Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Digestive Endoscopy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
BMJ Open Gastroenterol. 2021 Feb;8(1). doi: 10.1136/bmjgast-2020-000578.
Although evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported.
We aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19.
All consecutive patients with COVID-19 undergoing endoscopy in 16 institutions from high-prevalence regions were enrolled. Mann-Whitney U, χ 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.
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.
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.
ClinicalTrial.gov (ID: NCT04318366).
虽然有证据表明 2019 年冠状病毒病（COVID-19）期间经常发生胃肠道（GI）受累，但内镜检查结果鲜有报道。
我们旨在登记 COVID-19 患者的内镜异常和潜在相关危险因素。
在高流行地区的 16 个机构中，连续纳入接受内镜检查的 COVID-19 连续患者。使用 Mann-Whitney U、χ 或 Fisher 确切检验比较主要异常患者与阴性检查患者，使用多变量逻辑回归识别独立预测因素。
在 2020 年 2 月至 5 月期间，在第一次大流行爆发期间，内镜检查活动受到严重限制，在 16 个机构对 106 例 COVID-19 患者进行了 114 次内镜检查（男性=70.8%，中位年龄=68（58-74）岁；33%入住重症监护病房；44.4%报告有胃肠道症状）。66.7%的内镜检查为紧急检查，主要用于明显的胃肠道出血。52 例（45.6%）患者有主要异常，而 13 例因先前疾病出血。最常见的上消化道异常为溃疡（25.3%）、糜烂/溃疡性胃-十二指肠病（16.1%）和瘀点/出血性胃病（9.2%）。在进行的下消化道内镜检查中，33.3%显示出类似于缺血性结肠炎。受试者工作特征曲线分析发现 D-二聚体>1850ng/ml 可预测主要异常。只有 D-二聚体>1850ng/ml（OR=12.12（1.69-86.87））和存在胃肠道症状（OR=6.17（1.13-33.67））在多变量分析中与主要异常独立相关。
在这项对需要内镜检查的住院 COVID-19 患者的高度选择队列中，近一半的患者表现出急性黏膜损伤，超过三分之一的下消化道内镜检查显示出缺血性结肠炎的特征。在本研究中评估的与住院相关和患者相关的变量中，D-二聚体>1850ng/ml 是预测内镜下主要黏膜异常最有用的指标。
ClinicalTrials.gov（注册号：NCT04318366）。
