Background and Aims. The coronavirus disease 2019 (COVID-19) has severely impacted the daily practice of gastrointestinal endoscopy worldwide. Most endoscopy centers in China were shut down in late January 2020. We investigated the impact of the shutdown on acute upper gastrointestinal bleeding (AUGIB) events in Xingtai City, Hebei Province, China. Methods. A web-based survey collected information on gastroscopy workload and AUGIB events. The study period was from 4 weeks before to 4 weeks after lockdown initiation in Xingtai City. Fourteen public gastrointestinal endoscopy centers performing emergency endoscopies were contacted via e-mail to collect weekly emergency gastroscopy volumes and the number of AUGIB events. AUGIB was defined as recent melena, hematemesis, or both, with an endoscopically visible source of bleeding. Results. Twelve (85.7%) of the 14 surveyed gastrointestinal endoscopy centers in the city- and county-level hospitals responded. Altogether, 4,045 and 1,077 gastroscopy procedures were performed 4 weeks before and after lockdown initiation (73.4% reduction), respectively. Peptic ulcer-related AUGIB and variceal AUGIB events showed a 58.5% and 52.9% decline, respectively, compared with pre-COVID-19 data. Although the absolute number of AUGIB events decreased during the pandemic (from 149 to 66), the likelihood of detecting AUGIB during gastroscopy increased (3.68% (pre-COVID-19 period) versus 6.13% (COVID-19 period); P < 0.05 ). Conclusion. The COVID-19 pandemic resulted in a considerable reduction in gastroscopy workload and AUGIB events; however, the likelihood of detecting AUGIB increased significantly during gastroscopies.

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Background. The Baveno VI criteria based on platelet count and liver stiffness, measured by transient elastography (TE), have been proposed to rule out high-risk varices (HRV) defined as medium or large-sized varices or the presence of high-risk stigmata (cherry red spots and red wale marks). However, TE is not available in all hospitals. Recently, the Rete Sicilia Selezione Terapia hepatitis C virus (RESIST-HCV) criteria recommended that cirrhotic patients with a platelet count>120000/μL and serum albumin>36 g/L could avoid esophagogastroduodenoscopy (EGD) screening for HRV. Aim. We aimed to validate the performance of the RESIST-HCV criteria in two cohorts predominantly characterized with hepatitis B infection. Methods. Patients with compensated cirrhosis who had blood tests within three months of performing EGD and TE were enrolled retrospectively from two centers. RESIST-HCV criteria were applied to identify patients who did not require EGD screening. Results. This study included 188 patients from the Xingtai cohort (28 (14.9%) with HRV) and 104 patients from the Beijing cohort (19 (18.3%) with HRV). Of the patients who met the RESIST-HCV criteria (83 in the Xingtai cohort and 26 in the Beijing cohort), 0 and 1 had HRV, respectively, accounting for 44.1% (Xingtai cohort) and 25% (Beijing cohort) of endoscopies that were unnecessary. In the combined cohort, 109 (37.3%) patients met the RESIST-HCV criteria, only 1 (0.9%) HRV was missed, and the negative predictive value was 99.1%. Baveno VI and Expanded Baveno VI criteria spared 15.6% and 23.3% of EGDs, respectively, while missing 0% and 4.8% of HRV, respectively. Conclusions. In our population, the combined criteria based on platelet count and serum albumin performed well, saving 30-40% of EGDs and correctly identifying 99.1% of patients who could safely avoid screening endoscopies for high-risk varices in compensated cirrhotic patients.

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We read with interest the article entitled "Management of upper GI bleeding in patients with COVID-19" by Cavaliere et al, 1 published recently in Gastrointestinal Endoscopy. The authors reported a case series of 6 patients who presented with coronavirus disease 2019 (COVID-19) and upper GI bleeding (UGIB). Cavaliere et al 1 concluded that COVID-19 patients with UGIB could be treated conservatively without endoscopy because they responded to conservative treatment in 24 hours. This study is very interesting and important; however, we would like to put forth some suggestions.First, endoscopy, which could identify the cause of UGIB, 2 was not performed in this study, and the exact cause of hematemesis or melena is still unclear. Indeed, not all patients with hematemesis or melena had "true" UGIB episodes. Some coffee-ground hematemesis episodes are due to pulmonary embolism, myocardial infarction, and renal failure. 3 Also, the intake of substances, including iron supplements, bismuth subsalicylate, and foods such as blood soup, can lead to black stools similar to melena. 4 It is unknown whether the patients had consumed the above-mentioned medications or foods before admission. In addition, the nature of hematemesis (bloody, fresh coffee-ground, or old) is not reported.Second, the presence of coexisting diseases such as liver cirrhosis, renal disease, Helicobacter pylori infection, and history of variceal bleeding, peptic ulcers, GI tumor, severe vomiting, and use of nonsteroidal anti-inflammatory drugs or antiplatelet medications was unclear. Many studies 5,6 have demonstrated that patients with severe COVID-19 have subclinical or obvious coagulation abnormalities with increased risk of thromboembolic disease. However, prothrombin time, activated partial thromboplastin time, and international normalized ratio were not reported in Table 1 of the article. It should be noted that detailed medical history taking and elaborate laboratory tests are very important to diagnose the cause of UGIB when endoscopy is not performed.Third, we suggest that the authors use the Horibe GI bleeding prediction score (HARBINGER), 7 which is simple and accurate for triage in patients with suspected upper GI bleeding. In a study of 1486 patients with suspected UGIB, the HARBINGER score was more accurate (area under the curve [AUC] 0.76) than both the Glasgow-Blatchford Score (GBS) (AUC 0.68) and AIMS65 (AUC 0.54). Moreover, the HARBINGER is the first DISCLOSURE All authors disclosed no financial relationships.