.: ORİJİNAL ARAŞTIRMA
Has the Number of Upper Gastrointestinal Bleeding Cases Presenting to the Emergency Department Decreased During the COVID-19 Pandemic?: A Single-Center Experience
COVID-19 Pandemisinde Acil Servise Başvuran Üst Gastrointestinal Kanamalı Hastaların Sayısı Azaldı mı?: Tek Merkez Deneyimi
Turkiye Klinikleri J Med Sci. 2022;42(3):171-7
doi: 10.5336/medsci.2021-87373
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: In the period of the coronavirus disease-19 (COVID-19) pandemic, upper gastrointestinal endoscopy was either postponed or canceled, except for emergencies, due to the high risk of transmission. Our study aimed to evaluate the effect of the COVID-19 pandemic on patients with upper gastrointestinal bleeding presenting to the emergency department and to compare it with the data before the pandemic. Material and Methods: In this single-center, retrospective study, patients were divided into 2 groups: pre-COVID-19 (pre-C) (March 2019-March 2020) and post-COVID-19 (post-C) (March 2020- March 2021). Patients who presented to the emergency department with upper gastrointestinal bleeding during these periods and underwent endoscopic examination were included in the study. Results: Endoscopy for upper gastrointestinal bleeding was urgently performed in 125 patients in the pre-C period and in 89 (29% decrease) patients in the post- C period. The Glasgow-Blatchford Score was higher in the pre-C period (p=0.02). Peptic ulcers were the most common cause of bleeding in both groups. High-risk peptic ulcer (forrest 1a/1b/2a/2b), and malignancy were observed more frequently in the post-C period (p=0.003, p=0.04; respectively). Endoscopic combined treatment rate was higher in the post-C group (p<0.001). Re-bleeding ratios were similar for both the groups (p=0.48). Conclusion: During the post-C period, the number of upper gastrointestinal bleeding cases admitted to the emergency department decreased significantly. However, the rate of high-risk peptic ulcer and malignancy in the etiology of upper gastrointestinal bleeding increased in the post-C period.
Keywords: COVID-19; upper gastrointestinal bleeding; emergency department
Objective: In the period of the coronavirus disease-19 (COVID-19) pandemic, upper gastrointestinal endoscopy was either postponed or canceled, except for emergencies, due to the high risk of transmission. Our study aimed to evaluate the effect of the COVID-19 pandemic on patients with upper gastrointestinal bleeding presenting to the emergency department and to compare it with the data before the pandemic. Material and Methods: In this single-center, retrospective study, patients were divided into 2 groups: pre-COVID-19 (pre-C) (March 2019-March 2020) and post-COVID-19 (post-C) (March 2020- March 2021). Patients who presented to the emergency department with upper gastrointestinal bleeding during these periods and underwent endoscopic examination were included in the study. Results: Endoscopy for upper gastrointestinal bleeding was urgently performed in 125 patients in the pre-C period and in 89 (29% decrease) patients in the post- C period. The Glasgow-Blatchford Score was higher in the pre-C period (p=0.02). Peptic ulcers were the most common cause of bleeding in both groups. High-risk peptic ulcer (forrest 1a/1b/2a/2b), and malignancy were observed more frequently in the post-C period (p=0.003, p=0.04; respectively). Endoscopic combined treatment rate was higher in the post-C group (p<0.001). Re-bleeding ratios were similar for both the groups (p=0.48). Conclusion: During the post-C period, the number of upper gastrointestinal bleeding cases admitted to the emergency department decreased significantly. However, the rate of high-risk peptic ulcer and malignancy in the etiology of upper gastrointestinal bleeding increased in the post-C period.
Keywords: COVID-19; upper gastrointestinal bleeding; emergency department
ÖZET
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-19 (COVID-19)] pandemisinde üst gastrointestinal sistem endoskopisi, bulaş açısından yüksek riskli olması nedeniyle acil vakalar dışında ertelenmiş veya iptal edilmiştir. Çalışmamızın amacı, COVID-19 pandemisinin acil servise başvuran üst gastrointestinal kanamalı hastalar üzerindeki etkisini, COVID-19 öncesi dönem ile karşılaştırarak değerlendirmektir. Gereç ve Yöntemler: Tek merkezli, retrospektif çalışmada hastalar COVID-19 öncesi (pre-C) (Mart 2019-Mart 2020) ve COVID-19 sonrası (post-C) (Mart 2020-Mart 2021) olmak üzere 2 dönem olarak gruplandı. Bu dönemlerde, acil servise üst gastrointestinal kanaması nedeniyle başvuran ve endoskopik inceleme yapılan hastalar çalışmaya dâhil edildi. Bulgular: Pre-C dönemde 125 hastada, post-C dönemde ise 89 (%29 azalma) hastaya üst gastrointestinal kanaması nedeniyle acil endoskopi uygulandı. Glasgow-Blatchford Skoru, pre-C döneminde daha yüksekti (p=0,02). Her iki grupta da en sık kanama nedeni peptik ülserdi. Kanama etiyolojisinde yüksek riskli peptik ülser (forest 1a/1b/2a/2b) oranı ve malignite oranı post-C dönemde daha fazlaydı (sırayla p=0,003, p=0,04). Endoskopik kombine tedavi oranı post-C grupta daha fazla fazlaydı (p<0,001). Tekrar kanama oranları her iki grup için benzerdi (p=0,48). Sonuç: Post-C döneminde acil servise başvuran üst gastrointestinal kanamalı hasta sayısı belirgin azalmıştır. Post-C dönemde üst gastrointestinal kanama etiyolojisinde yüksek riskli peptik ülser ve malignite oranı artmıştır.
Anahtar Kelimeler: COVID-19; üst gastrointestinal kanama; acil servis
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-19 (COVID-19)] pandemisinde üst gastrointestinal sistem endoskopisi, bulaş açısından yüksek riskli olması nedeniyle acil vakalar dışında ertelenmiş veya iptal edilmiştir. Çalışmamızın amacı, COVID-19 pandemisinin acil servise başvuran üst gastrointestinal kanamalı hastalar üzerindeki etkisini, COVID-19 öncesi dönem ile karşılaştırarak değerlendirmektir. Gereç ve Yöntemler: Tek merkezli, retrospektif çalışmada hastalar COVID-19 öncesi (pre-C) (Mart 2019-Mart 2020) ve COVID-19 sonrası (post-C) (Mart 2020-Mart 2021) olmak üzere 2 dönem olarak gruplandı. Bu dönemlerde, acil servise üst gastrointestinal kanaması nedeniyle başvuran ve endoskopik inceleme yapılan hastalar çalışmaya dâhil edildi. Bulgular: Pre-C dönemde 125 hastada, post-C dönemde ise 89 (%29 azalma) hastaya üst gastrointestinal kanaması nedeniyle acil endoskopi uygulandı. Glasgow-Blatchford Skoru, pre-C döneminde daha yüksekti (p=0,02). Her iki grupta da en sık kanama nedeni peptik ülserdi. Kanama etiyolojisinde yüksek riskli peptik ülser (forest 1a/1b/2a/2b) oranı ve malignite oranı post-C dönemde daha fazlaydı (sırayla p=0,003, p=0,04). Endoskopik kombine tedavi oranı post-C grupta daha fazla fazlaydı (p<0,001). Tekrar kanama oranları her iki grup için benzerdi (p=0,48). Sonuç: Post-C döneminde acil servise başvuran üst gastrointestinal kanamalı hasta sayısı belirgin azalmıştır. Post-C dönemde üst gastrointestinal kanama etiyolojisinde yüksek riskli peptik ülser ve malignite oranı artmıştır.
Anahtar Kelimeler: COVID-19; üst gastrointestinal kanama; acil servis
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