Endoscopic Findings In Sars-Cov-2 ICU Patients With Gastro Intestinal Bleeding

Aims To identify the endoscopic findings in patients with severe SARS COV2 admitted in ICU and presenting GI bleeding. Methods A retrospective case series, including all patients with SARS COV2 admitted in ICU presenting GI bleedingbetween March 2020 and November 2020. Data regarding clinical presentations were analysed by SPSS. Results 12 patients were included. The median age was 65 years [38-93] with a male predominance of 91,7 % .Comorbidites were: hypertension 41,6 %, obeisity 41,6 %, diabetes type II 33,4 %, cardiomyopathy 25 %, cirrhosis 8,1 %.All patients needed respiratory support,25 % with mechanical ventilation, 8,3 % noninvasive ventilation, 41,7 %nonrebreather mask and 16,7 % nasal oxygen cannula .Empiric Full dose anticoagulation was administred in 91,6 % and58,3 % received prophylactic PPIs therapy. 60 % had Naso gastric tube. Upper GI bleeding was diagnosed in 83,4 % andlower GI bleeding in 16,6 %. Mean delay between GI bleeding and anticoagulant intake was 8 days. Mean Hemoglobin level was 9,2 g/dl. Endoscopy was performed in 66,6 %, 25 % died before endoscopy by respiratory worsening and 8,4 % had noemergency indication for endoscopy . Endoscopic findings were ulcers in 75 %: gastric 33,3 %, duodenal bulb 66,6 %,multiple 66,6 %, unique 33,3 %,classified as Forrest IIa 16,6 %, IIb 33,3 %, III 50 % with the mean size at 22 mm . Otherfindings were: oesophagitis 25 %, erosive gastritis 12,5 %, gastric tumor 12,5 %, esophageal blood clot with no GI bleedingorigin 12,5 %. Hemostasis clip was placed in 33,3 %,blood transfusion in 58,3 % associated to PPIs therapy in all patients.No recurrence of GI bleeding in 33,3 % while 66,6 % died by respiratory complications. Conclusions In our study, main endoscopic findings were ulcers in 75 % .Prophylactic PPIs should be considered in patients with severe SARS COV2 in ICU requiring anticoagulation therapy.