Optimal timing of endoscopy in patients with acute upper gastrointestinal bleeding

Chaudhary, Sardar; Stanley, Adrian J.

doi:10.1016/j.bpg.2019.05.005

Cited by 7 publications

(5 citation statements)

References 49 publications

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“…3 The most important intervention with respect to decreasing patient mortality is performance of upper endoscopy, which will localize and treat the underlying source of hemorrhage. 4 Recurrent bleeding is a common problem among patients with bleeding ulcers and requires vigilance at bedside for signs and symptoms of ongoing gastrointestinal bleeding (GIB). Repeat endoscopy and angioembolization in the interventional radiology suite are management options for the bleeding ulcer that remains treatment resistant to an initial trial of endoscopic management.…”

Section: Gastroenterological Surgical Emergencies Peptic Ulcer Diseas...mentioning

confidence: 99%

“…Management is focused on hemodynamic stabilization, correction of the underlying coagulopathy, and airway protection with endotracheal intubation in patients at risk for aspiration as a result of hematemesis 3. The most important intervention with respect to decreasing patient mortality is performance of upper endoscopy, which will localize and treat the underlying source of hemorrhage 4. Recurrent bleeding is a common problem among patients with bleeding ulcers and requires vigilance at bedside for signs and symptoms of ongoing gastrointestinal bleeding (GIB).…”

Section: Gastroenterological Surgical Emergenciesmentioning

confidence: 99%

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Surgical Emergencies in the ICU

Saini

Ashraf

Babowice

et al. 2023

Critical Care Nursing Quarterly

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Surgical emergencies are common in the critical care setting and require prompt diagnosis and management. Here, we discuss some of the surgical emergencies involving the gastrointestinal, hepatobiliary, and genitourinary sites. In addition, foreign body aspiration and necrotizing soft-tissue infections have been elaborated. Clinicians should be aware of the risk factors, keys examination findings, diagnostic modalities, and medical as well as surgical treatment options for these potentially fatal illnesses.

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Section: Gastroenterological Surgical Emergencies Peptic Ulcer Diseas...mentioning

confidence: 99%

Section: Gastroenterological Surgical Emergenciesmentioning

confidence: 99%

Surgical Emergencies in the ICU

Saini

Ashraf

Babowice

et al. 2023

Critical Care Nursing Quarterly

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“…However, there is no consensus on this issue yet. [9,10] The GBS is the recommended score to be used in the guidelines for identifying risky patients and deciding on the endoscopy time. [2] GBS has the highest accuracy in predicting the need for immediate intervention and mortality.…”

Section: Introductionmentioning

confidence: 99%

Akut Üst Gastrointestinal Kanama İle Başvuran Hastaların Endoskopi Yapılma Zamanının Hastaların Mortalitesine Etkileri

YURTSEVER

2023

Journal of Contemporary Medicine

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Background: Endoscopy is recommended in acute upper gastrointestinal bleeding (AUGIB) to detect the bleeding source and stop the bleeding. The optimal timing of endoscopy in AUGIB is controversial. We aimed to investigate the time of endoscopy and the factors affecting it. Materials and methods: Retrospective, single-center study. The patients were divided into four groups: endoscopy after discharge, 0-12 hours endoscopy, 12-24 hours endoscopy and 24 hours later. Age, sex, vital signs, laboratory findings were recorded. Glasgow-Blatchford Score (GBS) and Charlson comorbidity index (CCI) were calculated. The obtained data were compared between these four groups. All-cause mortality for 30 days was recorded. Results: A total of 318 patients were included. In the comparison of endoscopy times, the parameters found to be statistically significant between the four groups are Hb, BUN, and INR levels, GBS and CCI. As a result of CHAID analysis, the most crucial variable affecting the timing of endoscopy was found to be the Hb value of the patients (χ2=66.528; adjusted p=0.000). Mortality occurred in 10.69% of the patients. The timing of endoscopy did not affect mortality. In binary logistic regression analysis, low systolic BP (0.967 times increase), high CCI (86,402 times increase) were found to affect mortality. Conclusion: The factors affecting the timing of endoscopy are the signs of bleeding. A thorough follow-up of vital signs in patients presenting to the emergency department with acute gastrointestinal bleeding, particularly an evaluation of systolic blood pressure and detailed questioning of additional comorbid conditions, is critical to reduce mortality.

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“…CT-scan is the gold standard of diagnostic imaging to identify the cause of MB (Brofman et al, 2006 ). While the management of upper and lower gastrointestinal bleeding has been well established (Chaudhary & Stanley, 2019 ; Gralnek et al, 2015 ; Barkun et al, 2019 ), the management of active mesenteric bleeding is less defined in the medical literature. Emergency laparotomy is indicated to drain a mesenteric hematoma, especially if it is associated with blunt bowel injury.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of emergency transarterial embolization for mesenteric bleeding

et al. 2022

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Background Patients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications. Results Among the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications. Conclusion Transarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.

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Optimal timing of endoscopy in patients with acute upper gastrointestinal bleeding

Cited by 7 publications

References 49 publications

Surgical Emergencies in the ICU

Surgical Emergencies in the ICU

Akut Üst Gastrointestinal Kanama İle Başvuran Hastaların Endoskopi Yapılma Zamanının Hastaların Mortalitesine Etkileri

Safety and efficacy of emergency transarterial embolization for mesenteric bleeding

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