COVID-19’lu üst gastrointestinal sistem kanamalı hastalarda endoskopik bulgular farklı değildir

Giriş ve Amaç: Kovid-19 hastalığı, küresel halk sağlığı endişesi yaratan yeni ortaya çıkan bir hastalıktır. Üst gastrointestinal sistem kanaması olan Kovid-19 hastalarının demografik verilerini, klinik özelliklerini, risk faktörlerini ve endoskopi bulgularını değerlendirmeyi amaçladık. Gereç ve Yöntem: 2 Temmuz 2020 - 29 Ocak 2021 tarihleri arasında üst gastrointestinal sistem kanaması nedeniyle endoskopi yapılan ve polimerize zincir reaksiyon ile doğrulanmış ağır akut solunum sendrom-koronavirüs-2 tanısı konan hastalar çalışmaya alındı. Gastrointestinal sistem kanaması olan Kovid-19’lu hastalar retrospektif olarak karşılaştırıldı. Üst gastrointestinal sistem kanaması nedeniyle endoskopi yapılan Kovid-19 hastaları ile kontrol grubu retrospektif olarak demografik veriler, komorbid hastalıklar, kanama semptomu, uygulanan ilaçlar, laboratuvar parametreleri, kanama semptomu ile endoskopi arasındaki süre, endoskopi bulguları, gastrointestinal kanama tedavisi ve ölüm oranları açısından karşılaştırıldı. Bulgular: Üst gastrointestinal sistem kanaması nedeniyle endoskopisi yapılan 40 Kovid-19 hastası (23 erkek, ortalama yaş ± SD, 65.92 ± 12.97) ve 80 Kovid-19 hastalığı olmayan kontrol (43 erkek, ortalama yaş ± SD, 66.17 ± 15.61) hastası karşılaştırıldı. Her iki grupta da en sık görülen kanama semptomu melena idi (%50’ye karşı %60). Yoğun bakım ünitesinde yatış (%47.5'e karşı %20, p = 0.004) ve mekanik ventilasyon ihtiyacı (%22.5'e karşı %5, p = 0.006), kortikosteroid kullanımı (%30'a karşı %2.5, p = 0.000) Kovid-19 hastalığı grubunda daha yaygındı. Eritrosit replasmanı ihtiyacı gruplar arasında farklı değildi [medyan (min - maks) 1.5 (0-13) vs 0.5 (0-22), p = 0.397]. Düşük moleküler ağırlıklı heparin kullanımı Kovid-19 hastalığı grubunda istatistiksel olarak daha yaygındı (%32.5'e karşı %5, p = 0.00). Endoskopi performansına kadar geçen süre, saat olarak Kovid-19 hastalık grubunda anlamlı olarak daha uzundu (62.97 ± 84.59 vs. 21.85 ± 33.91, p = 0.006). Her iki grupta da en sık görülen endoskopik bulgu gastroduodenal ülserdi. Tekrar kanama oranları açısından anlamlı bir fark görülmedi. Ölüm oranı Kovid-19 hastalığı grubunda istatistiksel olarak daha yüksekti (%37.5'e karşı %8.8, p = 0.000). Sonuç: Kovid-19 hastalarında gastrointestinal sistem kanamalarının yönetimine ilişkin daha kesin kılavuzlar geliştirilinceye kadar, hastanın durumu, medikal tedaviye yanıt, tedavi kaynakları ve risklerin değerlendirilmesi açısından multidisipliner değerlendirmeler yapıldıktan sonra, endoskopi yapılıp yapılmayacağına ve işlemin zamanlamasına vaka bazında karar verilmelidir.

Anahtar Kelimeler:

Kovid-19, gastrointestinal kanama, antikogülan

Endoscopic findings are not different in patients with upper gastrointestinal bleeding with COVID-19

Background and Aims: Coronavirus disease-2019 is an emerging disease of global public health concern. We aimed to evaluate the demographic data, clinical properties, risk factors and endoscopy findings of coronavirus disease-2019 patients with upper gastrointestinal system bleeding. Materials and Method: Patients who underwent endoscopy for upper gastrointestinal bleeding between July 2, 2020 and January 29, 2021 and were diagnosed with severe acute respiratory syndrome coronavirus-2 confirmed by polymerase chain reaction were included in the study. In this retrospective study patients with gastrointestinal bleeding were compared as 1:2 case-control. Coronavirus disease-2019 patients who underwent endoscopy for upper gastrointestinal bleeding and the control group were compared retrospectively in terms of demographic data, comorbid diseases, bleeding symptom, drugs administered, laboratory parameters, time between bleeding symptom and endoscopy, endoscopy findings, gastrointestinal bleeding treatment, and mortality rates. Results: Forty Covid-19 patients (23 males, mean age ± SD, 65.92 ± 12.97) and 80 non-Covid-19 control patients (43 males, mean age ± SD, 66.17 ± 15.61) who underwent endoscopy for upper gastrointestinal bleeding were compared. The most common bleeding symptom was melena in both groups (50% vs 60%). Hospitalization in intensive care unit (47.5% vs 20%, P = 0.004) and need for mechanic ventilation (22.5% vs 5%, p = 0.006), use of corticosteroids were more common in coronavirus disease-2019 group (30% vs. 2.5%, p = 0.000). The need for erythrocyt replacement were not different between the groups [median (min - max) 1.5 (0 - 13) vs 0.5 (0 - 22), p = 0.397]. Use of low molecular weight heparin was statistically more common in coronavirus disease-2019 group (32.5% vs 5%, p=0.00). Time elapsed until the performance of endoscopy in terms of hours was significantly longer in coronavirus disease-2019 group (62.97 ± 84.59 vs. 21.85 ± 33.91, p = 0.006). The most common endoscopic finding was gastroduodenal ulcer in both groups. No significant differences were seen in terms of rebleeeding rates. Mortality rate was statistically higher in coronavirus disease-2019 group (37.5% vs 8.8%, p = 0.000). Conclusions: Until more precise guidelines for the management of gastrointestinal bleeding in COVID-19 patients are developed, a case-by-case decision should be made on whether to perform endoscopy and the timing of the procedure, after multidisciplinary assessments are made in terms of patient status, response to medical therapy, treatment resources, and assessment of risks.

Keywords:

Covid-19, gastrointestinal bleeding, anticogulant,

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