Dr Yoon-Seon Lee and colleagues from Korea investigated clinical outcomes in high-risk patients with acute nonvariceal upper gastrointestinal bleeding and determined if urgent endoscopy is effective.
Consecutive patients with a Glasgow–Blatchford score greater than 7 who underwent endoscopy for acute nonvariceal upper gastrointestinal bleeding at the emergency department from 2005 to 2014, were included.
Urgent and elective endoscopies were defined according to the time to endoscopy after the initial presentation.
The primary outcomes were mortality and rebleeding within 28 days of admission.
| 28-day rebleeding rate was 10%.
|Clinical Gastroenterology and Hepatology
Among 961 patients, 571 patients underwent urgent endoscopy.
The researchers determined the 28-day mortality rate was 2.5%, and the rebleeding rate was 10%.
There were significant differences in mortality rate, the number of transfused packed red blood cells, need for intervention and embolization, but no differences in rebleeding, intensive care unit admission, vasopressor use, and length of stay between the urgent and elective endoscopy groups.
The team found mortality was associated with malignancy, cirrhosis, urgent endoscopy, failed primary endoscopic treatment and rebleeding.
Rebleeding was associated with Forrest I ulcers, Forrest II ulcers and coagulopathy.
Dr Lee's team concluded, "Urgent endoscopy was an independent predictor of lower mortality rate but was not associated with rebleeding in high-risk patients with acute nonvariceal upper gastrointestinal bleeding."