key: cord-1024970-1xxq2edi
authors: D’Ovidio, Valeria; Lucidi, Cristina; Bruno, Giovanni; Miglioresi, Lucia; Lisi, Daniele; Bazuro, Marco Emilio
title: A snapshot of urgent upper gastrointestinal endoscopy care during the Covid‐19 outbreak in Italy
date: 2020-06-04
journal: J Gastroenterol Hepatol
DOI: 10.1111/jgh.15132
sha: 157100ef0eb35aec16992c5e83f39394d262a10c
doc_id: 1024970
cord_uid: 1xxq2edi

nan

During the entire COVID-19 pandemic, medical attention was focused on treating affected patients, protecting the population from infection and reorganizing daily hospital routine upon resumption as described by Lui RN Wong SH et al (4) .

According to recent evidences, even a few months delay in the diagnosis of cancer and up to six months delay in performing a colonoscopy after a positive faecal immunochemical test (FIT) may not lead to a worse clinical outcome (5) .

However, postponing less urgent procedures may lead to collateral damage for patients in need for an urgent procedure. For many interventions the line between urgent and non-urgent can be drawn only retrospectively. That's especially true for urgent upper endoscopy but no data are still available until now.

Our Hospital was selected by regional committee as "COVID-19 free" and our endoscopic daily activity continued according to local indications (emergency, inpatients and high priority outpatients). Moreover, in the lockdown group a higher incidence of severe endoscopic findings has been detected, including gastroduodenal ulcers, food bolus, Dielafoy lesions or bleeding angiodisplasia (p= 0.008). In comparison with the lockdown group, the reasons of admission to the Emergency room were less relevant in the control group (occult anemia, dysphagia, heartburn or chest pain, CT thickening).

Confirming these observations, mild or absent endoscopic findings were more often described in the control group than in the lockdown group.

Focusing on clinical characteristics of patients with upper gastrointestinal bleedings the mean range of hemoglobin level was lower in lockdown group (6.5 +2 vs 9.9 + 2.5, p <0.001). Patients in the lockdown group also had significantly higher need for blood transfusions (p 0.06). No statistical significant difference has been observed between these two groups with respect to NSAID abuse or antithrombotic agent therapy.

Furthermore the average time between the onset of evident bleeding symptoms and hospital admission was significantly longer in lockdown group patients [6.5 + 1.6 vs 1.7 + 0.6, p< 0.001].

Taking into account the most severe endoscopic bleeding stigmata (Forrest Ia or Ib), these have been observed more often in lockdown group than in control group, although without statistical significance (p= 0.04).

Half of the patients in the lockdown group required an endoscopic treatment versus one third of the patients requiring endoscopic treatment in the control group (table 1) . In all the cases the procedure was effective.

The endoscopic treatment was realized by using a combined approach, metallic clips with epinephrine, hemospray ® , or metallic clips alone. Regarding helicobacter pylori infection, no statistical significant difference has been found between the two groups.

All the endoscopic procedures were performed safely during the lockdown period. The entire medical staff has been randomly tested by oropharyngeal swabs to detect SARS-CoV-2 and resulted negative. Serological testing will be performed in the next month to confirm these data. Onset evident bleeding (mean days) 6.5 ± 1.6 (range 1-10) 1.7 ± 0.6 (range 1-3) 0,0001

Hemoglobin at admission (g/dL) 

Covid-19 Outbreak Progression in Italian Regions: Approaching the Peak by the End of March in Northern Italy and First Week of April in Southern Italy

COVID-19 and Italy: what next? The Lancet

Overview of guidance for endoscopy during the coronavirus disease 2019 pandemic

Lay-off of Endoscopy services for the COVID-19 pandemic: how can we resume the practice of routine cases