Endoscopy Timing in Patients with Acute Upper Gastrointestinal Bleeding

Abstract

Background/AimsThe role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12–24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding. MethodsThis retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing was defined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding.ResultsA total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very early endoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of the composite outcome. ConclusionsVery early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomes in specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial and should be further clarified.

Validation of a new risk score system for non-variceal upper gastrointestinal bleeding

“…Mallory-Weiss syndrome, Dieulafoy's ulcer, angiodysplasia, and cancer-related bleeding are also causes of NVUGIB [17]. While therapies such as Helicobacter pylori eradication therapy and proton pump inhibitors might be expected to reduce peptic ulcers and decreased the mortality rate of NVU-GIB patients, studies show that the mortality rate is still high at 6 to 14% due to population aging and the use of anti-platelet drugs [18][19][20][21]. In these NVUGIB patients, timely hemostatic endoscopic procedures are important for survival improvement.…”

Outcomes of Upper Gastrointestinal Bleeding Based on Time to Endoscopy: A Retrospective Study

“…Several studies have been conducted to evaluate the timing of endoscopy. In a systematic review done by Kelvin et al and a retrospective study conducted by Alexandrino G et al, early endoscopy within 12 hours did not reduce the re-bleeding rate or improve survival [7][8]. Clinical trials to evaluate the outcomes based on the timing of endoscopy are sparse, as it is considered unethical to delay endoscopy when a patient might require it.…”

Validation of a New Risk Score System for Non-variceal Upper Gastrointestinal Bleeding

“…17 The use of anti-ulcer drugs, such as Helicobacter pylori eradication therapy and protonpump inhibitors, was expected to reduce peptic ulcers and decrease the mortality rate of NVUGIB patients, but the mortality rate was still as high as 6%-14% owing to population aging and use of antiplatelet drugs, anticoagulants, and non-steroidal anti-inflammatory drugs. [18][19][20][21] In these NVUGIB patients, timely hemostatic endoscopic procedures are important for survival improvement. For a successful treatment, assessing the hemodynamic status and appropriate risk measurement are necessary.…”