ABSTRACT
Objective: In the period of the coronavirus disease-19 (COVID-19) pandemic, upper gastrointestinal endoscopy was either postponed or canceled, except for emergencies, due to the high risk of transmission. Our study aimed to evaluate the effect of the COVID-19 pandemic on patients with upper gastrointestinal bleeding presenting to the emergency department and to compare it with the data before the pandemic. Material(s) and Method(s): In this single-center, retrospective study, patients were divided into 2 groups: pre-COVID-19 (pre-C) (March 2019-March 2020) and post-COVID-19 (post-C) (March 2020-March 2021). Patients who presented to the emergency department with upper gastrointestinal bleeding during these periods and underwent endoscopic examination were included in the study. Result(s): Endoscopy for upper gastrointestinal bleeding was urgently performed in 125 patients in the pre-C period and in 89 (29% decrease) patients in the post-C period. The Glasgow-Blatchford Score was higher in the pre-C period (p=0.02). Peptic ulcers were the most common cause of bleeding in both groups. High-risk peptic ulcer (forrest 1a/1b/2a/2b), and malignancy were observed more frequently in the post-C period (p=0.003, p=0.04;respectively). Endoscopic combined treatment rate was higher in the post-C group (p<0.001). Re-bleeding ratios were similar for both the groups (p=0.48). Conclusion(s): During the post-C period, the number of upper gastrointestinal bleeding cases admitted to the emergency department decreased significantly. However, the rate of high-risk peptic ulcer and malignancy in the etiology of upper gastrointestinal bleeding increased in the post-C period. Copyright © 2022 by Turkiye Klinikleri.
ABSTRACT
Introduction Acute upper gastrointestinal bleeding (AUGIB) has an incidence between 84-172 per 100,000 people per year resulting in 50-70000 hospital admissions every year. Out -of-hours (OOH) endoscopy rotas for AUGIB are typically delivered by Consultant Gastroenterologists. Prior to the COVID-19 pandemic, the AUGIB OOH service was Specialty Registrar (SpR) led at Leeds Teaching Hospitals, and was felt to provide invaluable exposure and experience for SpRs in the endoscopic management of patients presenting with AUGIB. Following the start of the COVID pandemic, and subsequent redeployment of SpRs, the AUGIB OOH service has been a Consultant delivered one. The aim of this retrospective study was to compare the safety and efficacy of a SpR led OOH AUGIB service (2016 database) with a Consultant delivered service (2020-21 database) at the same trust. Methods We included adult patients (>16 years), presenting to LTHT between March and September 2016 with suspected AUGIB having an endoscopy procedure performed on a SpR led OOH rota and compared this with patients presenting with suspected AUGIB between September 2020 and March 2021 during which period the service was entirely consultant delivered. Baseline clinical, laboratory, admission Glasgow- Blatchford Score, demographic data, grade of endoscopist, place of endoscopy, findings of endoscopy and treatments applied were recorded. Primary outcome was 30-day mortality secondary to GI bleeding. Secondary outcomes included time to endoscopy and rebleed rate Results 177 patients from the 2016 database (62% male, median age 67, range 18-97) and 100 patients from the 2020-21 database (60% male, median age 63, range 18-96) were included in the study. 97.2% patients (2016) vs 93% (2020-21) had a GBS score ≥7. 30-day GI bleed related mortality was 2.89% (2016) vs 3% (2020-21) (p value 0.93). The median time to endoscopy was 16.3 hours (2016) vs 17.2 hours (2020-21). 8.9% (2016) vs 7% (2020-21) experienced a rebleed. Conclusions This study has shown that a Registrar led OOH AUGIB service has comparable outcomes to a Consultant delivered rota in important outcomes such as time to endoscopy and 30-day mortality. Where service configuration allows, a registrar led rota can aid in improving the standard of SpR training whilst also freeing up Consultants to undertake increased elective work and reduce the backlog created by the COVID-19 pandemic.
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)