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  • Reduced survival after upper gastrointestinal bleed endoscopy in the COVID-19 era is a secondary effect of the response to the global pandemic: a retrospective cohort study

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Endoscopy
Original research
Reduced survival after upper gastrointestinal bleed endoscopy in the COVID-19 era is a secondary effect of the response to the global pandemic: a retrospective cohort study
  1. Oliver D Tavabie1,
  2. Jennie N Clough2,
  3. Jonathan Blackwell3,
  4. Maria Bashyam4,
  5. Harry Martin5,
  6. Anet Soubieres6,
  7. Natalie Direkze6,
  8. David Graham7,
  9. Christopher Groves3,
  10. Sean L Preston8,
  11. Sabina DeMartino2,
  12. Upkar S Gill8,9,
  13. Bu'Hussain Hayee10,
  14. Deepak Joshi1
  1. 1 Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK
  2. 2 Department of Gastroenterology, Guy’s and Saint Thomas’ NHS Foundation Trust, London, UK
  3. 3 Department of Gastroenterology, St George’s Hospitals NHS Foundation Trust, London, UK
  4. 4 The Liver Unit, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, London, UK
  5. 5 Pancreaticobiliary Medicine Unit, UCLH, London, London, UK
  6. 6 Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, London, UK
  7. 7 Department of Gastroenterology, UCLH, London, London, UK
  8. 8 Department of Gastroenterology, Royal London Hospital, London, London, UK
  9. 9 Barts Liver Centre, Immunobiology, Barts and the London School of Medicine and Dentistry, QMUL, London, London, UK
  10. 10 Department of Gastroenterology, King’s College Hospital, London, UK
  1. Correspondence to Dr Oliver D Tavabie, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK; oliver.tavabie{at}nhs.net

Abstract

Objective The COVID-19 pandemic has placed increased strain on healthcare systems worldwide with enormous reorganisation undertaken to support ‘COVID-centric’ services. Non-COVID-19 admissions reduced secondary to public health measures to halt viral transmission. We aimed to understand the impact of the response to COVID-19 on the outcomes of upper gastrointestinal (UGI) bleeds.

Design/methods A retrospective observational multicentre study comparing outcomes following endoscopy for UGI bleeds from 24 March 2020 to 20 April 2020 to the corresponding dates in 2019. The primary outcome was in-hospital survival at 30 days with secondary outcomes of major rebleeding within 30 days postprocedure and intervention at the time of endoscopy.

Results 224 endoscopies for 203 patients with UGI bleeds were included within this study. 19 patients were diagnosed with COVID-19. There was a 44.4% reduction in the number of procedures performed between 2019 and 2020. Endoscopies performed for UGI bleeds in the COVID-19 era were associated with an adjusted reduced 30-day survival (OR 0.25, 95% CI 0.08–0.67). There was no increased risk of major rebleeding or interventions during this era. Patients with COVID-19 did not have reduced survival or increased complication rates.

Conclusion Endoscopy for UGI bleeds in the COVID-19 era is associated with reduced survival. No clear cause has been identified but we suspect that this is a secondary effect of the response to the COVID-19 pandemic. Urgent work is required to encourage the public to seek medical help if required and to optimise patient pathways to ensure that the best possible care is provided.

  • gastrointestinal bleeding
  • endoscopy
  • therapeutic endoscopy
  • oesophageal varices

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. De-identified participant data is stored on an encrypted password-protected computer in the Institute of Liver Studies, King’s College Hospital. Data is available on request from Dr OD Tavabie at oliver.tavabie@nhs.net.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/flgastro-2020-101592

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. De-identified participant data is stored on an encrypted password-protected computer in the Institute of Liver Studies, King’s College Hospital. Data is available on request from Dr OD Tavabie at oliver.tavabie@nhs.net.

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    Footnotes

    • B'HH and DJ are joint senior authors.

    • Twitter @jennie_clough, @IBDdoc

    • Contributors BH and DG: study supervision and guarantors of the manuscript.ODT, JNC, USG, BH and DJ: study concept & design. ODT, JNC, JB, MB, HM and USG: acquisition of data. ODT: analysis & Interpretation of data; mathematical & statistical analysis. AS, ND, DG, CG, SLP, SD, USG, BH and DJ: administrative/technical/material support. ODT, JNC, JB and USG: drafting of manuscript. ODT, JNC, JB, MB, HM, AS, ND, DG, CG, SLP, SD, USG, BH and DJ: critical revision of manuscript. All authors approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.