ABSTRACT
We reported the results of our multicenter cohort study in all patients who presented for endoscopy between March 1 and May 17 and were evaluated before their endoscopy for SARS-CoV2 and were followed after their endoscopy for COVID-19 status. This cohort enabled us to calculate the conversion rate from COVID-19 negative to positive during the study period and evaluate the change in conversion rate with the implementation of social distancing and masking at the population level in New York City. Data were retrieved from electronic medical records systems of six tertiary care centers in New York City. We identified all adult patients who had endoscopy between March 1, and May 17, 2020. Conversion was defined as having a negative COVID-19 status before endoscopy and a positive status afterwards. Participants COVID-19 status was defined based on SARS-CoV2 PCR test or a combination of symptoms (Fever plus at least one of: dyspnea, cough, dysgeusia, or anosmia). Patients were evaluated before endoscopy and then by phone or telehealth visit afterwards. Spline regression was used to evaluate the conversion rate before and after adoption of social distancing (March 20, 2020) and mandatory masks (April 15, 2020) in New York City. Of the 1467 patients presenting for endoscopy during the study period, we had follow-up data on 1222 patients (51% outpatient and 49% inpatient endoscopies). Overall, 78 participants (6.38 %) converted after endoscopy (74 with a positive PCR, and 4 with symptoms as defined above), at a median of 23 days after endoscopy (IQR 11 to 42 days). Patients had a mean age of 62±15 years, and were 62% male (n=48). Multivariable analysis demonstrated that date of endoscopy, institution, and presence of cardiovascular disease were the independent predictors of conversion after endoscopy, with cardiovascular disease associated with a more than 2 fold increase in the risk of conversion (OR=2.1, 95%CI 1.2-3.6, p=0.009). The range of conversion from the six institutions varied widely (1 to 11%, p=0.035). Overall, participants whose endoscopies were performed later during the study period had a lower risk of conversion (OR for one week=0.87, 95%CI 0.80-0.94, p=0.001). Before social distancing, conversion rate was 8.4% on average and was increasing by 2.3% per week (p<0.001). After social distancing, the conversion rate was 6.7% on average, and started to decrease by 4.2% per week (p<0.001). After mandatory masks, the conversion rate was 2.2% on average but has started to increase slowly by 0.9% per week (p<0.001;see figure 1). These findings do support decrease in conversion rate amongst New Yorkers who presented for endoscopy with the implementation of social distancing and mandatory masking. We believe the slow but significant increase in conversion rates by the end of May reflects the relative loosening in social distancing in New York City.(Figure Presented)
ABSTRACT
Introduction: Little is known about the extent of GI tract involvement in acute COVID-19 infection. GI bleed (GIB) has been reported in COVID patients;the etiology is difficult to determine given that of confirmed COVID infection where patients, without prior medical history, presumably developed COVID induced HC, and it was their only presenting symptom. Case Description/Methods: Case 1 A 44 year old male presented with hematochezia, abdominal pain, and syncope and a drop in hemoglobin (Hb) from 15.3 to 12.6g/dL. COVID PCR was positive. Fecal calprotectin (FCP) elevated at 169ug/g (n, 49ug/g), with negative stool cultures (SCx). CT showed a long segment of circumferential wall thickening of the mid-distal descending colon with haustral thickening of the transverse colon. Patient declined treatment with remdesivir and dexamethasone Case 2 A 65 year old female presented with hematochezia and confirmed COVID infection. CBC revealed a drop in Hb 13.5 to 11.8g/dL, platelets 237 to 184K/uL. Negative SCx, elevated FCP 88ug/g, procalcitonin 0.31ng/nL, CRP 7.1mg/dL, and D-Dimer 740ng/mL. CT showed severe wall thickening of the transverse, descending and rectosigmoid colon with fat stranding. Given negative SCx, patient was started on methylprednisolone Case 3 A 38 year old male presented with painless hematochezia. Negative SCx, O&P, C. diff. Elevated FCP, ESR and CRP (ESR 80mmh/CRP 12.1mg/dL). COVID PCR positive. CT showed extensive colonic wall thickening in the rectum, sigmoid, descending colon and splenic flexure, increased vascularity around the inflamed colon and fat stranding. Given lack of clinical improvement with antibiotics and conservative management, patient was started on methylprednisolone with improvement Discussion: GI symptoms due to COVID occur from the expression of ACE2 receptors on intestinal epithelial cells that allow for binding and replication. This leads to a direct inflammatory state accounting for enteritis and HC. All patients presented had hematochezia without bleeding history, AC use or a source of bleeding, except for the colitis seen on CT. Confirmed HC in the setting of COVID infection has been documented twice;one case with a similar presentation who had colonoscopy with biopsy proven HC, another case with diffuse HC on endoscopic evaluation. Nonetheless, more research is needed to explore the effects of COVID on the GI tract. (Figure Presented).