Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study
Giuseppe Vanella, Gabriele Capurso, Cesare Burti, Lorella Fanti, Luigi Ricciardiello, Andre Souza Lino, Ivo Boškoski, Michiel Bronswijk, Amy Tyberg, Govind Nair, Stefano Angeletti, Aurelio Mauro, Fabiana Zingone, Kofi Oppong, Daniel de la Iglesia, Lieven Pouillon, Ioannis S. Papanikolaou, Pierluigi Fracasso, Fabio Ciceri, Patrizia Rovere‐Querini, Carolina Tomba, Edi Viale, Leonardo Henry Eusebi, Maria Elena Riccioni, Van der Merwe, Haroon Shahid, Avik Sarkar, Jin Woo Yoo, Emanuele Dilaghi, Ally Speight, Francesco Azzolini, Francesco Buttitta, Serena Porcari, Maria Chiara Petrone, Julio Iglesias‐García, Edoardo Savarino, Antonio Di Sabatino, Emilio Di Giulio, James J. Farrell, Michel Kahaleh, Philip Roelandt, Guido Costamagna, Everson L. Artifon, Franco Bazzoli, Per Alberto Testoni, Salvatore Greco, Paolo Giorgio Arcidiacono
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: 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).