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Gastrointestinal Endoscopy ; 95(6):AB189, 2022.
Article in English | EMBASE | ID: covidwho-1885785


DDW 2022 Author Disclosures: Dennis Jensen: NO financial relationship with a commercial interest ;Rome Jutabha: NO financial relationship with a commercial interest ;Gareth Dulai: NO financial relationship with a commercial interest ;Noam Jacob: NO financial relationship with a commercial interest ;Jeffrey Gornbein: NO financial relationship with a commercial interest Background and Aims: The best strategy to prevent DPPIUH is controversial. Some colonoscopists recommend hemoclip closure of PPIU’s but this has mixed success rates in different RCT’s and is reported not to be cost effective. In addition to known risks, arterial blood flow detected in PPIU’s is an important predictor of DPPIUH. Our AIMS are to report study methods and interim results of a RCT of blood flow monitoring to prevent DPPIUH. Methods: This is an ongoing blinded RCT at several major Los Angeles Medical Centers by experienced colonoscopists. Outpatients having colonoscopies are screened and consented for enrollment. Sessile and multilobulated polyps are removed by EMR techniques. Thermal coagulation is used for polypectomies in this study. Randomized patients are stratified by whether they take chronic anti-platelet or anti-thrombotic drugs and have PPIU’s of 10-40 mm;or those without bleed drugs and have PPIU’s between 15-40 mm. By opening a sealed envelope after polypectomies, randomization is to either standard management (e.g. following ASGE guidelines of bleed drugs) or DEP interrogation of the PPIU and guided treatment of the artery with hemoclips or multipolar probe coagulation in the PPIU until blood flow is eradicated. Patients and their care givers were blinded to treatments allocated during colonoscopy. Prospective follow-up is by a research coordinator contacting each patient at 7, 14, and 30 days to record whether any complications (e.g. pain, vomiting, or bleeding);or rectal bleeding and its severity (e.g. # and days of bloody BM’s);whether they sought ER, clinic, or telemedicine care for bleeding;or were hospitalized. Major DPPIUH was diagnosed in patients with hospitalization for severe bleeding and/or for 3 or more days of ongoing severe rectal bleeding but refusal of hospitalization because of high rates of COVID here. Demographic, laboratory, colonoscopic, and pathology results are recorded on standard forms along with 30-day outcomes. Patients are assigned a code, data are entered onto HIPAA compliant computer files by a data manager and managed with SAS. With half the projected sample size randomized and followed up (e.g. 133 of 268 total), this is a planned interim analysis of the primary outcome - rates of DPPIUH by treatment. Severe adverse events (SAE’s) were also reviewed. Results: For 133 high risk patients randomized to date, 67 are in the standard group and 66 in the DEP group. The groups were well matched in risk factors – see Table 1. Overall, the Doppler group had lower rates of delayed PPIU bleeding – both major and total- see Table 2. There were no SAE’s. Conclusions: The major DPPIUH rate was higher with standard treatment than DEP treatment (7.46 % vs. 0 %), as was the rate of Total DPPIUH (10.45 % vs. 1.52%). Based upon these promising results, this RCT will continue. [Formula presented] [Formula presented]

Hepatology ; 72(1 SUPPL):266A, 2020.
Article in English | EMBASE | ID: covidwho-986083


Background: Abnormal liver enzymes are frequently seen in the course of the COVID-19 in patients with no prior liver disease and has been frequent reason to consult Hepatology services during COVID-19 pandemic So far there is a relatively very poor characterization of this special population and we do not know whether mortality, severity of disease and health care burden is the same as described in the general population with COVID-19 Methods: We performed a retrospective, single-center study of 35 COVID-19 patients with no prior liver disease who developed significant liver enzymes elevation from April 1 to May 31, 2020 Inclusion criteria was nucleic acidconfirmed COVID-19 infection, no known history of prior liver disease, AST and/or ALT values at least 5 times the upper limit of normal and request for Hepatology Consult We recorded demographics (age, sex, BMI, race, ethnicity) comorbidities, laboratory values (CRP (C Reactive Protein), Procalcitonin, Fibrinogen, chemistry data), and clinical characteristics (hospital length of stay, Intensive Care Unit (ICU) admission, and mortality) for these patients The primary outcome was mortality Secondary outcomes were severity of disease defined as need for ICU admission and health care burden defined as an extended hospital stay beyond the average length of stay for the general COVID 19 population (14 days) Comparisons between the groups who reached primary and secondary end points were performed using unpaired t tests with Welch's correction and chi squared analysis (p-values <0 05) via the Prism statistical analysis software Results: Striking, from all the multiple variables analyzed, only the CRP was confirmed to be statistically significantly higher in deceased patients, ICU-admitted patients, and patients with extended hospital stay The mean CRP for deceased patients was 352 1+/-79 55 mg/L (p 0026) while the mean CRP for patients who lived was 277 7+/-133 8 mg/L (p 0026) Patients with ICU admissions had CRP mean of 309 9+/-105 5 mg/L (p 0016) versus 126 2 +/-111 4 mg/L (p 0016) without ICU admission Extended hospital stay patients had a CRP mean of 318 9+/-97 55 mg/L (p-value: 012) versus 201 2+/- 142 3 mg/L (p-value 012) for non-extended hospital stay patients As expected, patients requiring ICU admission or prolonged hospital stay had higher use of vasopressors, higher Alkaline Phosphatase peak and longer time interval to reach the ALT and Alkaline Phosphatase peak No other demographics, clinical or laboratory data were identified more frequent in patients who reached the end points in this specific COVID-19 group Conclusion: Patients with COVID-19 and moderate hepatocellular liver enzymes elevation and not known prior chronic liver disease is a specific subset of patients with risk factors for mortality, severity and length of stay different than the general population. These findings support the need for additional studies and prognostic modeling.