Researchers showed that management of patients with coronavirus disease 2019 (COVID-19) pneumonia and upper gastrointestinal (GI) bleeding was possible without endoscopy, according to findings published in Gastrointestinal Endoscopy.
Gastrointestinal symptoms such as abdominal pain, vomiting, diarrhea, and nausea are being increasingly being recognized among clinical presentations of COVID-19. Researchers at the Zucker School of Medicine at Hofstra/Northwell, New York treated a total of 6 patients (50% male) with COVID-19–associated pneumonia (defined as shortness of breath requiring oxygen, fever, positive COVID-19 polymerase chain reaction [PCR] test, and infiltrates on chest radiograph), and upper GI bleeding. A total of 5 of the patients were treated with supplemental oxygen while 1 was treated with an endotracheal tube.
Current guidance recommends that patients presenting with acute upper GI bleeding undergo endoscopy within 24 hours of presentation. However, endoscopy in patients with COVID-19 pneumonia brings about various management challenges. These include: extubating after the procedure in a pneumonia setting; increased mortality rate for patients with COVID-19-associuated pneumonia once intubated; respiratory failure; and transmission of the virus to hospital staff.
Given that the risks of endoscopy may outweigh the benefits, the researchers implemented a more conservative approach to treatment. Patients were managed with a proton pump inhibitor drip, blood transfusion as required, and regular monitoring of vital signs, GI symptoms, and hemoglobin value. Endoscopy was reserved in the event of a lack of response in 24 hours. All 6 patients responded to conservative management demonstrated by cessation of clinical symptoms of acute upper GI bleeding in combination with stabilization of hemoglobin. None required upper endoscopy during their clinical course.
The authors conclude that the symptoms of patients with COVID-19 pneumonia who develop upper GI bleeding can be managed successfully without endoscopy.
Cavaliere K, Levine C, Wander P, Sejpal DV, Trindade AJ. Management of upper GI bleeding in patients with COVID-19 pneumonia (published online April 13, 2020). Gastrointest Endosc. doi.org/10.1016/j.gie.2020.04.028