Timing of endoscopy in high-risk patients with acute upper gastrointestinal bleeding: Results of a multicenter international cohort study.

Abstract

Objective: The optimal timing for high-risk patients with acute upper gastrointestinal bleeding (AUGIB) remains uncertain. The study aimed to evaluate whether the timing of endoscopy influences outcomes in high-risk patients with AUGIB.

Patients and methods: We conducted a retrospective, international, multicenter cohort study. High-risk patients (Glasgow-Blatchford score >7 points) with AUGIB, who underwent therapeutic endoscopy between September and December 2023 (n=511), were recruited. Patients were classified into three groups based on endoscopic timing: urgent (t≤6h), early (624h). Using descriptive statistics and logistic regression analyses, we identified the optimal timing for endoscopy and analyzed its association with 30-day outcomes, adjusting for confounding factors.

Results: The results showed that urgent timing (n=130) was associated with worse outcomes compared to early (n=205) and elective (n=176) endoscopy, including higher 30-day all-cause mortality (p=0.047), increased rates of repeat endoscopy (p=0.034), higher 30-day transfusion rates (p=0.021), and longer lengths of stay (p=0.038). These findings were particularly consistent among patients admitted with non-variceal bleeding. In the multivariate analysis, urgent endoscopy (OR 2.47, 1.28-4.57), Charlson index (OR 1.39, 1.01-1.93), systolic blood pressure <90mmHg (OR 3.66, 1.44-9.31), tachycardia (OR 1.02, 1.01-1.05), and malignancy (OR 1.68, 1.37-7.73) were identified as worse prognostic factors.

Conclusions: High-risk patients with AUGIB who underwent urgent endoscopy exhibited worse outcomes, particularly those patients with non-variceal bleeding. Comorbidities, shock, urgent endoscopy and malignancy were identified as predictors of 30-day mortality. These findings highlight the importance of prior resuscitation, pharmacotherapy, and early endoscopy.