Timing of Endoscopy For Acute Upper GI Bleeding Important in Outcomes

Patients with acute upper gastrointestinal bleeding had significantly better clinical outcomes when therapeutic endoscopy was performed between 6 and 24 hours after hospital admission compared with earlier or later, according to study findings published online ahead of print in Gut.

“Results of this study suggest that most acute upper gastrointestinal bleeding patients need not be rushed to endoscopy immediately,” researchers advised. “Rather, active resuscitation and optimal medical treatment should be initiated as appropriate, then with endoscopy performed within 24 hours of presentation.”

Researchers arrived at the recommendation after reviewing data for 6474 adults who received endoscopy for acute upper gastrointestinal bleeding within 48 hours of hospital admission. The study included patients from all public hospitals in Hong Kong. Among patients, 1008 received urgent endoscopy (within 6 hours of admission), 3865 received early endoscopy (between 6 and 24 hours of admission), and 1601 received late endoscopy (between 24 and 48 hours of admission).

Patients who received urgent endoscopy had higher 30-day all-cause mortality, repeat endoscopy rates, and intensive care unit (ICU) admission rates compared with patients who received early endoscopy, the study found. Patients who received late endoscopy, meanwhile, had higher 30-day mortality, in-hospital mortality, and 30-day transfusion rates compared with those who received early endoscopy.

When researchers looked at bleeding etiology, results were consistent for nonvariceal bleeding but not variceal bleeding. For patients with variceal bleeding, late endoscopy was associated with increased risk of 30-day repeat therapeutic endoscopy rates and 30-day ICU admission rates. Urgent timing was not linked with any significant differences in outcomes.

“Given that acute upper gastrointestinal bleeding is one of the most common inpatient diseases,” researchers wrote, “we believe that our result has the potential to impact the management of patients around the world.”

—Jolynn Tumolo

Reference

Guo CLT, Wong SH, Lau LHS, et al. Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study. Gut. Published online ahead of print September 21, 2021.