Gastrointestinal bleeding and endoscopic findings in critically and non‐critically ill patients with corona virus disease 2019 (COVID‐19): Results from Lean European Open Survey on SARS‐CoV‐2 (LEOSS) and COKA registries

Zellmer, Stephan; Hanses, Frank; Muzalyova, Anna; Classen, Johanna; Braun, Georg; Piepel, Christiane; Erber, Johanna; Pilgram, Lisa; Walter, Lorenz; Göpel, Siri; Wille, Kai; Hower, Martin; Rüthrich, Maria Madeleine; Rupp, Jan; Degenhardt, Christian; Voigt, Ingo; Borgmann, Stefan; Stecher, Melanie; Jakob, Carolin E. M.; Dhillon, Christine; Messmann, Helmut; Ebigbo, Alanna; Römmele, Christoph

doi:10.1002/ueg2.12165

Cited by 16 publications

(21 citation statements)

References 24 publications

(49 reference statements)

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“…23 The rapid progression of necrotic pancreatitis and pseudoaneurysm rupture in our patient followed by massive gastrointestinal bleeding might have been accelerated by damage to the intestinal mucosa associated with SARS-CoV-2 infection. Indeed, patients with Covid-19 were recently reported to be at a high risk of such bleeding, 24,25 likely because of vasodilation and hyperemia of the intestinal mucosa which frequently occur in these patients. 26 Moreover, SARS-CoV-2 can have a direct cytotoxic effect on the gut, 27 while coagulopathy can occur following the prolonged use of anticoagulant drugs for thromboprophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Fatal gastrointestinal bleeding associated with acute pancreatitis as a complication of Covid-19: a case report

Mitrović¹,

Tadić

Janković³

et al. 2022

J Int Med Res

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Clinical manifestations of Covid-19 vary widely among patients. Recent studies suggest that up to 15% of patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections develop gastrointestinal symptoms. The location of virus–host cell receptors angiotensin-converting enzyme 2 and transmembrane serine protease 2 has an important role in the pathophysiology and presentation of disease. They are expressed in the respiratory tract, as well as other organs and tissues including exocrine and endocrine pancreatic cells. These cells are therefore a possible target for the virus, which could explain the relationship between SARS-CoV-2 infection and pancreatic injury. We report a disastrous collateral effect of the Covid-19 pandemic on a 33-year-old man with chronic renal insufficiency and asymptomatic SARS-CoV-2 infection, who developed acute pancreatitis. Inflammation progressed rapidly toward necrosis and the development of a peripancreatic pseudoaneurysm which subsequently ruptured, causing death.

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Section: Discussionmentioning

confidence: 99%

Fatal gastrointestinal bleeding associated with acute pancreatitis as a complication of Covid-19: a case report

Mitrović¹,

Tadić

Janković³

et al. 2022

J Int Med Res

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“…During the critical stage of disease, being on a therapeutic dose of anticoagulation was associated with a significant increase in the risk for GI bleeding. 28 …”

Section: Discussionmentioning

confidence: 99%

Analysis of the effects of the first and second/third waves of the COVID-19 pandemic on an Interdisciplinary Endoscopy Unit in a German ‘hotspot’ area: a single-center experience

Wichmann

Schempf

Göpel

et al. 2022

Therap Adv Gastroenterol

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Background: Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed a pandemic threat to global health. We are now in the fourth wave of this pandemic. As the pandemic developed, the requirements and therapeutic endoscopic procedures for SARS-CoV-2-positive patients underwent changes. Methods: Analysis of implications for an endoscopy unit during the first and second/third waves of the COVID-19 pandemic with a focus on COVID-19-related process changing. Addressed are number of SARS-CoV-2-positive patients and endoscopic examinations performed in patients who tested positive for SARS-CoV-2 during the various waves, adherence to scheduled examinations, rotation of staff to COVID-dedicated structures and, finally, impact of vaccination on infection rate among endoscopic staff. Results: During the first wave, 10 SARS-CoV-2-positive in-house patients underwent a total of 22 gastrointestinal (GI) endoscopic procedures. During the second and third waves, 59 GI endoscopies were performed in 38 patients. While in the first wave, GI bleeding was the main indication for endoscopy (82%), in the second and third waves the main indication for endoscopy was endoscopic insertion of deep feeding tubes (78%; p < 0.001). During the first wave, 5 (17%) of 29 Interdisciplinary Endoscopy Unit (IEU) staff members were moved to designated COVID wards, which was not necessary during the following waves. Lack of protective clothing was critical during the first wave, but not in the later waves. Screening tests for patients and staff were widely available after the first wave, and IEU staff was vaccinated during the second wave. Conclusion: Strategies to ensure safe endoscopies with respect to preventing transmission of SARS-CoV-2 from patients to staff were effective. Organizational adjustments allowed the routine program to continue unaffected. Indications for GI endoscopies changed over time: during the first wave, GI endoscopies were performed for life-threatening indications, whereas later supportive procedures were the main indication.

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“…1) [15]. Larger series reported a rate of gastroduodenal ulcers of 38–80% [16 ▪▪ ,20 ▪▪ ,31]. Other endoscopic findings such as erosive gastritis, esophagitis, Dieulafoy lesions, gastric neoplasia, angiectasia and Mallory–Weiss tears were less frequently reported [16 ▪▪ ,20 ▪▪ ,31].…”

Section: Clinical and Endoscopic Characteristicsmentioning

confidence: 99%

“…The authors reported an incidence of UGIB of 1.7%, with endoscopic confirmation of bleeding in 21 out of 1216 COVID-19 patients. In other 9 patients, a bleeding source was not found or endoscopy was not performed [20 ▪▪ ].…”

Section: Epidemiologymentioning

confidence: 99%

“…Melena and hematemesis are the most frequent manifestations present in 52–65% and in 6–22% of patients, respectively [16 ▪▪ ,31]. In the COKA registry melena and hematemesis were reported to have similar rates of incidence, being around 30% [20 ▪▪ ]. Coffee ground emesis and hematochezia were less frequently reported.…”

Section: Clinical and Endoscopic Characteristicsmentioning

confidence: 99%

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Upper gastrointestinal bleeding in coronavirus disease 2019 patients

Grazia

Anderloni

Sabatino³

2022

Current Opinion in Gastroenterology

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Purpose of reviewUpper gastrointestinal bleeding (UGIB) has significant morbidity and UGIB cases have been described in coronavirus disease 2019 patients. Management of this condition can be challenging considering both the possible severe COVID-19-related pneumonia as well as the risk of the virus spreading from patients to health operators. The aim of this paper is to review the most recent studies available in the literature in order to evaluate the actual incidence of UGIB, its clinical and endoscopic manifestations and its optimal management. Recent findingsUGIB has an incidence between 0.5% and 1.9% among COVID-19 patients, and it typically presents with melena or hematemesis. Peptic ulcers are the most common endoscopic findings. High Charlson Comorbidity Index (CCI), dialysis, acute kidney injury and advanced oncological disease increase the risk for UGIB. Although anticoagulants are commonly used in COVID-19 patients they are not associated with an increased incidence of UGIB. Conservative management is a common approach that results in similar outcomes compared to upper GI endoscopic treatment. Apparently, UGIB in COVID-19 seems not have a detrimental effect and only one study showed an increased mortality in those who developed UGIB during hospitalization.

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Gastrointestinal bleeding and endoscopic findings in critically and non‐critically ill patients with corona virus disease 2019 (COVID‐19): Results from Lean European Open Survey on SARS‐CoV‐2 (LEOSS) and COKA registries

Cited by 16 publications

References 24 publications

Fatal gastrointestinal bleeding associated with acute pancreatitis as a complication of Covid-19: a case report

Fatal gastrointestinal bleeding associated with acute pancreatitis as a complication of Covid-19: a case report

Analysis of the effects of the first and second/third waves of the COVID-19 pandemic on an Interdisciplinary Endoscopy Unit in a German ‘hotspot’ area: a single-center experience

Upper gastrointestinal bleeding in coronavirus disease 2019 patients

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