Pre-Endoscopy real-time PCR testing for SARS-CoV2 does not reduce health care workers infection and is associated with a higher reduction of endoscopic activity in an outpatient setting.

Objective: The role of pre-procedure SARS-CoV2 testing in digestive endoscopy is still debated. AGA guidelines recommend against pre-procedure testing considering low prevalence of SARS- CoV2 infection in the general population and low incidence of infection among endoscopy units Health Care Workers (HCWs). However, no studies have compared pre-procedure testing associated to symptom screening vs. symptom screening alone in reducing the risk of infection for HCWs. Main aim of the present study is to compare the risk of infection for HCWs in different Endoscopy Units adopting different pre-endoscopy screening and operating in two nearby hospital of the same region in Northern Italy in pre-vaccination period. For outpatients in the Endoscopy Unit of Trento (Unit 1) only pre-procedure symptom screening was performed, while in the Endoscopy Unit of Bolzano (Unit 2) pre-procedure symptom screening and negative pre-procedure real-time PCR were requested. Secondary aims were to assess the impact of pre-procedure real-time PCR testing on endoscopic activity and diagnostic delay. Design: Retrospective data collection on a prospectively maintained database was performed, including outpatient endoscopy procedures performed between June 1st 2020 and February 28th 2021 in Unit 1 and Unit 2. Results: No differences in terms of infection rate in HCWs have been identified in Unit 1 and Unit 2 (9.0 vs. 19.3% P=0.2) over a nine-month period. Moreover, in the unit performing pre- procedure real-time PCR before endoscopy a significantly higher reduction in endoscopic activity has been recorded (61.9% vs. 53.4%; P<0.01). In patients with positive real-time PCR, endoscopy was performed with a mean delay of 61.7 days (range 9-294) and 22.5% of them were lost at follow-up and did not undergo any endoscopic procedure in the following 12 months. Conclusions: This study supports the AGA recommendation suggesting that pre-endoscopy real-time PCR is an expensive and time-consuming procedure without proven benefits in an outpatient setting.

Prevalence of gastrointestinal symptoms in coronavirus disease 2019: A meta-analysis

Background and study aims: The coronavirus disease 2019 (COVID-19) is a pandemic infection spreading worldwide at an unprecedented rate. Our aim was to assess the frequency of gastrointestinal (GI) involvement in COVID-19. Patients and methods: We performed a systematic review and meta-analysis of all studies reporting clinical data about COVID-19 patients, published until 25th March 2020. The primary endpoint was the pooled prevalence of COVID-19 patients complaining of GI symptoms. Secondary endpoints were the pooled prevalence of cases with COVID-19 positive stool samples, and of asymptomatic COVID-19 patients. We used random-effects model for meta-analysis. Results: Thirty-three studies were included in the meta-analysis. Out of 4434 COVID-19 patients, the pooled prevalence of GI manifestations was 11.51% (95% CI: 8.16 to 15.35). The most frequent GI symptom was diarrhea (7.78% of cases;95% CI: 5.05 to 11.04), followed by nausea/vomiting (3.57%;95% CI: 1.87 to 5.80), poor appetite (2.39%;95%CI: 0.55;5.46) and abdominal pain (0.78%;95% CI: 0.26 to 1.57). Positivity for COVID-19 in stool samples was observed in 41.50% (95% CI: 17.70 to 67.65) of cases. 11.85% (95% CI: 3.53 to 24.17) of COVID-19 patients remained asymptomatic. Conclusions: The present meta-analysis shows that a significant proportion of COVID-19 patients suffer from GI manifestations, as well as COVID-19 positivity in stool samples. Asymptomatic patients need to be considered a further potential route of viral transmission. (Acta gastroenterol. belg., 2020, 83, 603-615).

Prevalence of liver injury in patients with coronavirus disease 2019 (COVID-19) : a systematic review and meta-analysis.

BACKGROUND AND STUDY AIMS: The coronavirus disease 2019 (COVID-19) represents a public health emergency of international concern, causing thousands of deaths worldwide. We performed a systematic review with meta-analysis in order to investigate the prevalence of COVID-19-induced liver injury. PATIENTS AND METHODS: We searched MEDLINE, Scopus, Web of Science and the Cochrane Library, for studies reporting laboratory data about COVID-19 patients, with last update on 25th March 2020. The primary outcome was the pooled prevalence of COVID- 19-induced liver damage, mainly represented by increase in serum transaminases and bilirubin. The secondary outcome was the description of abnormalities in serum albumin and prothrombin time (PT). We focused on laboratory data only on hospital admission, and adopted random-effects model for meta-analysis. RESULTS: Eleven studies were eligible for meta-analysis. Out of 793 included patients, the pooled prevalence of COVID-19-related liver damage was 22.17% (95% CI 17.64 to 27.07), mostly indicated by hypertransaminasemia. Serum bilirubin was increased in 5.53% (95% CI 3.60 to 7.85) of cases. Abnormal serum albumin was observed in 78.92% (95% CI 39.82 to 99.56), and increased PT value in 19.98% (95% CI 2.49 to 78.23), but these results derived from significantly heterogeneous studies. CONCLUSIONS: COVID-19-induced liver injury must not be ignored, as it is observed in one fifth of infected patients. Prospective studies evaluating liver function during the course of COVID-19 are needed to provide a complete overview of hepatic involvement during this viral infection.