ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) has affected more than 249 million people worldwide as of November 2021. Patients with chronic immune-mediated inflammatory diseases are at risk of viral infections either related to their underlying immune dysfunction or the immunosuppressive therapy, but little is known about the impact of COVID19 on outcomes and management of pancreatobiliary IgG4 related disease (IgG4 RD) patients. Methods: This was a multicenter retrospective cohort study aiming to investigate the impact of COVID-19 on the clinical outcomes and management of pancreatobiliary IgG4 RD patients in different geographic areas with COVID-19 outbreak. Pancreatobiliary IgG4 RD patients aged 18 years or older from 7 referral centers in Hong Kong, Japan, Thailand, Singapore, the United States and Italy were included. Case definition of IgG4 RD: elevated serum IgG4 serology with typical features of pancreatobiliary involvement on imaging, EUS, ERCP and/ or typical histopathologic features of IgG4 RD. Medical records were reviewed for IgG4 RD status (organ involvement, disease activity, treatment status), COVID-19 infection and outcome. Outcome measures were incidence and severity of COVID-19 in pancreatobiliary IgG4 RD patients, medical treatment for the IgG4 disease during COVID-19 and incidence of postponement or discontinuation of indicated medical treatment for IgG4 RD during COVID-19. Results: 101 pancreatobiliary IgG4 RD patients (mean age 66.4 +/- 12.1 years, male 74.3%) from 7 referral centers were included from January 2020 to November 2020. Major comorbidities of patients: none in 21.8%, diabetes in 45.5%, hypertension in 49.5%, ischemic heart disease in 8.9%, chronic liver disease in 8.9%, chronic kidney disease in 9.9% and cancer in 5.0% of patients. IgG4 RD organ involvement: pancreas only in 36.6%, pancreas and bile duct in 16.8%, bile duct only in 14.9%, pancreatobiliary and other organs in 26.7% of patients. The mean serum IgG4 serology level was 4.72+/-7.31 g/L. In 2020, 27.7% of patients had active IgG4 disease while 72.3% of patients were in remission. In 2020, 65.3% of patients received treatment (steroid in 48.5%, thiopurines in 22.7%, steroid and thiopurines in 25.8%, rituximab in 1.5%), while 30.7% of patients were not on treatment. 2 patients (2.0%) had COVID-19 infection, with 1 patient requiring ICU admission. All infected patients recovered from COVID-19 without flare up of IgG4 RD. In 2020, 6.9% of patients had postponement or discontinuation of indicated medical treatment for IgG4 RD during COVID-19 outbreak due to concern of COVID-19 infection while on immunosuppressive therapy. Conclusion: In this study, low incidence of COVID-19 infection and low rates of postponement or discontinuation of indicated medical treatment were observed in pancreatobiliary IgG4 RD patients during COVID-19 outbreak in 2020. (Table Presented)
ABSTRACT
Background: The COVID-19 pandemic resulted in implementing hospital policies to minimize the contamination from an aerosol-generating procedure. Only emergency endoscopic procedures were allowed, and a conservative management strategy has been applied given the limited personnel protective equipment and negative-pressure room in resources limited areas. Aim: To assess the impact of the conservative treatment strategy on the clinical outcomes of patients with upper gastrointestinal bleeding (UGIB). Methods: A retrospective pandemic (April to June 2020) and the year before the pandemic. Patient demographics, laboratory findings, inpatient procedures, clinical outcomes were collected and compared between the two periods. Results: A total of 520 patients were recruited (COVID-19 period= 60 patients, pre-COVID=460 patients). Among those admitted during the pandemic, 61% were male, with a mean age of 67. The mean Glasgow-Blatchford Score (GBS) was 10.77 + 3.90. Forty-three percent underwent EGD, but only 6.7% had the procedure within 24 hours. There were no differences in the clinical characteristics between the patients from both periods in terms of age, gender, comorbid conditions, antiplatelets and anticoagulants, and risk stratification. However, patients admitted during the pandemic had more solid malignancy (30% VS 18%, p=0.028) but less history of NSAIDs use (10% VS 25%, p=0.01). EGD was performed less frequently during the pandemic than the pre-COVID p<0.001). Also, the median time to endoscopy during the pandemic (70,48-the pre-COVID period (25,16-48) (p<0.001). Patients admitted during the pandemic required more blood transfusion (p=0.002), longer hospital stay (p<0.001), and had higher 30-day mortality (OR 3.41;95%CI 0.86-13.54, p=0.097) than those admitted during pre-COVID. Nonetheless, there was no difference in the re-bleeding rate at 30 days (OR 1.68;95%CI 0.74-3.79, p=0.208). When compared patients admitted during the pandemic who received EGD vs. conservative treatment without EGD vs. those admitted during pre-COVID receiving EGD, patients admitted during the pandemic who were treated conservatively had higher 30-day mortality than patients receiving EGD in the pre-COVID period (OR 3.27;95% CI 1.25-8.57, p=0.024). However, the cause of death was related to the underlying malignancy. Also, patients admitted during the pandemic had a longer hospital stay and required more blood transfusion than patients admitted during pre-COVID receiving an endoscopic procedure, as shown in Table 1. Conclusion: The conservative delayed or withhold EGD affected the outcomes of patients by increasing blood transfusion requirement, length of hospital stay, and 30-day mortality. (Table presented)
ABSTRACT
Background and Aim: The coronavirus disease-2019 (COVID-19) pandemic has placed significant stress on gastroenterologists worldwide. However, its toll on the mental health of gastroenterologists within Southeast Asia was unknown. A mixed methods, multi-national study was conducted to elucidate the prevalence of burnout and its stressors within the region. Methods: A survey was disseminated electronically to 1761 gastroenterologists via the gastroenterology and endoscopy societies of Brunei, the Philippines, Indonesia, Malaysia, Singapore, and Thailand from September 1 to December 7, 2020. This included the 22-item Maslach Burnout Inventory to detect burnout. Ethical approval was granted. Quantitative and qualitative data were collected. Logistic regression identified associations between variables and burnout. Qualitative data were analyzed by content analysis method. Results: The response rate was 38.8%;66.6% reported significant stress. The regional prevalence of burnout was 17.1% although inter-country variation existed (Fig. 1A). Depression, being a trainee, public sector work, and the lack of awareness or access to mental health support services increased burnout risk significantly (Fig. 1B). The 50.1% of gastroenterologists were unaware of or did not have access to support services. The onset of depression intra-pandemic was 2.1%;the pre-pandemic prevalence was 2.2%. Stressors commonly involved service requirements (53.2%), difficult relationships with patients and relatives (23.0%), and difficult relationships with colleagues (20.5%). Specific to the pandemic, the three most common stressors were fear of getting infected (39.7%), reduced income (28.0%), and stringent infection control measures adding to workload (18.5%). Conclusion: Burnout is common in gastroenterologists in Southeast Asia;however;better safeguards for mental health are urgently needed.
ABSTRACT
For management of endoscopy units during the worldwide coronavirus disease 2019 (COVID-19) outbreak caused by the new coronavirus SARS-CoV-2 in Thailand, a working group of the Thai Association for Gastrointestinal Endoscopy (TAGE) in collaboration with the Endoscopy Nurse Society (Thailand) (ENST) has developed the following recommendations for Thai doctors and medical personnel working in gastrointestinal endoscopy (GIE) units. Upper and lower GIE is considered as an aerosol generating procedure (AGP). Information regarding chance of infection in patients must be obtained before performing endoscopy to help determine the level of risk. Endoscopies should only be performed in emergency/urgency cases. Hospitals that have no confirmed cases with low incidences of infection in their coverage area may consider performing selective endoscopies. For the confirmed infected patient, the recommendations are as follows;the endoscopist who performed the procedure must be an experienced one, wear the enhanced personal protective equipment (PPE) with correct practice how to wear and take off PPE, and strict hand hygiene. The endoscopic procedure should be performed in a negative pressure room;however, If not available, a bedside procedure in the cohort ward should be performed. Endotracheal tube intubation and removal should be done by an anesthesiologist. Most enzymatic detergent solutions can eliminate SARS-CoV-2. The use of an additional pre-cleaning process in order to prevent AGP from occurring during endoscope reprocessing is recommended. Patient(s) under investigation (PUI) should wait for the test result before considering endoscopic procedure. For the low risk patient for COVID-19 infection who needs an endoscopic procedure, standard PPE is recommended. Due to the limitation of medical resources, only medical personnel who are necessary for the procedure and at risk of COVID-19 infection should be allowed to use the recommended PPE.