Urgent Endoscopy in Nonvariceal Upper Gastrointestinal Hemorrhage: A Retrospective Analysis

• Published in: Current medical science Vol. 42; no. 4; pp. 856 - 862
• Main Authors: Guan, Jia-lun, Han, Ying-ying, Fang, Dan, Wang, Mu-ru, Wang, Ge, Tian, De-an, Li, Pei-yuan
• Format: Journal Article
• Language: English
• Published: Wuhan Huazhong University of Science and Technology 01.08.2022; Division of Gastroenterology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China%Division of Gastroenterology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China; Department of Gastroenterology,Wenchang People's Hospital,Wenchang 571300,China
• Subjects: Medicine; Medicine & Public Health; clinical outcomes; nonvariceal upper gastrointestinal hemorrhage; urgent endoscopy; rebleeding; Glasgow-Blatchford score
• ISSN: 2096-5230; 1672-0733; 2523-899X
• DOI: 10.1007/s11596-022-2551-2

Objective The role of urgent endoscopy in nonvariceal upper gastrointestinal hemorrhage (NVUGIH) remains controversial. We designed a retrospective study to compare the outcomes between urgent endoscopy (within 12 h) and non-urgent endoscopy for patients with NVUGIH. Methods A total of 540 hospitalized patients with NVUGIH were included in our study. Patients who received endoscopy within 12 h or after 12 h were divided into two groups, the urgent and non-urgent endoscopy groups, respectively. The clinical outcomes including rebleeding, mortality, endoscopic re-intervention, need for emergency surgery and interventional radiotherapy were compared between the groups. Patients with Glasgow-Blatchford scores (GBS) <12 and ≥12 were defined as the lower- and high-risk groups, respectively, and the predictors of rebleeding and mortality in both groups were analyzed individually. Results Patients with NVUGIH in the urgent endoscopy group had a higher rate of rebleeding (27.6% vs. 16.9%, P =0.003) and blood transfusion (73.2% vs. 55.5%, P <0.001) than those in the non-urgent endoscopy group, while the mortality and the length of hospitalization were not significantly different between the groups ( P >0.05). For lower-risk patients, urgent endoscopy was independently associated with a higher likelihood of rebleeding (adjusted OR: 1.73, 95% CI: 1.03–2.88), while it was not associated with in-hospital mortality. However, the urgent need for endoscopy was not associated with rebleeding and inhospital mortality in high-risk patients. Conclusion Endoscopy within 12 h did not provide any advantage in the outcomes of patients with NVUGIH, and may even lead to an increased rebleeding rate in lower-risk patients.