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1.
Rev Esp Enferm Dig ; 114(8): 455-460, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1485586

ABSTRACT

BACKGROUND: the COVID-19 pandemic has impacted on several aspects of health care services worldwide. The aim of the study was to determine its influence on the case volume, success rate and complication rate of endoscopic retrograde cholangiopancreatography (ERCP). METHOD: all patients who underwent ERCP one-year before and after applying COVID-19 safety measures at the Qena University Hospital were included. Data were collected from the patients' records, analyzed and compared. RESULTS: a total of 250 patients underwent ERCP between April 1st, 2019 and March 31st, 2021, and the mean age of participants was 52 ± 18 years. There was a 5 % increase in case volume after applying COVID-19 safety measures (128 vs 122) and the total procedure time was significantly shorter (42 vs 46 minutes, p = 0.04). There was no significant difference in the overall success rate and complication rate. Procedure success significantly correlated with cannulation attempts and total procedure time in both groups, and serum bilirubin and cannulation time in the pre-COVID-19 patients and alkaline phosphatase (ALP) in post-COVID patients. ERCP-related complications significantly correlated with cannulation attempts in both groups, and ALP, international normalized ratio (INR), cannulation time and total procedure time in pre-COVID-19 patients, and platelet count and amylase in post-COVID patients. Two patients were confirmed COVID-19 cases at the time of ERCP; therapeutic targets were achieved in both with a smooth post-ERCP recovery. Three out of nine ERCP team members caught a mild to moderate COVID-19 infection and recovered after receiving proper management. CONCLUSION: our result show that there was no negative impact of using COVID-19 safety measures and precautions on the case-volume, indications, overall outcome or complication rate of ERCP.


Subject(s)
COVID-19 , Cholangiopancreatography, Endoscopic Retrograde , Adult , Aged , Alkaline Phosphatase , Catheterization/methods , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/methods , Humans , Middle Aged , Pandemics
5.
Am J Gastroenterol ; 116(5): 1077-1082, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1034416

ABSTRACT

INTRODUCTION: Liver chemistry abnormalities are a frequent manifestation of coronavirus disease 2019 (COVID-19) but are usually transient and resolve with disease resolution. METHODS: We describe the clinical course and histologic features of 3 adults who developed prolonged and severe cholestasis during recovery from critical cardiopulmonary COVID-19. RESULTS: These patients had clinical and histologic features similar to secondary sclerosing cholangitis of the critically ill patient, but with unique histologic features including severe cholangiocyte injury and intrahepatic microangiopathy suggestive of direct hepatic injury from COVID-19. DISCUSSION: We believe that these cases constitute a novel severe post-COVID-19 cholangiopathy with potential for long-term hepatic morbidity.


Subject(s)
COVID-19/complications , Cholangitis , Liver Function Tests/methods , Liver , Adult , Biopsy/methods , COVID-19/blood , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholangiopancreatography, Magnetic Resonance/methods , Cholangitis/diagnosis , Cholangitis/virology , Critical Care/methods , Critical Illness , Diagnosis, Differential , Endothelial Cells/pathology , Female , Humans , Liver/blood supply , Liver/diagnostic imaging , Liver/pathology , Male , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Severity of Illness Index
6.
BMJ Case Rep ; 13(11)2020 Nov 09.
Article in English | MEDLINE | ID: covidwho-917774

ABSTRACT

A previously well 59-year-old man required a prolonged intensive care unit stay due to severe COVID-19 symptoms. During the admission, he developed a cytokine storm, also known as secondary haemophagocytic lymphohistocytosis, and multiorgan failure. Despite recovering from his other organ failures, his liver function continued to deteriorate. Magnetic resonance cholangiopancreatography and subsequent endoscopic retrograde cholangiopancreatography revealed extensive intrahepatic duct dilatation with 'beading' but common bile duct sparing. Given the patient had no primary liver disease prior to admission, we considered secondary causes of cholestatic liver injury; this led us to an unusual diagnosis of secondary sclerosing cholangitis in critically ill patients. This case demonstrates a rare disease that has developed specifically in the context of SARS-CoV-2 infection. A review of current literature and the underlying pathophysiology for this rare disease are discussed, particularly in relation to COVID-19.


Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/methods , Cholangiopancreatography, Magnetic Resonance/methods , Cholangitis, Sclerosing/complications , Cholangitis, Sclerosing/diagnosis , Coronavirus Infections/complications , Pneumonia, Viral/complications , Betacoronavirus , Biliary Tract/diagnostic imaging , COVID-19 , Critical Illness , Diagnosis, Differential , Humans , Male , Middle Aged , Pandemics , Rare Diseases , SARS-CoV-2
7.
BMJ Case Rep ; 13(7)2020 Jul 16.
Article in English | MEDLINE | ID: covidwho-649278

ABSTRACT

WHO declared worldwide outbreak of COVID-19 a pandemic on 11 March 2020. Healthcare authorities have temporarily stopped all elective surgical and endoscopy procedures. Nevertheless, there is a subset of patients who require emergency treatment such as aerosol-generating procedures. Herein, we would like to discuss the management of a patient diagnosed with impending biliary sepsis during COVID-19 outbreak. The highlight of the discussion is mainly concerning the advantages of concurrent use of aerosol protective barrier in addition to personal protective equipment practice, necessary precautions to be taken during endoscopy retrograde cholangiopancreatography and handling of the patient preprocedure and postprocedure.


Subject(s)
Betacoronavirus , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholangitis/diagnosis , Coronavirus Infections/prevention & control , Emergency Service, Hospital , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/prevention & control , Adult , Aerosols , COVID-19 , Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Female , Humans , SARS-CoV-2
8.
Scand J Gastroenterol ; 55(8): 976-978, 2020 08.
Article in English | MEDLINE | ID: covidwho-639122

ABSTRACT

BACKGROUND: Radical changes to clinical and endoscopy practice have been rapidly introduced following the spread of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Urgent endoscopies are, however, intended to proceed as normal with additional personal protective procedures. A perceived reduction in hospital attendances may suggest a number of urgently indicated endoscopic retrograde cholangio-pancreatographies (ERCPs) are being missed. Objectives and Methods: A review of all ERCPs carried out in a large tertiary referral endoscopy unit under healthcare restrictions was compared to the same time period in previous years. The intention was to determine if ERCPs are proceeding as normal or if there is a difference in referral characteristics. RESULTS: Under service restrictions (13 March to the end of April 2020), 55 ERCPs were performed compared with 87 ERCPs in 2019. Similar numbers to 2019 were also recorded in the preceding years. One case of coronavirus disease 2019 (COVID-19) was reported in a patient in the days following ERCP, with no cases notified among staff related to endoscopy. CONCLUSIONS: A reduction in ERCP referrals raises concern that a cohort of patients with significant biliary disease remain undetected. Whether this results in later, and more severe, presentation remains to be seen but a potential surge in such cases could significantly burden all future endoscopy planning services.


Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/statistics & numerical data , Coronavirus Infections/epidemiology , Cross Infection/prevention & control , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Referral and Consultation/statistics & numerical data , Age Factors , Aged , Aged, 80 and over , COVID-19 , Cholangiopancreatography, Endoscopic Retrograde/methods , Cohort Studies , Coronavirus Infections/prevention & control , Cross Infection/epidemiology , Databases, Factual , Female , Humans , Incidence , Infection Control/organization & administration , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Reference Values , Retrospective Studies , Risk Assessment , Sex Factors
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