Analysis of Gastrointestinal and Hepatic Manifestations of SARS-CoV-2 Infection in 892 Patients in Queens, NY.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus responsible for coronavirus disease 2019 (COVID-19).1,2 The virus enters cells via the angiotensin-converting enzyme 2 receptor, which is present in enterocytes in the ileum and colon.3 Gastrointestinal (GI) manifestations include diarrhea, nausea, vomiting, and abdominal pain, and the prevalence of GI symptoms varies greatly, with a range between 2% and 57%.4 In addition, abnormal liver chemistries are reported commonly.4 As a medical center at the forefront of the early epidemic in the United States, we seek to contribute to the growing body of literature that outlines the gastrointestinal and hepatic manifestations of COVID-19.

Is there an effect of race/ethnicity on early complications of iliac vein stenting?

Background There have been well-documented implications of race/ethnicity on the outcome of various vascular diseases. Little literature has examined the effect of race/ethnicity on venous disease. Iliac vein stenting is an emerging technology in treating chronic venous insufficiency. To further characterize this disease and its treatment, we chose to study the effect of selected clinical factors including race/ethnicity on the early complications of non-thrombotic iliac vein stenting. Methods In this observational study, data analysis was performed for 623 patients with chronic venous insufficiency who underwent iliac vein stenting during the time period from August 2012 to September 2014. Patients were categorized by Caucasians ( n = 396), African Americans ( n = 89), Hispanics ( n = 138), and others ( n = 23). These were correlated with the age, gender, presenting sign according to CEAP classification, percentage of iliac vein stenosis, post-operative thrombosis and pain score. Pain score was obtained post-operatively on a Likert scale of 0-10. Follow-up was performed after completion of the procedure, through post-operative visits and duplex exams every three months for the first year. Statistical analysis was performed using Chi-square and Student's t-test, Pearson's test and multivariate regression. Results The average age of the study patients was 67.8 years (age range 23-96 years, ± 14.2 SD). Sixty-seven patients were women. The presenting sign according to CEAP classification was (C3 = 331, C4 = 175, C5 = 51, C6 = 66). The average pain score was 2.6 (±2.9 SD). The average degree of stenosis was 64.9% (±3.8 SD). There were insufficient numbers in the "other" race/ethnicity group for further analysis. The number of patients with iliac vein stent thrombosis was 14 (2.2%). When analyzing each race/ethnicity in our dataset with univariate analysis, we found that Caucasians were significantly older than the African Americans and Hispanics ( P < 0.0001). There tended to be more women in the Caucasian group as compared to the Hispanics ( P = 0.04). There were no differences in presenting sign according to CEAP classification or degree of stenosis between the three groups. Hispanics tended to have higher pain scores post-operatively than Caucasians ( P = 0.01). It was found that 1.8% of Caucasians, 3.4% of African Americans and 2.9% of Hispanics had post-operative iliac vein stent thrombosis ( P = 0.55). Men have higher CEAP score than women regardless of race/ethnicity ( P = 0.0001). On the other hand, women tended to have higher pain score than men ( P = 0.04). There were no differences between men and women regarding age, degree of stenosis, and stent thrombosis. Linear multivariate regression test and Pearson's test revealed that age is inversely related to pain score ( P < 0.0001). ANOVA multivariate regression statistical analysis showed no relation between race/ethnicity and pain score ( P = 0.98), and one-way ANOVA showed that the Caucasians were the eldest ethnic group in the study ( P < 0.0001). Linear multivariate regression test and Pearson's correlation test revealed that race/ethnicity is not correlated with thrombosis of iliac vein after stenting ( P = 0.8). Conclusion Race/ethnicity is not significantly associated with CEAP score, degree of iliac vein stenosis, or post-operative thrombosis or pain scores. Age was inversely associated with pain score after iliac vein stenting.

Novel Approach to Endoscopic Foreign Body Retrieval From the Gastric Body.

Foreign body (FB) ingestion is a common occurrence in the United States with a reported incidence of 120 per 1 million people, accounting for up to 1500 fatalities annually. The majority of FB ingestions will pass through the gastrointestinal tract spontaneously, while in 10% to 20% of patients, intervention will be necessary. A variety of endoscopic devices can be utilized to facilitate FB removal from the gastrointestinal tract, including snares, retrieval nets, and grasping forceps. We report the case of a 58-year-old female who required utilization of endoscopic scissors for FB removal in the setting of multiple failed attempts with traditional methods. This case highlights a novel approach to gastric FB removal utilizing endoscopic scissor forceps, which should be considered in select cases to further improve the efficacy of endoscopic FB removal and reduce the need for surgical intervention.

Bacterial Endocarditis Following Deep Enteroscopy: Is Prophylaxis Warranted?

The development of bacterial endocarditis as a result of endoscopic interventions within the gastrointestinal tract is exceedingly rare. Antibiotic prophylaxis for endoscopic procedures is generally not warranted, except for certain high-risk patients. Double-balloon enteroscopy (DBE) is a common endoscopic procedure for evaluation of the small bowel. Bacterial endocarditis secondary to DBE has not been previously described. We describe the first case of enterococcal endocarditis attributed to DBE in a patient with a history of stage 1 primary biliary cholangitis.

Common Antacid Medication-Ranitidine Causing a Rare Serious Adverse Effect.

Ranitidine is a widely used over-the-counter antacid medication, and is generally very well tolerated. To our knowledge, anaphylaxis secondary to ranitidine is exceedingly rare, and has only been reported in a few case reports. We present a patient who developed an anaphylactic reaction after one tablespoon of ranitidine. The goal of this manuscript is to add to the paucity of literature of this rare but life-threatening adverse effect of a commonly used medication.

Primary Endoscopic Closure of Duodenal Perforation Secondary to Biliary Stent Migration: A Case Report and Review of the Literature.

Duodenal perforation due to biliary stent migration is rare, and it often requires surgical repair; however, endoscopic closure has recently become a viable option in the appropriate patients. We present the case of a 79-year-old female who underwent biliary stent placement for a common bile duct stricture, who subsequently was found to have a duodenal wall perforation secondary to stent migration. The stent was extracted endoscopically with successful defect closure using a ConMed® repositional DuraClip™. We aim to contribute to the limited body of literature that describes endoscopic repair of duodenal perforation secondary to biliary stent migration using through-the-scope endoclips.

Serum-Derived Bovine Immunoglobulin as Novel Adjunct in Complicated Clostridium difficile Colitis Treatment.

Clostridium difficile infection (CDI) is a well-known complication of antibiotic therapy. It is associated with significant morbidity, mortality, and cost in the hospital setting. The main symptoms include watery diarrhea, abdominal pain, and distension, but CDI can also present as toxic megacolon, bowel perforation with peritonitis, sepsis and renal failure. Therapy includes metronidazole and oral vancomycin, with rectal vancomycin and fecal transplant reserved for more complicated cases. Adjunctive treatments such as probiotics have been tried with mixed results. We present a patient with complicated CDI treated with adjuvant serum-derived bovine immunoglobulin, a novel approach in this context.

A Case of Sub-Diaphragmatic Abscess after Injection of Botulinum Toxin to Treat Achalasia.

Achalasia is a disorder of the esophagus characterized by decreased lower esophageal sphincter (LES) relaxation and absence of esophageal peristalsis. Botulinum toxin (BT) injection targeting the LES has been used in the treatment of achalasia and other esophageal motility disorders, and it is considered to be safe and effective for short-term symptomatic relief. Serious adverse events of this procedure are rare. We report the case of an 83-year-old woman treated with BT injection for achalasia who subsequently developed a subdiaphragmatic abscess.

Rare Case of Duodenal Metastasis From Pulmonary Squamous Cell Carcinoma.

Pulmonary squamous cell carcinoma is the second most common non-small cell malignancy of the lung. It commonly metastasizes to the adrenal glands, bone, liver, brain, and kidneys. Most occurrences of metastatic squamous cell carcinoma involving the gastrointestinal tract originate from primary lung tumors. Metastasis to the duodenum, however, is exceedingly rare, with very few cases of stomach or duodenal involvement described in the literature. We report the case of a patient with stage IV pulmonary squamous cell carcinoma metastasizing to the duodenum with an uncommon presentation to add to the paucity of literature available regarding this rare finding.