Urgent endoscopy is associated with lower mortality in high-risk but not low-risk nonvariceal upper gastrointestinal bleeding.

Abstract

BACKGROUND AND STUDY AIMS:

The role of urgent endoscopy in high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) is unclear. The aim of this study was to determine whether esophagogastroduodenoscopy (EGD) performed sooner than the currently recommended 24 h in high-risk patients presenting with NVUGIB is associated with lower all-cause in-hospital mortality.

METHODS:

All adult patients undergoing EGD for the indications of coffee-grounds vomitus, hematemesis or melena at a university hospital over an 18-month period were enrolled. Patients with variceal and lower gastrointestinal bleeding were excluded. Data were prospectively collected.

RESULTS:

A total of 934 patients were included. The area under the receiver operating characteristic curve (AUROC) for the Glasgow-Blatchford score (GBS) was 0.813 for predicting all-cause in-hospital mortality, with a cut-off score of ≥ 12 resulting in 90 % specificity. In low-risk patients with GBS < 12, presentation-to-endoscopy time in those who died and in those who survived was similar. In high-risk patients with GBS of ≥ 12, presentation-to-endoscopy time was significantly longer in those who died than in those who survived. Multivariate analysis of the high-risk cohort showed presentation-to-endoscopy time to be the only factor associated with all-cause in-hospital mortality. For high-risk patients, the AUROC for presentation-to-endoscopy time in predicting all-cause in-hospital mortality was 0.803, with a sensitivity of 100 % at the cut-off time of 13 h. All-cause in-hospital mortality in high-risk patients was significantly higher in those with presentation-to-endoscopy time of > 13 h compared with those undergoing endoscopy in < 13 h from presentation (44 % vs. 0 %; P < 0.001).

CONCLUSIONS:

Endoscopy within 13 h of presentation was associated with lower mortality in high-risk but not low-risk NVUGIB.

• Authors: L G Lim, K Y Ho, Y H Chan, P L Teoh, C J Khor, L L Lim, A Rajnakova, T Z Ong, K G Yeoh
• Journal: Endoscopy (Endoscopy) Vol. 43 Issue 4 Pg. 300-6 (Apr 2011) ISSN: 1438-8812 [Electronic] Germany
• PMID: 21360421 (Publication Type: Journal Article)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Topics

• Acute Disease
• Aged
• Emergencies
• Endoscopy, Gastrointestinal
• Female
• Gastrointestinal Hemorrhage (mortality, therapy)
• Hemostasis, Endoscopic
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Risk Factors
• Survival Analysis