Urgent endoscopy in severe non-variceal upper gastrointestinal hemorrhage: does the Glasgow-Blatchford score help endoscopists?

Abstract

The GBS does not detect more patients at need for urgent UGIE than on-duty endoscopists. Both methods lead to numerous unjustified UGIEs. A score that would equally help endoscopists in their decision to intervene urgently is still warranted.

The Role of History of Gastro-Duodenal Ulcer in Patients with Upper Gastrointestinal Bleeding

“…Accordingly, approximately 90% of UGIB patients who were classified as high risk for EI actually do not need EI. Attar et al [9] reported that GBS does not detect more patients requiring endoscopy than on-duty endoscopists.…”

“…These scoring systems have been reported to be very useful in excluding low-risk patients with comparatively high sensitivity; however, they are not sufficient because of low specificity. For example, the specificity of GBS in determining the need for EI is approximately 10% [7, 9-11]. Accordingly, approximately 90% of UGIB patients who were classified as high risk for EI actually do not need EI.…”

“…Therefore, several scoring systems including the GBS, Rockall score, and pre-endoscopic Rockall score have been proposed to predict outcomes for UGIB patients [1, 3, 7, 9-13]. These scoring systems consist of simple and objective symptoms and results of blood examinations such as SBP, HR, Hb, and serum urea nitrogen.…”

Upper gastrointestinal bleeding risk scores: Who, when and why?

“…Farooq et al [76] reported that the use of clinical Rockall and GBS was less accurate than a clinical triage decision in predicting the need for endoscopic therapy. In the study by Attar et al [67] , the GBS showed an equivalent sensitivity when compared to endoscopists (both 98%) in the detection of urgent upper endoscopy necessity. However, both GBS and endoscopists showed a very poor specificity, being unable to detect non urgent patients to endoscopy.…”

“…However, the best GBS cut-off for these situations is not clearly defined. Moreover, using a cutoff of 0 to predict low risk for adverse events has a practical limitation, since most of the patients who visit the Emergency Department with UGIB will score at least 1 point [41,42,46,65,67] . Possible explanations for the reported cut-off variation are differences in the demographics characteristics, aetiology of UGIB, routine use of proton pump inhibitors before endoscopy and adherence to guidelines regarding the need for endoscopic therapy.…”