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

Vanella, Giuseppe; Capurso, Gabriele; Burti, Cesare; Fanti, Lorella; Ricciardiello, Luigi; Souza Lino, Andre; Boskoski, Ivo; Bronswijk, Michiel; Tyberg, Amy; Krishna Kumar Nair, Govind; Angeleti, Stefano; Mauro, Aurelio; Zingone, Fabiana; Oppong, Kofi W.; de la Iglesia-Garcia, Daniel; Pouillon, Lieven; Papanikolaou, Ioannis S.; Fracasso, Pierluigi; Ciceri, Fabio; Rovere-Querini, Patrizia; Tomba, Carolina; Viale, Edi; Eusebi, Leonardo Henry; Riccioni, Maria Elena; van der Merwe, Schalk; Shahid, Haroon; Sarkar, Avik; Yoo, Jin Woo (Gene); Dilaghi, Emanuele; Speight, R. Alexander; Azzolini, Francesco; Buttitta, Francesco; Porcari, Serena; Petrone, Maria Chiara; Iglesias-Garcia, Julio; Savarino, Edoardo V.; Di Sabatino, Antonio; Di Giulio, Emilio; Farrell, James J.; Kahaleh, Michel; Roelandt, Philip; Costamagna, Guido; de Almeida Artifon, Everson Luiz; Bazzoli, Franco; Testoni, Per Alberto; Greco, Salvatore; Arcidiacono, Paolo Giorgio

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, χ(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. TRIAL REGISTRATION NUMBER: ClinicalTrial.gov (ID: NCT04318366).