Coffee ground emesis and early endoscopy: Is timing actually relevant?

• Published in: Gastroenterología y hepatología Vol. 47; no. 5; p. 457
• Main Authors: Blanco Nodal, Ignacio, Roales Gómez, Valentín, Olivares Quintanar, David, Velasco Martínez, Elena, Molina Tejedor, Sara, Esteban López-Jamar, Jose Miguel, Rey Díaz-Rubio, Enrique
• Format: Journal Article
• Language: English
• Published: Spain 01.05.2024
• Subjects: Aged; Aged, 80 and over; Female; Gastrointestinal Hemorrhage - etiology; Gastroscopy; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Recurrence; Retrospective Studies; Time Factors; Vomiting - etiology; Posos de café; Hemorragia gastrointestinal; Coffee ground; Gastrointestinal bleeding; Vomiting; Endoscopy; Vómitos; Endoscopia
• ISSN: 0210-5705
• DOI: 10.1016/j.gastrohep.2023.09.010

Coffee ground vomiting is a classical symptom of upper gastrointestinal bleeding. However, the clinical usefulness is limited, due to the low positive predictive value. Our goal is to determine if whether an urgent endoscopy does modify our therapeutic management with a real impact on survival. It is a retrospective, observational and descriptive study. We selected all patients that underwent a gastroscopy in our center for coffee ground vomiting over the last 4 years (2017-2021). Two groups were established: urgent endoscopy (first 24h) and scheduled (over 24h). Then we studied differences between both groups regarding survival, ICU admission, hospitalization days and rebleeding. Three hundred and fourteen patients were identified, from which 276 were included, with 176 belonging to the urgency group and 109 to the scheduled group. There were no differences in the ICU admission, hospitalization days, survival or rebleeding after 30 days. There were no differences either in the number of potentially bleeding lesions or the need of endoscopic therapeutic. Coffee ground vomiting, without any other data supporting upper gastrointestinal bleeding, does not represent a reliable indicator. Performing urgent endoscopy is not beneficial in terms of morbimortality. Therefore, a more conservative strategy would allow to differ endoscopy, decreasing risks and reducing costs, without affecting the prognosis.