TIMING OF UPPER ENDOSCOPY IN GASTROESOPHAGEAL VARICELLA BLEEDING

Aims:

Current guidelines for treatment of gastroesophageal variceal bleeding recommend that upper endoscopy should be performed within the first 12 hours. The objective of this study was to evaluate the outcomes bleeding recurrence rate, 6 weeks mortality rate and 1 year mortality rate in relation to endoscopy timing.

Methods:

Retrospective study that included patients who presented on emergency department (ED) for variceal bleeding between 2011 – 2015. Considered very urgent endoscopy if performed in the first 6 hours.

Results:

Sixty patients (mean age 57 years, 90% male, 67% alcohol cirrhosis, mean Blatchford score 13.9) were included. Very urgent endoscopy was performed in 55% of patients. 85% of patients underwent endoscopic hemostasis – 67% elastic band ligation and 18% cyanoacrylate glue. All initiated vasopressor treatment (59% terlipressin and 41% octreotide) and prophylactic antibiotics (50% ceftriaxone and 50% ciprofloxacin). Bleeding recurrence rate was 25%, mortality at 6 weeks 10% and mortality at 1 year 44%. There was no statistically significant relationship between the 3 outcomes and endoscopy timing. As secondary outcomes, endoscopic hemostasis, need for blood transfusion and admission to intensive care unit were evaluated, none of which was related to endoscopy timing.

Conclusions:

Very urgent endoscopy in variceal bleeding in this sample was not associated with a decrease in bleeding recurrence, mortality, transfusion or admission in intensive care unit compared to endoscopy performed up to 12 hours. These data are important since they facilitate better management in the emergency deparment.