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Gastrointest Endosc. 2017 May;85(5):945-952.e1. doi: 10.1016/j.gie.2016.09.029. Epub 2016 Sep 29.

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

Author information

1
Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
2
Harvard Medical School, Boston, Massachusetts, USA.

Abstract

BACKGROUND AND AIMS:

Current guidelines advise that upper endoscopy be performed within 24 hours of presentation in patients with acute nonvariceal upper GI bleeding (UGIB). However, the role of urgent endoscopy (<12 hours) is controversial. Our aim was to assess whether patients admitted with acute nonvariceal UGIB with lower-risk versus high-risk bleeding have different outcomes with urgent compared with nonurgent endoscopy.

METHODS:

A retrospective cohort study was conducted of patients admitted to an academic hospital with nonvariceal UGIB. The primary outcome was a composite of inpatient death from any cause, inpatient rebleeding, need for surgical or interventional radiologic intervention, or endoscopic reintervention. The Glasgow-Blatchford score (GBS) was calculated; lower risk was defined as a GBS < 12, and high risk was defined as a GBS ≥ 12.

RESULTS:

Of 361 patients, 37 patients (10%) experienced the primary outcome. Patients who underwent urgent endoscopy had a greater than 5-fold increased risk of reaching the composite outcome (unadjusted odds ratio [OR], 5.6; 95% confidence interval [CI], 2.8-11.4; P < .001). Lower-risk patients who were taken urgently to endoscopy were more likely to reach the composite outcome (adjusted OR, 0.71 per 6 hours; 95% CI, 0.55-0.91; P = .008). However, in the high-risk patients, time to endoscopy was not a significant predictor of the primary outcome (adjusted OR, 0.93 per 6 hours; 95% CI, 0.77-1.13; P = .47; adjusted P for interaction = .039).

CONCLUSION:

Urgent endoscopy is a predictor of worse outcomes in select patients with acute nonvariceal UGIB.

PMID:
27693643
DOI:
10.1016/j.gie.2016.09.029
[Indexed for MEDLINE]

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