Early endoscopy linked to superior outcomes in upper GI bleeding
Click Here to Manage Email Alerts
Compared with urgent endoscopy and late endoscopy, early endoscopy correlated with better outcomes among patients presenting with acute upper gastrointestinal bleeding, according to research published in Gut.
“Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency. ... Fortunately, the mortality rates of AUGIB have decreased over the past few decades, largely attributable to improvements in endoscopic and pharmacological therapies,” Cosmos L.T. Guo, of the department of medicine and therapeutics at The Chinese University of Hong Kong, and colleagues wrote. “Currently, it is recommended that endoscopy should be performed within 24 hours on presentation to hospital. ... However, there is limited clinical data regarding the optimal timing of endoscopy within the 24-hour period.”
In a retrospective, territory-wide cohort study, researchers analyzed 6,474 patients aged 18 years and older admitted for AUGIB and compared outcomes between urgent endoscopy performed at a mean 4.08 hours after admission (n = 1,008), early endoscopy performed at a mean 15.6 hours after admission (n = 3,865) and late endoscopy performed at a mean 32.3 hours after admission (n = 1,601). Studied endpoints included 30-day all-cause mortality, repeated therapeutic endoscopy rate and ICU admission rate.
Compared with the early endoscopy group, Cox regression analyses demonstrated the highest 30-day all-cause mortality among the urgent endoscopy group (adjusted HR = 1.43; 95% CI, 1.24-1.65) followed by the late endoscopy group (aHR = 1.25; 95% CI, 1.078-1.449). The urgent endoscopy group yielded more in-hospital deaths (6.2% vs. 4.3% in early group), and higher rates of repeat therapeutic endoscopy (aHR = 1.22; 95% CI, 1.11-1.33) and ICU admissions (aHR = 1.4; 95% CI, 1.18-1.67). Late endoscopy also correlated with worse outcomes with higher in-hospital mortality (5.8% vs. 4.3% in early group) and 30-day transfusion rates. Researchers noted no significant difference regarding length of hospital stay between groups.
“We observed a lower mortality rate in non-variceal AUGIB patients receiving early endoscopy between 6 and 24 hours compared with patients receiving urgent endoscopy within 6 hours and those receiving endoscopy later between 24 and 48 hours of hospital admission,” Guo and colleagues concluded. “Results of this study suggest that most AUGIB patients need not be rushed to endoscopy immediately. Rather, active resuscitation and optimal medical treatment should be initiated as appropriate, then with endoscopy performed within 24 hours of presentation.”
Collapse
Read more about
Click Here to Manage Email Alerts