Comparison of urgent and early endoscopy for acute non-variceal upper gastrointestinal bleeding in high-risk patients Comparación entre endoscopia urgente y temprana para hemorragia digestiva alta no varicosa en pacientes de alto riesgo


Güven İ. E. , Başpınar B., Durak M. B. , Yüksel İ.

Gastroenterologia y Hepatologia, 2022 (Journal Indexed in SCI Expanded) identifier identifier

  • Publication Type: Article / Article
  • Publication Date: 2022
  • Doi Number: 10.1016/j.gastrohep.2022.05.002
  • Title of Journal : Gastroenterologia y Hepatologia
  • Keywords: Gastrointestinal endoscopy, Gastrointestinal hemorrhage, Outcome

Abstract

© 2022 Elsevier España, S.L.U.Objective: Data regarding early (within 24 h) and urgent endoscopy (within 12 h) in non-variceal upper gastrointestinal bleeding (NV-UGIB) revealed conflicting results. This study aimed to investigate the impact of endoscopy timing on the outcomes of high-risk patients with NV-UGIB. Patients and methods: From February 2020 to February 2021, consecutive high-risk (Glasgow–Blatchford score ≥12) adults admitted to the emergency department with NV-UGIB were analyzed retrospectively. The primary composite outcome was 30-day mortality from any cause, inpatient rebleeding, need for endoscopic re-intervention, need for surgery or angiographic embolization. Results: 240 patients were enrolled: 152 (63%) patients underwent urgent endoscopy (<12 h) and 88 (37%) patients underwent early endoscopy (12–24 h). One or more components of the composite outcome were observed in 53 (22.1%) patients: 30 (12.5%) had 30-day mortality, rebleeding occurred in 27 (11.3%), 7 (2.9%) underwent endoscopic re-intervention, and 5 (2.1%) required surgery or angiographic embolization. The composite outcome was similar between the groups. Multivariate analysis showed only hemodynamic instability on admission (OR: 3.05, p = 0.006), and the previous history of cancer (OR: 2.42, p = 0.029) were significant in predicting composite outcome. In terms of secondary outcomes, the endoscopic intervention was higher in the urgent endoscopy group (p = 0.006), whereas the number of transfused erythrocyte suspensions and the length of hospital stay was higher in the early endoscopy group (p = 0.002 and p = 0.040, respectively). Conclusions: Urgent endoscopy leads to a significant reduction in the length of hospitalization and the number of transfused erythrocyte suspensions in NV-UGIB, which can contribute to patient satisfaction, reduce healthcare expenditure, and improve hospital bed availability. The composite outcome and its sub-outcomes were the same among both groups.