Endoscopy 2020; 52(S 01): S58
DOI: 10.1055/s-0040-1704182
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 16:30 – 18:00 Removing doubt from the red-out: Liffey Meeting Room 1 Upper GI hemostasis
© Georg Thieme Verlag KG Stuttgart · New York

THE SOONER, THE BETTER: EARLY ENDOSCOPY IS ASSOCIATED WITH LOWER 30-DAY MORTALITY IN LOW-RISK NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING PATIENTS

M Freitas
1   Hospital da Senhora da Oliveira, Gastroenterology Department, Guimarães, Portugal
2   Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
3   ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
,
TC Gonçalves
1   Hospital da Senhora da Oliveira, Gastroenterology Department, Guimarães, Portugal
2   Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
3   ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
,
C Marinho
1   Hospital da Senhora da Oliveira, Gastroenterology Department, Guimarães, Portugal
2   Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
3   ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
,
J Cotter
1   Hospital da Senhora da Oliveira, Gastroenterology Department, Guimarães, Portugal
2   Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
3   ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims Although upper gastrointestinal bleeding (UGIB) management has improved substantially during the past decades, there is still much controversy regarding the optimal timing to perform endoscopy. Recent guidelines suggest performing early endoscopy within 24 hours of non-variceal UGIB (NVUGIB) presentation, although its impact in different risk patients remains unclear.

    Aim To evaluate the impact of performing endoscopy within 24 hours on NVUGIB outcomes.

    Methods Retrospective unicentric cohort study including consecutive patients undergoing upper endoscopy for suspected NVUGIB over 4 years. Demographic, clinical, biochemical, endoscopic and outcome data were collected. Lower-risk was defined as a Glasgow-Blatchford score (GBS) of < 12 and high risk was defined as a GBS of ≥12.

    Results Two hundred and ninety-eight patients with suspected NVUGIB were included, 55% were high-risk patients. Endoscopy was performed within 24 hours in 62.1% of patients. In lower-risk patients, performing endoscopy within 24 hours was associated with higher need of endoscopic treatment (p=0.003); lower 30-day mortality (p=0.03) and lower need for transfusion (p=0.03). Lower-risk patients that performed endoscopy later than 24 hours were significantly older (70.8±15.2 vs 63.5±16.7; p=0.01), with more comorbidities (Charlson Comorbidity Index: 4.0±2.1 vs 3.1±2.5; p=0.02), lower hemoglobin levels (10.1±3.1 vs 11.3±2.8; p=0.03), and with higher weekend/holiday presentation (27 vs 0; p< 0.001). In high-risk patients, there were no statistically significant differences in NVUGIB outcomes in performing endoscopy within 24 hours.

    Conclusions Endoscopy within 24 hours of presentation was associated with lower need for transfusion, higher need for endoscopic treatment and lower 30-day mortality in lower-risk but not high-risk NVUGIB patients. Our study suggests that performing endoscopy within the first 24 hours of presentation may have a positive impact in NVUGIB outcomes in lower-risk patients, particularly in older ones with more comorbidities and lower hemoglobin levels.


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