Descriptive Analysis of COVID-19 Patients Who Required Endoscopic Evaluation for Gastrointestinal Bleeding

TL;DR

This study examines the outcomes of COVID-19 patients with gastrointestinal bleeding who required endoscopic evaluation, finding higher mortality rates among those needing intervention.

Contribution

The study specifically evaluates mortality and outcomes in SARS-CoV-2 patients with clinically significant gastrointestinal hemorrhage requiring endoscopic intervention.

Findings

Patients requiring endoscopic intervention had higher mortality (50%) compared to general trends.

65% of esophagogastroduodenoscopies required intervention, versus 16% for colonoscopies.

Mortality was similar between ICU and non-ICU patients (52% vs. 48%).

Abstract

Introduction: Gastrointestinal (GI) hemorrhage has been reported in patients with SARS-CoV-2. Although there is consensus that the infection is associated with GI sequelae, controversy remains regarding its clinical significance. Endoscopic intervention was limited during the pandemic due to safety concerns and resource constraints, which may have hindered a full assessment of the impact of GI hemorrhage on patient outcomes. This paper aims to evaluate the outcomes of patients diagnosed with SARS-CoV-2 and concurrent clinically significant GI hemorrhage.

Materials and methods: A total of 125 patients (69 male, 56 female) over the age of 18, with signed procedural consent, were included. All met the criteria for a SARS-CoV-2 diagnosis and underwent diagnostic endoscopic intervention. Data were analyzed using the Mann-Whitney U test with Excel (Microsoft Corporation, Redmond, WA, USA) and SPSS Statistics version 25 (IBM Corp., Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.).

Results: The overall hospital length of stay was 8 ± 6 days. A subset analysis compared patients requiring ICU admission with those who did not. The average ICU length of stay was 13 ± 6 days, compared to 5 ± 3 days for non-ICU patients. Among patients who underwent esophagogastroduodenoscopy, 65% (70/108) required intervention, while 16% (3/19) of colonoscopies required intervention. There was no significant difference in underlying comorbidities or rates of non-invasive mechanical ventilation between groups. Overall mortality was 50% (62/125), with no significant difference between ICU (26/50) and non-ICU (36/75) patients (52% vs. 48%).

Conclusions: While studies have indicated an increased risk of GI complications in SARS-CoV-2 patients, many have not differentiated between hemorrhagic and non-hemorrhagic sequelae or accounted for the level of care. We conclude that there was higher mortality among patients requiring endoscopic intervention, regardless of their level of care or patient-specific factors.