Introduction. Metabolic-associated fatty liver disease (MAFLD) is a hepatic manifestation of metabolic syndrome (MS). MAFLD patients have a higher prevalence of COVID-19. MAFLD is also associated with worse clinical outcomes of COVID-19, such as disease severity, ICU admission rate, and higher mortality rates. However, this evidence has not been well characterized in the literature. This meta-analysis aims to determine the clinical outcomes of COVID-19 among MAFLD patients compared to the non-MAFLD group.  Methods. A comprehensive search was conducted in CINAHL, PubMed/Medline, and Embase for studies reporting MAFLD prevalence among COVID-19 patients and comparing clinical outcomes such as severity, ICU admission, and mortality among patients with and without MAFLD. We calculated the pooled prevalence of MAFLD among COVID-19 patients. Also, the pooled odds ratios (ORs) with 95% confidence interval (CI) were calculated for clinical outcomes of COVID-19. Results. Twenty observational studies met inclusion criteria involving 13,036 overall study participants, including 2,374 MAFLD patients. The prevalence of COVID-19 among MAFLD patients was 0.28 (95% CI: 0.19-0.39). MAFLD was associated with the COVID-19 disease severity OR: 2.61 (95% CI: 1.77-3.83). Similarly, MAFLD was associated with an increased risk of ICU admission compared to the non-MAFLD group OR: 1.46 (95% CI: 1.12-1.91). Lastly, the association between MAFLD and COVID-19 mortality was not statistically significant OR: 1.25 (95% CI: 0.66-2.37). Conclusions. There was a higher prevalence of MAFLD among COVID-19 patients than the non-MAFLD group. Moreover, MAFLD patients had an increased risk of COVID-19 disease severity and ICU admission rate.

Background Barrett’s esophagus (BE) is a premalignant condition diagnosed using systematic 4-quadrant forceps biopsies (FB) during endoscopy. This method is fraught with errors due to the randomness of sampling and variability among operators. Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS 3D ) is an emerging technique used to collect esophageal samples. The aim of this study was to evaluate WATS 3D as a diagnostic tool for detecting BE in addition to FB, compared to FB alone. Methods A retrospective observational cohort study was conducted and included patients who underwent screening for BE with WATS 3D and FB between January 2015 and January 2019 across 3 endoscopy centers in Wichita, Kansas. The FB specimens were reviewed by community pathologists, while the WATS 3D samples were sent to CDX technology labs, NY. Results A total of 108 patients were screened for BE using both modalities concurrently. FB and WATS 3D detected 62 (57.4%) and 83 (76%) cases of BE, respectively. The absolute difference of 21 cases (18.6%) of BE was attributed to the addition of WATS 3D . The number needed to test with WATS 3D was 5. We divided the sample into 4 groups to compare the agreement across all groups: (FB–; WATS 3D +), (FB–; WATS 3D –), (FB+; WATS 3D +), and (FB+ and WATS 3D –). Overall agreement by kappa statistic was 0.74. Conclusion WATS 3D identified 21 cases of BE missed by FB. Using WATS 3D in addition to FB increased the yield of BE during surveillance endoscopy, with no increase in complications.

INTRODUCTION: Barrett’s esophagus (BE) is a pre-malignant condition of the esophagus currently diagnosed using systematic 4-quadrant cold forceps biopsies during endoscopy. Demonstration of intestinal metaplasia on histopathology and the degree of dysplasia is the cornerstone of BE diagnosis and management. This current method of biopsy is fraught with errors due to the randomness of sampling and experience of the operator. Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS3D) is an emerging technique to collect esophageal samples and improve detection of BE. We compared WATS3D with traditional biopsy as a screening tool in BE. METHODS: We reviewed the charts of adult patients that underwent BE screening by 3 of our gastroenterologists involved in the study with WATS3D and traditional cold forceps biopsy (FB) over the last year across community hospitals in Wichita, KS. The biopsy specimens were processed and analyzed by in-house pathologists while the WATS3D specimen were sent to CDX technology labs, NY. WATS3D specimens were obtained after FB in all instances. RESULTS: A total of 108 patients were identified to have undergone both WATS3D and FB at the same time for BE screening. FB detected 62 cases (57.4%) while WATS3D detected 83 (76%) cases of BE. This attributed to an absolute increase in 21 cases (18.6%) of incident BE detection by WATS3D. The number needed to test (to detect an additional patient with BE) with WATS3D was 5. We divided the sample into 4 groups – WATS3D+FB+, WATS3D+FB-, WATS3D-FB+, WATS3D-FB- to compare the agreement across the 4 groups (Table 1). Overall agreement by kappa statistic was 0.74 (good). There were 62 and 23 cases that were identified as positive and negative respectively by both methods. The pathologist read both cases of FB+ that was WATS3D- as intestinal metaplasia with no dysplasia. Of the 21 cases that were FB-, WATS3D identified 15 cases of goblet cell metaplasia, 4 cases of crypt dysplasia, 1 case of low-grade dysplasia and 1 case of adenocarcinoma. There were no immediate complications reported among the patients studied. CONCLUSION: WATS3D identified 20 cases of BE missed by FB, including 1 case of low-grade dysplasia and 1 case of adenocarcinoma. It is possible that the cases missed by WATS3D were due to the presence of an island of BE that was removed during FB. Overall, with no added increase in complications, WATS3D improved incident detection of BE compared to FB alone.

No abstract