Endoscopic Findings in Patients Infected With 2019 Novel Coronavirus in Lombardy, Italy

Abstract

This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e122. Learning Objective-Upon completion of this activity, successful learners will be able to list the most common upper endoscopic findings in patients infected with 2019 novel coronavirus (SARS-Cov-2), list the most common lower endoscopic findings in patients infected with SARS-Cov-2; list appropriate PPE for health care providers performing endoscopic evaluation in patients positive or at high risk of SARS-Cov-2; and realize prioritization of endoscopic evaluation of GI bleeding in high-risk patients should be determined by clinical factors and not SARS-Cov-2 status. C oronavirus disease 2019 (COVID-19) is a major worldwide threat caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rapidly spreading to a global pandemic. As of May 11, 2020, 4,176,346 cases have been reported worldwide, 219,814 in Italy, and of them, 81,871 occurred in the Lombardy region. 1 Although the respiratory manifestations of COVID-19 have been widely described, the impact on the gastrointestinal (GI) system remains less clear. The reported prevalence of digestive symptoms ranges from 3% to 79%, depending on the setting, 2-5 but data on GI endoscopic and histologic findings in COVID-19 patients are lacking. Therefore, the aim of this study is to describe the GI endoscopic and histologic findings in COVID-19 patients.

Clinical Features and Pathogenic Mechanisms of Gastrointestinal Injury in COVID-19

“…Some studies used abdominal diagnostic imaging in patients with SARS-CoV-2 infection to assess their intestinal condition and provide evidence for GI involvement. The most frequently reported observations are intestinal ischemia, including vessel thrombosis/embolism in the small bowel and/or colon and ischemic colitis [ 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Bhayana et al examined 42 abdominal CT scans of 412 hospitalized patients with COVID-19 [ 48 ].…”

“…The GI injury observed in COVID-19 is not limited to intestinal ischemia because cases without evidence of ischemia have also been reported [ 46 , 52 , 53 , 54 , 55 ]. In a case report of a SARS-CoV-2 GI infection causing acute hemorrhagic colitis, as diagnosed by colonoscopy, the biopsy showed slight expansion of the lamina propria by edema, with normal cellularity, intact crypts, and no evidence of ischemia, virocytes, or protozoa [ 52 ].…”

“…In a case report of a SARS-CoV-2 GI infection causing acute hemorrhagic colitis, as diagnosed by colonoscopy, the biopsy showed slight expansion of the lamina propria by edema, with normal cellularity, intact crypts, and no evidence of ischemia, virocytes, or protozoa [ 52 ]. Massironi et al identified endoscopic lesions in 70% (14/20) of colonoscopies on patients with COVID-19 [ 46 ]. The main findings, other than four cases (20%) of histologically confirmed colon ischemia, included five cases (25%) of segmental colitis associated with diverticulosis and one case of diffuse hemorrhagic colitis; in three cases, the colonic mucosa appeared normal on visualization, but histological evidence of microscopic (two cases) and lymphocytic (one case) colitis was found.…”

COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist

“…The cause of the bleeding is often not identified, since endoscopic procedures are not always performed, and patients are managed conservatively with high-dose PPIs [ 92 ]. When an upper GI endoscopy was performed, GI mucosal herpetic-like erosions and ulcers with biopsies testing positive for the SARS-CoV-2 virus have been reported [ 93 ]. In 24 upper GI endoscopic procedures performed in patients with COVID-19 in one study, 75% had lesions including oesophagitis (20.8%), duodenal ulcer (20.8%), erosive gastritis (16.6%), neoplasm (8.3%) and Mallory-Weiss tear (4.1%), but no data on the indication for performing the endoscopic procedures were given [ 93 ].…”

Management of patients with digestive diseases during the COVID-19 pandemic: Clinical Practice Guidelines by the Gastroenterological Scientific Society of Russia

“…При тяжелых формах COVID-19 НПВП-энтеропатия может осложняться желудочно-кишечным кровотечением, как из-за влияния вируса на энтероциты, так и в результате использования в лечении низкомолекулярных гепаринов. Основной причиной проведения эндоскопических исследований при COVID-19 по опубликованным данным явилось желудочно-кишечное кровотечение, чаще всего связанное с применением антикоагулянтов (76%) [99].…”