Endoscopic Features of Post-COVID-19 Cholangiopathy and Its Management Using ERCP.

INTRODUCTION: Despite growing awareness of post-coronavirus disease 2019 (COVID-19) cholangiopathy as one of the most serious long-term gastrointestinal consequences of COVID-19, the endoscopic features of this disease are still poorly characterized. This study aimed to more precisely define its endoscopic features and to outline the role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of this entity. METHODS: In this observational study, 46 patients with confirmed post-COVID-19 cholangiopathy were included. RESULTS: Based on the endoscopic features observed in 141 ERCP procedures, post-COVID-19 cholangiopathy can be classified as a variant of secondary sclerosing cholangitis in critically ill patients. It appeared early in the course of intensive care treatment of patients with COVID-19 (cholestasis onset 4.5 days after intubation, median). This form of cholangiopathy was more destructive than stricturing in nature and caused irreversible damage to the bile ducts. A centripetal pattern of intrahepatic bile duct destruction, the phenomenon of vanishing bile ducts, the absence of extrahepatic involvement, and the presence of intraductal biliary casts (85% of patients) were typical cholangiographic features of post-COVID-19 cholangiopathy. This cholangiopathy was often complicated by small peribiliary liver abscesses with isolation of Enterococcus faecium and Candida spp. in bile culture. The prognosis was dismal, with a 1-year liver transplantation-free survival rate of 44%. In particular, patients with peribiliary liver abscesses or destruction of the central bile ducts tended to have a poor prognosis (n.s.). As shown by multivariate analysis, bilirubin levels (on intensive care unit day 25-36) negatively correlated with liver transplantation-free survival (hazard ratio 1.08, P < 0.001). Interventional endoscopy with cast removal had a positive effect on cholestasis parameters (gamma-glutamyl transpeptidase, alkaline phosphatase, and bilirubin); approximately 60% of all individual values decreased. DISCUSSION: Gastrointestinal endoscopy makes an important contribution to the management of post-COVID-19 cholangiopathy. ERCP is not only of great diagnostic and prognostic value but also has therapeutic value and therefore remains indispensable.

The Evidence-Based Sexual Abuse Prevention Program: Strong With Sam.

The present study was initiated to design and evaluate a sexual abuse prevention program for deaf and hard of hearing (DHH) children. This evidence-based prevention program is the first of its kind for DHH children. A total of 92 DHH children aged 8-12 years participated in the program "STARK mit SAM" (Strong with Sam, SmS), a program conducted in primary schools for DHH children in Germany. The program evaluation consisted of a pretest-posttest design. As per class, the subjects were assigned to either the experimental or the wait list control group. Participants from both groups were pretested for their knowledge about content related to the prevention of sexual abuse. The experimental group received the prevention program and both groups were posttested to examine the effects of the program. Additionally, the experimental group was tested again 6 months after the program. DHH children who participated in the SmS program showed a significant knowledge gain and a nonsignificant change in their anxiety. No significant factor affecting the children's significant knowledge gain was found. SmS is an effective sexual abuse prevention program for DHH children, which can be offered without incurring anxiety in the children.