Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study

被引：40

作者：

Vanella, Giuseppe ^{[1
]}

Capurso, Gabriele ^{[1
]}

Burti, Cesare ^{[2
]}

Fanti, Lorella ^{[3
]}

Ricciardiello, Luigi ^{[4
,5
]}

Souza Lino, Andre ^{[6
]}

Boskoski, Ivo ^{[7
,8
]}

Bronswijk, Michiel ^{[9
]}

Tyberg, Amy ^{[10
]}

Krishna Kumar Nair, Govind ^{[11
]}

Angeletti, Stefano ^{[12
]}

Mauro, Aurelio ^{[13
]}

Zingone, Fabiana ^{[14
]}

Oppong, Kofi W. ^{[15
]}

de la Iglesia-garcia, Daniel ^{[16
]}

Pouillon, Lieven ^{[17
]}

Papanikolaou, Ioannis S. ^{[18
]}

Fracasso, Pierluigi ^{[19
]}

Ciceri, Fabio ^{[20
]}

Rovere-Querini, Patrizia ^{[21
]}

Tomba, Carolina ^{[2
]}

Viale, Edi ^{[3
]}

Eusebi, Leonardo Henry ^{[4
,5
]}

Riccioni, Maria Elena ^{[7
,8
]}

van der Merwe, Schalk ^{[9
,22
]}

Shahid, Haroon ^{[10
]}

Sarkar, Avik ^{[10
]}

Yoo, Jin Woo ^{[11
]}

Dilaghi, Emanuele ^{[12
]}

Speight, R. Alexander

Azzolini, Francesco ^{[4
]}

Buttitta, Francesco ^{[5
]}

Porcari, Serena ^{[7
,8
]}

Petrone, Maria Chiara ^{[1
]}

Iglesias-Garcia, Julio ^{[16
]}

Savarino, Edoardo V. ^{[14
]}

Di Sabatino, Antonio ^{[13
]}

Di Giulio, Emilio ^{[12
]}

Farrell, James J. ^{[11
]}

Kahaleh, Michel ^{[10
]}

Roelandt, Philip ^{[9
,22
]}

Costamagna, Guido ^{[7
,8
]}

Artifon, Everson Luiz de Almeida ^{[6
]}

Bazzoli, Franco ^{[4
,5
]}

Testoni, Per Alberto ^{[3
]}

Greco, Salvatore ^{[2
]}

Arcidiacono, Paolo Giorgio ^{[1
]}

机构：

[1] Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Pancreatobiliary Endoscopy & Endosonog Div, Milan, Italy

[2] ASST Papa Giovanni XXIII, Digest Endoscopy Unit, Bergamo, Italy

[3] Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Gastroenterol & Gastrointestinal Endoscopy Div, Milan, Italy

[4] Univ Bologna, Dept Med & Surg Sci, Bologna, Italy

[5] St Orsola Malpighi Hosp, Bologna, Italy

[6] Hosp Casa Saude Santos, GI Endoscopy Serv, Santos, SP, Brazil

[7] Fdn Policlin Univ Agostino Gemelli IRCC, Digest Endoscopy Unit, Rome, Italy

[8] Univ Cattolica Sacro Cuore, Ctr Endoscop Res Therapeut & Training CERTT, Rome, Italy

[9] Univ Hosp Leuven, Dept Gastroenterol & Hepatol, Leuven, Belgium

[10] Rutgers State Univ, Robert Wood Johnson Med Sch, New Brunswick, NJ USA

[11] Yale Univ, Sch Med, Dept Internal Med, Sect Digest Dis, New Haven, CT 06510 USA

[12] Sapienza Univ, St Andrea Hosp, Digest Endoscopy Unit, Rome, Italy

[13] Univ Pavia, San Matteo Hosp Fdn, Dept Internal Med, Pavia, Italy

[14] Univ Padua, Dept Surg Oncol & Gastroenterol, Gastroenterol Unit, Padua, Italy

[15] Newcastle Tyne Hosp NHS Trust, Dept Gastroenterol, Newcastle Upon Tyne, Tyne & Wear, England

[16] Univ Hosp Santiago De Compostela, Hlth Res Inst Santiago Compostela IDIS, Dept Gastroenterol & Hepatol, Santiago De Compostela, Spain

[17] Imeldaziekenhuis, Imelda GI Clin Res Ctr, Bonheiden, Belgium

[18] Natl & Kapodistrian Univ Athens, Attikon Univ Gen Hosp, Athens, Greece

[19] Osped Sandro Pertini, Rome, Italy

[20] Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Dept Hematol & Stem Cell Transplantat, Milan, Italy

[21] Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Div Immunol Transplantat & Infect Dis, Milan, Italy

[22] Katholieke Univ Leuven, Dept Chron Dis Metab & Ageing CHROMETA, Leuven, Belgium

来源：

BMJ OPEN GASTROENTEROLOGY | 2021年 / 8卷 / 01期

关键词：

endoscopy; mucosal infection; gastrointestinal tract; covid-19; CORONAVIRUS;

D O I：

10.1136/bmjgast-2020-000578

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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 All consecutive patients with COVID-19 undergoing endoscopy in 16 institutions from high-prevalence regions were enrolled. Mann-Whitney U, chi(2) 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.

引用

页数：11

共 40 条

[1] Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19
Ackermann, Maximilian
Verleden, Stijn E.
Kuehnel, Mark
Haverich, Axel
Welte, Tobias
Laenger, Florian
Vanstapel, Arno
Werlein, Christopher
Stark, Helge
Tzankov, Alexandar
Li, William W.
Li, Vincent W.
Mentzer, Steven J.
Jonigk, Danny
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 2020, 383 (02) : 120 - 128
[2] A novel severity score to predict inpatient mortality in COVID-19 patients
Altschul, David J.
Unda, Santiago R.
Benton, Joshua
Ramos, Rafael de la Garza
Cezayirli, Phillip
Mehler, Mark
Eskandar, Emad N.
[J]. SCIENTIFIC REPORTS, 2020, 10 (01)
[3] [Anonymous], 2020, ESGE ESGENA POSITION
[4] ASGE, GASTROENTEROLOGY PRO
[5] Stress-related mucosal disease in the critically ill patient
Bardou, Marc
Quenot, Jean-Pierre
Barkun, Alan
[J]. NATURE REVIEWS GASTROENTEROLOGY & HEPATOLOGY, 2015, 12 (02) : 98 - 107
[6] Abdominal Imaging Findings in COVID-19: Preliminary Observations
Bhayana, Rajesh
Som, Avik
Li, Matthew D.
Carey, Denston E.
Anderson, Mark A.
Blake, Michael A.
Catalano, Onofrio
Gee, Michael S.
Hahn, Peter F.
Harisinghani, Mukesh
Kilcoyne, Aoife
Lee, Susanna, I
Mojtahed, Amirkasra
Pandharipande, Pari, V
Pierce, Theodore T.
Rosman, David A.
Saini, Sanjay
Samir, Anthony E.
Simeone, Joseph F.
Gervais, Debra A.
Velmahos, George
Misdraji, Joseph
Kambadakone, Avinash
[J]. RADIOLOGY, 2020, 297 (01) : E207 - E215
[7] COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow
Bikdeli, Behnood
Madhavan, Mahesh V.
Jimenez, David
Chuich, Taylor
Dreyfus, Isaac
Driggin, Elissa
Der Nigoghossian, Caroline
Ageno, Walter
Madjid, Mohammad
Guo, Yutao
Tang, Liang V.
Hu, Yu
Giri, Jay
Cushman, Mary
Quere, Isabelle
Dimakakos, Evangelos P.
Gibson, C. Michael
Lippi, Giuseppe
Favaloro, Emmanuel J.
Fareed, Jawed
Caprini, Joseph A.
Tafur, Alfonso J.
Burton, John R.
Francese, Dominic P.
Wang, Elizabeth Y.
Falanga, Anna
McLintock, Claire
Hunt, Beverley J.
Spyropoulos, Alex C.
Barnes, Geoffrey D.
Eikelboom, John W.
Weinberg, Ido
Schulman, Sam
Carrier, Marc
Piazza, Gregory
Beckman, Joshua A.
Steg, Gabriel
Stone, Gregg W.
Rosenkranz, Stephan
Goldhaber, Samuel Z.
Parikh, Sahil A.
Monreal, Manuel
Krumholz, Harlan M.
Konstantinides, Stavros V.
Weitz, Jeffrey I.
Lip, Gregory Y. H.
[J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2020, 75 (23) : 2950 - 2973
[8] Intestinal permeability changes with bacterial translocation as key events modulating systemic host immune response to SARS-CoV-2: A working hypothesis
Cardinale, Vincenzo
Capurso, Gabriele
Ianiro, Gianluca
Gasbarrini, Antonio
Arcidiacono, Paolo Giorgio
Alvaro, Domenico
[J]. DIGESTIVE AND LIVER DISEASE, 2020, 52 (12) : 1383 - 1389
[9] Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis
Cheung, Ka Shing
Hung, Ivan F. N.
Chan, Pierre P. Y.
Lung, K. C.
Tso, Eugene
Liu, Raymond
Ng, Y. Y.
Chu, Man Y.
Chung, Tom W. H.
Tam, Anthony Raymond
Yip, Cyril C. Y.
Leung, Kit-Hang
Fung, Agnes Yim-Fong
Zhang, Ricky R.
Lin, Yansheng
Cheng, Ho Ming
Zhang, Anna J. X.
To, Kelvin K. W.
Chan, Kwok-H
Yuen, Kwok-Y
Leung, Wai K.
[J]. GASTROENTEROLOGY, 2020, 159 (01) : 81 - 95
[10] Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements)
Chiu, Philip Wai Yan
Ng, Siew C.
Inoue, Haruhiro
Reddy, D. Nageshwar
Hu, Encliang Ling
Cho, Joo Young
Ho, Lawrence K. Y.
Hewett, David G.
Chiu, Han-Mo
Rerknimitr, Rungsun
Wang, Hsiu-Po
Ho, Shiaw Hooi
Seo, Dong Wan
Goh, Khean-Lee
Tajiri, Hisao
Kitano, Seigo
Chan, Francis K. L.
[J]. GUT, 2020, 69 (06) : 991 - 996

← 1 2 3 4 →