Outcomes and role of urgent endoscopy in high-risk patients with acute nonvariceal gastrointestinal bleeding.
Clin Gastroenterol Hepatol. 2017 Jun 17;:
Authors: Cho SH, Lee YS, Kim YJ, Sohn CH, Ahn S, Seo DW, Kim WY, Lee JH, Lim KS
BACKGROUND & AIMS: We investigated clinical outcomes in high-risk patients with acute nonvariceal upper gastrointestinal bleeding (UGIB), and determined if urgent endoscopy is effective.
METHODS: Consecutive patients with Glasgow-Blatchford score >7 who underwent endoscopy for acute nonvariceal UGIB at the emergency department from January 1, 2005, to December 31, 2014, were included. Urgent (<6 h) and elective (6-48 h) endoscopies were defined according to the time to endoscopy after the initial presentation. The primary outcomes were mortality and rebleeding within 28 days of admission.
RESULTS: Among 961 patients, 571 received urgent endoscopy. The 28-day mortality was 2.5%, and rebleeding rate was 10.4%. There were significant differences in mortality (1.6% vs. 3.8%), transfused packed red blood cells (2.6 ± 2.5 vs. 2.3 ± 2.1 packs), need for intervention (69.5% vs. 53.5%), and embolization (2.8% vs. 0.5%), but no differences in rebleeding, intensive care unit admission, vasopressor use, and length of stay between the urgent and elective endoscopy groups. Mortality was associated with malignancy (odds ratio [OR]: 3.58, 95% confidence interval [CI]: 1.33-9.62), cirrhosis (OR: 4.67, 95% CI: 1.85-11.76), urgent endoscopy (OR: 0.36, 95% CI: 0.14-0.95), failed primary endoscopic treatment (OR: 15.03, 95% CI: 4.63-48.82), and rebleeding (OR: 2.77, 95% CI: 1.03-7.45). Rebleeding was associated with Forrest I ulcers (OR: 7.67, 95% CI: 2.71-21.69), Forrest II ulcers (OR: 2.34, 95% CI: 1.51-3.60), and coagulopathy (OR: 2.34, 95% CI: 1.51-3.60).
CONCLUSIONS: Urgent endoscopy was an independent predictor of lower mortality but not associated with rebleeding in high-risk patients with acute nonvariceal UGIB.
PMID: 28634135 [PubMed - as supplied by publisher]