Timing of upper endoscopy influences outcomes in patients with acute nonvariceal upper GI bleeding

Kumar, Navin L.; Cohen, Aarón; Nayor, Jennifer; Claggett, Brian; Saltzman, John R.

doi:10.1016/j.gie.2016.09.029

Cited by 77 publications

(71 citation statements)

References 21 publications

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“…A retrospective study (n=361) reported that patients undergoing endoscopy within 12 hours for AUGIB had a fivefold increased risk of incurring the composite outcome of rebleeding, surgical or radiological intervention or need for repeat endoscopic intervention. 85 Other confounders may exist, but one possible explanation could be inadequate resuscitation, as patients who underwent early endoscopy had significantly lower blood pressure and higher heart rate. A nationwide cohort study of patients with peptic ulcer bleeding from Denmark (n=12 601) associated endoscopy undertaken too early, or too late, with higher mortality, particularly in patients with higher levels of comorbidity or haemodynamic instability.…”

Section: Warfarinmentioning

confidence: 99%

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

Siau¹,

Hearnshaw

Stanley

et al. 2020

Frontline Gastroenterol

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Medical care bundles improve standards of care and patient outcomes. Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency which has been consistently associated with suboptimal care. We aimed to develop a multisociety care bundle centred on the early management of AUGIB.Commissioned by the British Society of Gastroenterology (BSG), a UK multisociety task force was assembled to produce an evidence-based and consensus-based care bundle detailing key interventions to be performed within 24 hours of presentation with AUGIB. A modified Delphi process was conducted with stakeholder representation from BSG, Association of Upper Gastrointestinal Surgeons, Society for Acute Medicine and the National Blood Transfusion Service of the UK. A formal literature search was conducted and international AUGIB guidelines reviewed. Evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation tool and statements were formulated and subjected to anonymous electronic voting to achieve consensus. Accepted statements were eligible for incorporation into the final bundle after a separate round of voting. The final version of the care bundle was reviewed by the BSG Clinical Services and Standards Committee and approved by all stakeholder groups.Consensus was reached on 19 statements; these culminated in 14 corresponding care bundle items, contained within 6 management domains: Recognition, Resuscitation, Risk assessment, Rx (Treatment), Refer and Review.A multisociety care bundle for AUGIB has been developed to facilitate timely delivery of evidence-based interventions and drive quality improvement and patient outcomes in AUGIB.

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Section: Warfarinmentioning

confidence: 99%

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

Siau¹,

Hearnshaw

Stanley

et al. 2020

Frontline Gastroenterol

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“…It is possible that the study was not powered to detect a small difference between the two groups. However, timely endoscopic interventions could have played a role . Despite the high‐risk profile of these patients as evidenced by the ASA score, with the exception of one patient, all our other patients received endoscopic intervention in a timely fashion, which is important in identifying a bleeding source and deliver targeted haemostatic therapy.…”

Section: Discussionmentioning

confidence: 98%

Upper gastrointestinal bleeding in neck of femur fracture patients: a single tertiary centre experience

Liu

Gupta

Hay

et al. 2018

Internal Medicine Journal

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This study aimed to identify the incidence of perioperative acute upper gastrointestinal bleeding (UGIB) in our hip fracture patients; to evaluate the characteristics, management and clinical outcomes of these patients; and to explore risk factors and protective factors. Of the 1691 consecutive patients admitted for surgical management of hip fractures, 11 (0.65%) had UGIB and a further four patients for each case were selected as controls for evaluation of risk factors and protective factors. Pre-existing peptic ulcer disease was identified as a risk factor for acute UGIB (odds ratio 7.9; 95% confidence interval: 1.1-54.9). This study reported a very low incidence of UGIB in hip fracture patients. Despite being a high-risk population, timely endoscopic evaluation can be safely undertaken to optimise patient outcome. When risk factors such as history of peptic ulcer disease are present, additional precaution including gastro-protective agent and nutritional support should be undertaken.

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“…A retrospective study involving 361 patients with a complaint of upper GIB admitted to an academic hospital in the USA reported no significant difference in mortality from urgent (<12 hours) versus non-urgent (>12 hours) endoscopy. 8 However, urgent endoscopy was reported to be associated with poor clinical outcomes (inpatient re-bleeding, need for surgery or interventional radiology, or repeat endoscopic intervention). A large cohort study of 12,601 patients, admitted to a hospital in Denmark with peptic ulcer bleeding, reported that endoscopy 12 to 36 hours after admission was associated with lower inpatient mortality compared to endoscopy outside of this timeframe in hemodynamically stable patients.…”

Section: Discussionmentioning

confidence: 99%

“…9,13,15,16 Due to different results obtained from various clinical research studies the appropriate timing of endoscopy procedure for the management of acute GIB is under debate and requires to be validated in future randomized clinical studies. 7,8,10 However, many of these clinical studies have shown that early endoscopic intervention has the potential to reduce the number of blood transfusions required in patients presented with acute GIB.…”

Section: Introductionmentioning

confidence: 99%

Early endoscopic intervention in acute gastrointestinal bleeding may reduce the need for blood transfusion

Ferman¹,

M²,

M³

et al. 2019

AMJ

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BackgroundAcute gastrointestinal bleeding (GIB) is a common gastroenterological emergency worldwide with significant morbidity and mortality of 6 per cent-14 per cent. The main causes of death in patients with GIB include shock, aspiration, and therapeutic procedure carried out for the management of the GIB. Thus, the resuscitation strategy of blood transfusion plays a very important role in these patients before any other specific treatment. Currently, endoscopy is considered the mainstay of diagnosis and treatment for patients with GIB. AimsTo assess the effect of an early endoscopic intervention on the need for blood transfusion in patients presented with GIB. MethodsWe retrospectively analysed the data for patients presented with hematemesis, melena, or haematochezia, from July 2015 to July 2016, in Ballarat Base Hospital (BHS) in Victoria, Australia. Data were extracted from the hospital coding system related to patient's demographic history, alcohol intake, comorbidity, procedure details including the timing and the type of procedure performed, and the number of units of blood transfused. Additionally, the laboratory blood test results for each patient were examined through the electronic records to assess the haemoglobin level before and after the blood transfusion.[AMJ 2019;12(2):56-62] of cost of treatment from blood transfusion can be achieved by adopting an optimized restrictive transfusion strategy. What this study adds:1. What is known about this subject? Most guidelines recommend performing endoscopic procedures within 24 hours of acute GI bleeding. What new information is offered in this study?This study assesses the time to perform an endoscopic procedure in patients presenting with acute GIB in relation to the need for blood transfusion. There is a trend towards having more blood transfusion with delayed endoscopic procedure (>12 hours). What are the implications for research, policy, or practice?More prospective studies are needed to further assess the role of early endoscopic intervention in patients with acute GIB.

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Timing of upper endoscopy influences outcomes in patients with acute nonvariceal upper GI bleeding

Cited by 77 publications

References 21 publications

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

Upper gastrointestinal bleeding in neck of femur fracture patients: a single tertiary centre experience

Early endoscopic intervention in acute gastrointestinal bleeding may reduce the need for blood transfusion

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