UEGJournal Abstracts 2021 - 893

COVID-19
wave in 2020, due to redeployment of staff, challenges with personal protective
equipment (PPE), room air-change cycle and patients' unwillingness
to attend during lockdown restrictions. ERCP is a higher-risk procedure
often performed in patients with an urgent indication such as cancer
obstruction or gallstone-related biliary sepsis or pancreatitis. We aimed
to define the impact of COVID-19 on our ERCP service delivery, clinical outcomes,
patient safety and endoscopists' KPIs.
Aims & Methods: We examined Nottingham ERCP outcomes during the
COVID-19 pandemic in 2020 compared to those before in 2019 at a highvolume
HPB endoscopy centre serving a local population of 750,000 and
tertiary HPB MDT population of 2.3 million. Technical success, comfort
rates and complications according to RCP JAG and ESGE quality standards,
including 8- and 30-day readmission rates and deaths were recorded. We
also assessed the incidence of Covid-19 infection among the population
who underwent ERCP.
Results: Pre-pandemic, during 2019, 686 ERCP procedures were performed.
Of these, 433 (63.1%) were cases of first ever ERCP. In 2020, 614
ERCPs were performed including 390 (63.5%) cases of first ever ERCP.
During the COVID-19 pandemic in 2020, compared to 2019, there was no
significant reduction in any of: total number of ERCP procedures (619 vs.
686); virgin ERCP successful cannulation of the intended duct (91.3% vs.
89.6%; p=0.8); complete CBD stone clearance (80% vs. 81%; p=0.9); successful
stent placement across extrahepatic stricture (91.9% vs. 97.3%;
p=0.6); obtaining stricture cytology (85.6% vs. 84.4%; p=0.9). The sensitivity
of biliary cytology for cancer (C5 or C4 with compatible imaging/tumour
markers or clinical follow up) was 68% vs. 70%; p=0.6.
Patient comfort score was recorded as moderate/severe in 6% of cases
in 2019 vs. 7.1% in 2020 (p=0.4). Following ERCP, the number of patients
re-admitted within 8- and 30-days was 22 (3.2%) and 37 (5.4%) in 2019,
versus 30 (4.9%) and 42 (6.8%) in 2020; p= 0.15 and p= 0.3, respectively.
All-cause and procedure-related mortality within 30 days from ERCP was
1.6% and 0.14% in 2019 vs. 1.79% and 0.65% in 2020; p=0.8 and p=0.15,
respectively.
In total, 25/9500 (0.26%) of all patients undergoing any endoscopy tested
positive for COVID-19 within 14 days of endoscopy. However, none tested
positive following ERCP.
Conclusion: Our provision of clinically urgent ERCP during 2020 and the
COVID-19 pandemic did not significantly fall due to combination of senior
prioritisation of all referrals, accessing unused operating theatres and
reducing training lists. Patients underwent ERCP in a safe environment,
keeping comfort levels within accepted limits and post-operative Covid-19
infection levels to zero. The endoscopists' KPIs of successful outcome and
adverse events were similar despite the challenges of PPE and staff anxieties
or exhaustion.
References:
1. Rutter MD, Brookes M, Lee TJ, Rogers P, Sharp L. Impact of the COVID-19
pandemic on UK endoscopic activity and cancer detection: a National
Endoscopy Database Analysis. Gut. 2021 Mar;70(3):537-543. doi:
10.1136/gutjnl-2020-322179. Epub 2020 Jul 20. PMID: 32690602; PMCID:
PMC7385747.
Disclosure: Nothing to disclose.
P1096
PREVALENCE AND SEVERITY OF DIARRHEA AND
CLOSTRIDIOIDES DIFFICILE INFECTION IN PATIENTS TREATED
FOR COVID-19 INFECTION
A. Okhlobystin1, A. Ufimtseva1
V. Ivashkin1
1
, O. Okhlobystina2
, L. Androsova2
Sechenov University, Chair of Internal Diseases Propedeutics,
Gastroenterology and Hepatology, Moscow, Russia, 2
University, Department of Internal Disease Propedeutics,
Gastoenterology and Hepatology, Moscow, Russia
Contact E-Mail Address: okhlobystin@mail.ru
Introduction: COVID-19, which is caused by infection with SARS-CoV-2
predominantly includes pulmonary symptoms; however, almost 10% of
cases develop diarrhea. A US clinical surveillance study demonstrated
high prevalence of Clostridioides difficile infection (CDI) in COVID-19 patients
with the rate of 3.6/10,000 patient-days [1].
Antibiotics frequently used for COVID-19 infected patients (i.e. macrolides,
cephalosporins and fluoroquinolones) are commonly associated to CDI.
Aims & Methods: To evaluate the prevalence diarrhea and CDI in patients
treated for COVID-19 infection.
Overall 556 patients hospitalized to COVID hospital of Sechenov university
were evaluated (mean age - 55.9, 20 to 96 years; m 46.8%, f 53.2%). CDI
was diagnosed by enzyme immunoassay using monoclonal antibodies
against Clostridioides difficile toxins A and B.
Results: Overall (both during out- and in-hospital stage) 158 patients
(28.4%) developed diarrhea 52 - before admission (9.4%), 107 - during
hospitalization (19.2%). Overall 311 patients (55.9%) received antibiotics
before admission to the hospital.
525 patients (94.3%) received antibiotics during hospital stay. During hospitalization
macrolides were prescribed to 79,6% of patients, fluoroquinolones
- 36,3%, penicillins - 15,8%, carbapenems - 6,8%, 1st
cephalosporins - 0,4%, 3rd generation cephalosporins - 61%, 4th
generation
generation
cephalosporins - 0,5%.
No relation of out-patient antibiotic treatment to diarrhea developed during
hospital stay was found.
Following effects were found for in-hospital antibiotics: azithromycin
demonstrated negative correlation to the risk of diarrhea development:
OR=0.482 (95%CI=0.31-0.75, χ2
azithromycin: OR=0.340 (95%CI=0.12- 0.97, χ2
lins: OR=0.921 (95%CI=0.51-1.66, χ2=0.07, p=NS). 3rd
sporins: OR=0.59 (95%CI=0.38-0.90, χ2
OR=1.23 (95%CI=0.80-1.89, χ2
=0.85, p=NS).
Carbapenems: OR=2.06 (95%CI=1.00-4.22, χ2
=3.99, p=0.046).
Of patients, who developed in-hospital diarrhea 61,3% were positive for
CD toxin A, 54,8% - for toxin B, 45,2% - for both toxins A and B.
No association of the in-hospital antibiotic group to the presence of CD
toxins in patients with diarrhea was found.
Conclusion: Research is needed to understand if, when, and how antibiotics
should be used to treat COVID-19 patients while minimizing adverse
effects such as CDI.
CDI in COVID-19 patients should be investigated to identify risk factors
such as use of specific antibiotics, previous CDI, and/or presentation of
COVID-19 gastrointestinal symptoms.
Pathogenesis of CD-associated colitis in COVID-19 patients may be related
not only to the broad-spectrum antibiotic treatment, but to overall severity
of the patient, length of hospital stay, presence of multi-organ failure
and secondary vascular disorders.
References:
1. Clostridioides difficile in COVID-19 Patients, Detroit, Michigan, USA,
March-April 2020 A. Sandhu, G. Tillotson, J. Polistico, H. Salimnia, M.
Vol. 9 | October 2021
893
Sechenov
,
=10,85, p=0.001). Other macrolides, but
=4,470, p=0.034. Penicilgeneration
cephalo=6.14,
p=0.013). Fluoroquinolones:
UEGJournal Abstracts 2021

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