Clinical question: How does the timing of endoscopic intervention affect clinical outcomes in patients with acute non-variceal upper gastrointestinal (GI) bleeding?
Background: Previous studies have shown that acute non-variceal upper GI bleeds should undergo endoscopic intervention within 24 hours, however the optimal window during the first 24 hours to optimize outcomes has not been well studied.
Study design: A retrospective, territory-wide, cohort study
Setting: Hong Kong
Synopsis: A territory-wide database covering patients in all public hospitals was used to identify 6,474 patients with a diagnosis of non-variceal GI bleeding who underwent esophagogastroduodenoscopy between the years 2013 and 2019. Patients were divided into three groups based on the timing of endoscopy: <6 hours (urgent), 6-24 hours (early), and 24-48 hours (late). Patients in the early group were found to have overall lower 30-day mortality (HR, 1.4 (urgent), 1.3 (late)), 30-day repeat endoscopy (HR, 1.2 (urgent), 1.0 (late)) and 30-day ICU admission after index endoscopy (HR, 1.4 (urgent), 0.72 (late)). Urgent endoscopy within 6 hours produces overall worse outcomes compared to endoscopy within 6-24 hours. Medical optimization with fluid resuscitation, blood transfusion, and medical therapies (initiation of proton pump inhibitors) prior to endoscopic therapy is crucial to producing positive patient outcomes. Limitations of the study: the sick patient population was excluded, and the timing of endoscopy varied between the two groups.
Bottom line: Endoscopy during the 6- to 24-hour window after admission results in lower 30-day mortality, repeat endoscopy, and ICU admission compared to <6 hours and 24 to 48 hours for non-variceal upper GI bleeds.
Citation: Guo CLT, et al. Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study. Gut. 2022;71(8):1544-1550.
Dr. Sheikh is associate program director for the department of internal medicine and assistant professor of medicine at the University of New Mexico Hospital, Albuquerque, N.M.