The Time of Endoscopy for Nonvariceal Upper Gastrointestinal Bleeding: An Observational Study.

Abstract

Objectives: In cases of nonvariceal upper gastrointestinal bleeding (NVUGIB), endoscopic intervention within the first 24 hours is widely recommended. However, data on the efficacy of urgent endoscopy are limited. Here, we used the Glasgow-Blatchford score to assess bleeding outcomes based on time-to-endoscopy.

Methods: Prospectively collected multicenter data, which included 1554 patients with NVUGIB, were retrospectively reviewed between February 2011 and December 2013. Based on time-to-endoscopy, patients were grouped into the early (<24 hours) versus the delayed (≥24 hours) group and the urgent (<6 hours) versus the nonurgent (≥6 hours) group. The rates of re-bleeding, mortality, secondary intervention, transfusion, and morbidity aggravation were analyzed.

Results: The mean time-to-endoscopy and median Glasgow-Blatchford score were 33.0±75.5 hours and 12 (range: 1-23), respectively. Univariate analyses revealed that in the delayed endoscopy group, the transfusion and re-bleeding rates were higher (hazard ratio [HR]: 1.257, 95% confidence interval [CI]: 1.026-1.540) and lower (HR: 0.610, 95% CI: 0.413-0.901), respectively. Multivariate analysis revealed that delayed endoscopy was a significant factor for lower re-bleeding rate (HR: 0.576, 95% CI: 0.387- 0.859), which was prominent in the low-risk group (HR: 0.417, 95% CI: 0.225-0.774). Multivariate analysis showed that when compared with the low-risk group, in-hospital comorbidity aggravation was more common in high-risk patients who underwent non-urgent endoscopy (HR: 2.957, 95% CI: 1.045-6.454).

Conclusions: In low-risk patients, delayed endoscopy is sufficient for NVUGIB management. In high-risk patients, urgent endoscopy reduced comorbidity aggravation during hospital care.