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

https://doi.org/10.1016/j.gie.2016.09.029Get rights and content

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.

Section snippets

Study cohort

The research patient data registry (RPDR) is a centralized clinical data registry that gathers and stores data from various electronic health record systems in the Partners Healthcare network. The RPDR was used to identify patients at the Brigham and Women’s Hospital who were seen in the emergency department and subsequently admitted to the hospital during 2004 to 2014. Any patients who were transferred from an outside hospital were not included in the study. The initial query was limited to

Patient characteristics

There were 361 patients included in the study cohort, with 89 patients (25%) receiving urgent endoscopy and 272 patients (75%) receiving nonurgent endoscopy. Table 1 shows the patient characteristics according to timing of endoscopy. The mean age, sex, and presentation on a weekend or holiday were not significantly different between the two groups. Patients receiving nonurgent endoscopy were more likely to be receiving a thienopyridine (14% vs 6%; P = .035) or warfarin (18% vs 9%; P = .036),

Discussion

In this retrospective cohort study of 361 patients with an acute nonvariceal UGIB at an academic center, time to endoscopy was a significant predictor of reaching a composite clinical outcome of death, inpatient rebleeding, need for surgical or interventional radiology intervention, or repeat endoscopic intervention. Patients who underwent urgent endoscopy (within 12 hours) had a greater than 5-fold increased risk of reaching the composite outcome than patients who received nonurgent endoscopy

References (21)

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Cited by (61)

  • Comparison of urgent and early endoscopy for acute non-variceal upper gastrointestinal bleeding in high-risk patients

    2023, Gastroenterologia y Hepatologia
    Citation Excerpt :

    However, there was no difference in endoscopic findings between the two groups. Lastly, we defined primary composite outcome, similar to Kumar et al.20, which can effectively assess the clinical outcomes in non-variceal UGIB. In conclusion, urgent endoscopy significantly reduced the length of hospital stay and the number of transfused erythrocyte suspensions, which can contribute to patient satisfaction, reduce healthcare expenditure, and improve hospital bed availability.

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DISCLOSURE: All authors disclose no financial relationships relevant to this publication.

If you would like to chat with an author of this article, you may contact Dr Saltzman at [email protected].

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