Endoscopic findings are not different in patients with upper gastrointestinal bleeding with COVID-19

Abstract

Background and Aims: Coronavirus disease-2019 is an emerging disease of global public health concern. We aimed to evaluate the demographic data, clinical properties, risk factors and endoscopy findings of coronavirus disease-2019 patients with upper gastrointestinal system bleeding. Materials and Method: Patients who underwent endoscopy for upper gastrointestinal bleeding between July 2, 2020 and January 29, 2021 and were diagnosed with severe acute respiratory syndrome coronavirus-2 confirmed by polymerase chain reaction were included in the study. In this retrospective study patients with gastrointestinal bleeding were compared as 1:2 case-control. Coronavirus disease-2019 patients who underwent endoscopy for upper gastrointestinal bleeding and the control group were compared retrospectively in terms of demographic data, comorbid diseases, bleeding symptom, drugs administered, laboratory parameters, time between bleeding symptom and endoscopy, endoscopy findings, gastrointestinal bleeding treatment, and mortality rates. Results: Forty Covid-19 patients (23 males, mean age ± SD, 65.92 ± 12.97) and 80 non-Covid-19 control patients (43 males, mean age ± SD, 66.17 ± 15.61) who underwent endoscopy for upper gastrointestinal bleeding were compared. The most common bleeding symptom was melena in both groups (50% vs 60%). Hospitalization in intensive care unit (47.5% vs 20%, P = 0.004) and need for mechanic ventilation (22.5% vs 5%, p = 0.006), use of corticosteroids were more common in coronavirus disease-2019 group (30% vs. 2.5%, p = 0.000). The need for erythrocyt replacement were not different between the groups [median (min - max) 1.5 (0 - 13) vs 0.5 (0 - 22), p = 0.397]. Use of low molecular weight heparin was statistically more common in coronavirus disease-2019 group (32.5% vs 5%, p=0.00). Time elapsed until the performance of endoscopy in terms of hours was significantly longer in coronavirus disease-2019 group (62.97 ± 84.59 vs. 21.85 ± 33.91, p = 0.006). The most common endoscopic finding was gastroduodenal ulcer in both groups. No significant differences were seen in terms of rebleeeding rates. Mortality rate was statistically higher in coronavirus disease-2019 group (37.5% vs 8.8%, p = 0.000). Conclusions: Until more precise guidelines for the management of gastrointestinal bleeding in COVID-19 patients are developed, a case-by-case decision should be made on whether to perform endoscopy and the timing of the procedure, after multidisciplinary assessments are made in terms of patient status, response to medical therapy, treatment resources, and assessment of risks.