key: cord-0761721-7yv20hym authors: Xie, Xiao‐Ping; Sheng, Li‐Ping; Han, Chao‐Qun; Jin, Yu; Bai, Tao; Lin, Rong; Ding, Zhen; Hou, Xiao‐Hua title: Features of capsule endoscopy in COVID‐19 patients with a six‐month follow‐up: A prospective observational study date: 2021-09-10 journal: J Med Virol DOI: 10.1002/jmv.27308 sha: 9c912aba9edd29d32b0d1fa528a2615f1f4a2b29 doc_id: 761721 cord_uid: 7yv20hym Recently, the coronavirus disease 2019 (COVID‐19) has caused a global pandemic. Several studies indicate that the digestive system can also be affected by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Therefore, patients with digestive symptoms should have a capsule endoscopy (CE). COVID‐19 patients with gastrointestinal (GI) symptoms who underwent CE were recruited from March 2020 to April 2020. We collected patients’ data and performed a prospective follow‐up study for 6 months. All 11 COVID‐19 cases with GI symptoms who underwent CE presented gastritis. Eight cases (72.7%) had intestinal mucosa inflammation. Among them, two cases showed intestinal ulcers or erosions. Moreover, two cases displayed colonic mucositis. One case was lost during follow‐up. At 3–6 months after hospital discharge, five patients underwent CE again, presenting gastrointestinal lesions. Five of the 10 cases had GI symptoms, such as abdominal pain, diarrhea, constipation, and others. Among these five cases, the GI symptoms of three patients disappeared at the last follow‐up and two patients still presented diarrhea symptoms. Overall, we observed damaged digestive tract mucosa that could be caused by SARS‐CoV‐2. Moreover, after discharge, some patients still presented intestinal lesions and GI symptoms. College. For cases 1-6, CE was performed with PillCam™ SB3. To evaluate colonic lesions better, PillCam™ COLON2 was used for cases 7-11 and follow-ups. All participants signed informed consent. At least 6 months of clinical follow-up time was conducted for all patients. However, one patient was lost during follow-up. At 3-6 months after hospital discharge, five of the patients underwent CE again. Figure 1 displays patient flow. Information including clinical and laboratory data was retrieved from patients' medical records and was verified by doctors. Clinical data include age, gender, time from onset of symptoms to diagnosis, respiratory symptoms, gastrointestinal symptoms, medication, and hospital stay length. Laboratory assessments consisted of white blood cell (WBC) count, neutrophil ratio (N%), lymphocyte ratio (L%), total bilirubin, direct bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine, and potassium. For missing information, direct communications with attending doctors or patients were performed. All CE images were reviewed by one experienced endoscopist. For all patients, CE images were evaluated for the following characteristics: Data are reported as mean ± standard deviation (SD), maximums, minimums, number, and percentages, when appropriate. antivirus, and nonsteroidal anti-inflammatory drugs (NSAIDs), and three received antivirus and NSAIDs. Four patients received only one of these three drugs and no drugs were used in three cases. The hospital stay ranged between 9 and 41 days. Clinical characteristics are summarized in Table 1 . WBC counts and N% were high in Case 1 and WBC counts were low in Case 3. L% levels decreased in Cases 1 and 2. Total and direct bilirubin did not increase in all cases. Case 6, 7, and 9 showed abnormal levels of AST or ALT. Creatine only increased in Case 2. Potassium levels were mildly low only in Case 6. These results are shown in Table 2 . In this study, all cases presented gastritis. Additionally, only Case 2 showed gastric ulcer. Eight (72.7%) patients had intestinal mucosa inflammation. Among these eight patients, Case 1 and 5 presented intestinal erosions or ulcers. Case 5 and 8 showed colonic mucositis. However, the CE imaging for colonic mucosa was not available in Case 2. These details are shown in Table 3 and representative images are shown in Figure 2 . Table 4 and the representative images are shown in In the past, severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome, both caused by coronaviruses, represented two large-scale pandemics. 13 Also, other studies support our findings. 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