHS Trust, Newcastle upon Tyne, UK
- Ioannis S. Papanikolaou
- National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
- Pierluigi Fracasso
- Ospedale Sandro Pertini, Rome, Italy
- Carolina Tomba
- Digestive Endoscopy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Edi Viale
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Maria Elena Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Schalk van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Haroon Shahid
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
- Avik Sarkar
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
- Jin Woo (Gene) Yoo
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Emanuele Dilaghi
- Digestive Endoscopy Unit, Sant`Andrea Hospital, Sapienza University, Rome, Italy
- R. Alexander Speight
- Department of Gastroenterology, Newcastle upon Tyne hospitals NHS Trust, Newcastle upon Tyne, UK
- Francesco Azzolini
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Francesco Buttitta
- Department of Medical and Surgical Sciences, University of Bologna and Sant’Orsola Malpighi Hospital, Bologna, Italy
- Serena Porcari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Maria Chiara Petrone
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Edoardo V. Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- James J. Farrell
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Michel Kahaleh
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
- Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna and Sant’Orsola Malpighi Hospital, Bologna, Italy
- Per Alberto Testoni
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Salvatore Greco
- Digestive Endoscopy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Stefano Angeletti
- Digestive Endoscopy Unit, Sant`Andrea Hospital, Sapienza University, Rome, Italy
- Everson Luiz de Almeida Artifon
- GI Endoscopy Service, Hospital Casa de Saude de Santos, Santos, Brazil
- DOI
- https://doi.org/10.1136/bmjgast-2020-000578
- Journal volume & issue
-
Vol. 8,
no. 1
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).
