BACKGROUND
Tracheoesophageal fistulas (TEFs) can be described as a pathological communication between the trachea and the esophagus. According to their origin, they may be classified as benign or malignant. Benign TEFs occur mostly as a consequence of prolonged mechanical ventilation, particularly among patients exposed to endotracheal cuff overinflation. During the severe acute respiratory syndrome coronavirus 2 virus pandemic, the amount of patients requiring prolonged ventilation rose, which in turn increased the incidence of TEFs.
CASE SUMMARY
We report the cases of 14 patients with different comorbidities such as being overweight, or having been diagnosed with diabetes mellitus or systemic hypertension. The most common symptoms on arrival were dyspnea and cough. In all cases, the diagnosis of TEFs was made through upper endoscopy. Depending on the location and size of each fistula, either endoscopic or surgical treatment was provided. Eight patients were treated endoscopically. Successful closure of the defect was achieved through over the scope clips in two patients, while three of them required endoscopic metal stenting. A hemoclip was used to successfully treat one patient, and it was used temporarily for another patient pended surgery. Surgical treatment was performed in patients with failed endoscopic management, leading to successful defect correction. Two patients died before receiving corrective treatment and four died later on in their clinical course due to infectious complications.
CONCLUSION
The incidence of TEFs increased during the coronavirus disease 2019 pandemic (from 0.5% to 1.5%). We believe that endoscopic treatment should be considered as an option for this group of patients, since evidence reported in the literature is still a growing area. Therefore, we propose an algorithm to lead intervention in patients presenting with TEFs due to prolonged intubation.
Trabajo Ganador del Premio en la Categoría Trabajo de Investigación Clínica o Básica en Medicina del Adulto. Concurso Trabajos Científicos del XXVII Congreso Colombiano de Medicina Interna, Bucaramanga, 10-13 de agosto 2022
Introducción: El compromiso gastrointestinal en COVID-19 se presenta en el 20% de los pacientes aproximadamente y puede incluir nauseas, vomito, dolor abdominal, diarrea o alteración del perfil hepático. En nuestro país, no se han estudiado las características del compromiso gastrointestinal en los pacientes con COVID-19.
Objetivos: Determinar la prevalencia de compromiso gastrointestinal y hepático en pacientes con COVID-19 atendidos en dos hospitales de Bogotá, Colombia. Determinar la asociación del compromiso gastrointestinal por COVID-19 con estancia hospitalaria, severidad y mortalidad.
Diseño y metodología: Estudio de corte transversal, realizado en dos hospitales de una subred hospitalaria de Bogotá, Colombia, entre febrero del 2020 y marzo del 2021.
Resultados. Se incluyeron 1176 pacientes con RT-PCR (reverse transcription polymerase chain reaction) positiva. Las manifestaciones gastrointestinales se presentaron en el 50% (IC95% 47-52%), las más frecuentes fueron diarrea en el 18,4%, odinofagia 17,6%, anorexia 14.7% y dolor abdominal en el 8,8%. Se demostró asociación de la diarrea durante la hospitalización con hospitalización prolongada (OR 1.93 IC95% 1.19-3.13), sangrado gastrointestinal al ingreso con mortalidad (OR 3.13, IC95% 1.1-9.1), entre otros. Las alteraciones del perfil hepático se presentaron en el 46% (IC95% 43-49%), siendo mayor en pacientes con enfermedad grave o mortalidad.
Conclusiones: La prevalencia de las manifestaciones gastrointestinales en pacientes con COVID-19 fue de 50%. La diarrea se asoció a mayor estancia hospitalaria, el sangrado gastrointestinal se asoció a falla ventilatoria y mortalidad. El 46% de los pacientes presentaron alteración del perfil hepático, siendo la elevación de transaminasas lo más frecuente. Se demostró que la elevación de la aspartato aminotransferasa (AST) desde el ingreso se asocia a mayor mortalidad.
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