Comparison of the Effectiveness of Interventional Endoscopy in Bleeding Peptic Ulcer Disease according to the Timing of Endoscopy

Abstract

Background/AimsThe optimal timing for interventional endoscopy in bleeding peptic ulcer disease is controversial. This study compared the outcomes between early endoscopy and delayed endoscopy in patients with bleeding peptic ulcer disease.MethodsWe conducted a prospective analysis of data from 90 patients with bleeding peptic ulcer disease who visited the emergency room between May 2006 and September 2007. Patients were categorized into two groups: the early-endoscopy group (admitted during the daytime or at night with prompt endoscopic management) and the delayed-endoscopy group (admitted at night or during weekends, with endoscopic management delayed until the next day). We compared the clinical outcomes of endoscopy between the two groups.ResultsThere were 49 patients in the early-endoscopy group and 41 patients in the delayed-endoscopy group. Patient demographics, clinical characteristics, bleeding control modality, and Rockall score did not differ between the two groups. There were also no significant differences between the early- and delayed-endoscopy groups in the re-bleeding rate (3/49 vs 5/41, p=0.313), the duration of hospital stay (10.7 vs 9.3 days, p=0.437), and the total amount of blood transfused (3.4 vs 2.7 units, p=0.240).ConclusionsThe effectiveness of interventional endoscopy for patients with bleeding peptic ulcer disease is not significantly affected by the timing of endoscopy.

Effect of intravenous proton pump inhibitor regimens and timing of endoscopy on clinical outcomes of peptic ulcer bleeding

“…A nationwide analysis conducted in the USA suggests that patients with non‐variceal upper gastrointestinal bleeding admitted on weekends are less likely to undergo early endoscopy within 1 day of hospitalization 30 . Similar findings have been reported from the UK, 31 and Korea 9 and we attest to a similar approach in China. Therefore, we thought it was appropriate and meaningful for us to assess the clinical effectiveness of early versus delayed endoscopy, especially since evidence from China regarding this is scant.…”

“…Endoscopy is firmly established as an effective treatment for bleeding peptic ulcers, and is currently the standard of care 9,28,29 . A systematic review 29 found that early endoscopy is safe and effective for patients in all risk groups.…”

“…Cho et al . report that the effectiveness of interventional endoscopy in bleeding peptic ulcer disease is not significantly affected by the timing of endoscopy 9 . Moreover, there is indirect evidence to suggest that early endoscopy may be associated with more complications than delayed endoscopy 29 .…”

Chronic Kidney Disease, Hemodynamic Instability, and Endoscopic High-Risk Appearance Are Associated with 30-Day Rebleeding in Patients with Non-Variceal Upper Gastrointestinal Bleeding

“…Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common gastrointestinal cause of hospital admission and generates significant morbidity and mortality despite advancements in endoscopic and acid-suppressive therapy (1). Recent studies have identified rebleeding as a significant predictor of mortality (2-6).…”

Emergency pancreatic surgery—demanding and dangerous

“…This underlines that only few patients require this type of operation, which can be attributed to the fact that endoscopic and interventional management is often successful in these situations-especially with regard to bleeding management of duodenal lesions [18,19]. Paradoxically, complications of diagnostic or therapeutic endoscopy themselves are a relevant cause of emergency pancreatectomies, as one out of four patients in the study collective had to undergo surgery following iatrogenic duodenal or bile duct perforation which could not be handled conservatively.…”