EXPRESS: Time To Endoscopy and its Effect on Outcomes in Acute Nonvariceal and Variceal Upper Gastrointestinal Bleeding.

Introduction: The role of early endoscopy in patients with non-variceal upper gastrointestinal bleeding (UGIB) is controversial; additionally, the timing of endoscopy in patients with variceal hemorrhage has been poorly studied. We aimed to determine the effect of time to endoscopy on clinical outcomes in non-variceal and variceal UGIB.

Materials and methods: We identified patients with acute UGIB admitted from the emergency room in an academic medical center. Patients were stratified by risk (low and high) and source of bleeding (variceal or non-variceal). We examined time to endoscopy (within 3h, >3-6h, >6-12h, and >12-24h) and assessed the following outcomes: stigmata of bleeding, transfusions, rebleeding, surgery, mortality, ICU admission, readmission (within 42 days), weekday vs weekend admission, and length of stay (LOS).

Results: We identified 987 patients with non-variceal UGIB and 288 patients with variceal UGIB. Clinical outcomes including transfusions, rebleeding, surgery, mortality, ICU admission or readmission did not vary as a function of the time to endoscopy. However, a shorter time to endoscopy was an independent predictor of identifying stigmata of bleeding (p<0.001) and increases in time to endoscopy reduced the likelihood of identifying stigmata of bleeding to 66%, 35%, and 23% at 2, 6, and 12 hours, respectively (p<0.001). Endoscopy performed within 3 hours was also associated with a significantly reduced LOS in low risk patients with non-variceal UGIB (p<0.001).

Discussion: The earlier endoscopy is performed, the more likely stigmata are identified and treatment is employed. Earlier endoscopy is associated with earlier discharge in low risk patients.