Early detection of COVID-19 cholangiopathy using cholangioscopy-a case report of two critically ill patients.

Background: The coronavirus disease 2019 (COVID-19) crisis caused by the severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) rapidly led to a pandemic. While the majority of SARS-CoV-2-infected patients present with fever and respiratory symptoms, gastrointestinal symptoms may also occur. In addition, serious hepatic manifestations like cholangiopathy and liver failure have been described. Patients and methods: We identified two critically ill patients suffering from SARS-CoV­2 infection in our intensive care unit (ICU). In both patients, laboratory testing revealed elevated liver chemistries weeks after initial diagnosis with COVID-19. Results: During repeated endoscopic retrograde cholangiopancreatography (ERCP) with cholangioscopy, a severely destructed biliary mucosa with ischemia and epithelial roughness was seen in both patients. Due to the prolonged course of COVID-19 and chronic liver damage with ongoing sepsis, both patients succumbed to the disease. Conclusion: In our opinion, a COVID-19 infection can lead to development of cholangiopathy in critically ill patients. Cholangioscopy performed early can confirm the diagnosis of COVID-19-associated cholangioscopy.

Decline in acute upper gastrointestinal bleeding during Covid-19 pandemic after lockdown in Austria

Background and study aims COVID-19 disease has rapidly spread all over the world. The Austrian government has implemented a lockdown to contain further spread of this disease on March 16th. We investigated the effects of lockdown on acute upper gastrointestinal (GI) bleeding in Austria. Patients and methods We contacted 98 Austrian hospitals performing emergency endoscopies. The hospitals were asked to report upper GI endoscopies performed because of recent hematemesis, melena, or both and exhibiting endoscopically visible signs of bleeding. Investigated time points included three weeks before and after lockdown. Results 61% of Austrian hospitals and importantly all major state hospitals responded. 575 upper GI bleedings occurred in the three weeks before and 341 after lockdown (40.7% reduction). When comparing the first and last calendar week of investigation we observed an almost 55% decline in nonvariceal bleeding events (calendar week 9 versus 14: 196 versus 89) whereas rates of variceal hemorrhage did not change (calendar week 9 versus 14: 17 versus 15). Conclusions National lockdown resulted in a dramatic decrease in upper gastrointestinal bleeding events.