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The COVID-19 pandemic has presented new challenges in the management of acute non–COVID-19-related illnesses such as gastrointestinal (GI) bleeding. Practice guidelines recommend minimizing performance of high-risk, aerosol-generating procedures such as upper endoscopy. In areas with high rates of COVID-19 infection, it is unknown if the presentation of GI bleeding has changed and how clinical management has adapted.
In a retrospective study conducted at two hospitals in New York City, researchers compared the presentation and management of GI bleeding in 123 patients admitted just before the COVID-19 outbreak (from February 1 until March 16, 2020, the date when COVID-19-related hospital policies were implemented), and 88 patients admitted during the outbreak (from March 16 to April 24).
In univariate analyses, patients admitted during the outbreak had significantly lower hemoglobin and platelet counts and higher international normalized ratios (INRs). In multivariate analyses, these patients were significantly more likely to have a longer hospital stay (≥5 days vs. <5; adjusted odds ratio, 2.6) and to receive at least one blood transfusion (aOR, 2.9). During the outbreak, endoscopy was 70% less likely to be performed (aOR, 0.3).
Kim J et al. Effect of the COVID-19 pandemic on outcomes for patients admitted with gastrointestinal bleeding in New York City. Gastroenterology 2020 May 13; [e-pub]. (https://doi.org/10.1053/j.gastro.2020.05.031)
Comment
Patients are likely trying to avoid going to the hospital to prevent SARS-CoV-2 exposure and are thus presenting at later stages. The increased need for blood transfusion and the longer hospital stays likely reflect the increase in disease severity. Physicians are clearly trying to avoid unnecessary aerosolizing procedures and thus have reduced endoscopy performance. Although not reported, I suspect that use of capsule endoscopy studies may have increased to provide some endoscopic information in a noninvasive way. Clinicians should be aware that patients are presenting with increased GI bleeding severity during the pandemic and adapt management approaches as necessary to provide appropriate patient care and keep hospital staff safe.