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 25 May 2018

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News

Early versus delayed endoscopy in bleeding peptic ulcers

This month's issue of Endoscopy finds that endoscopy at admission in an emergency room does not improve the clinical outcome in patients with bleeding peptic ulcer as compared with delayed endoscopy occurring within 24 hours.”

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In previous randomized trials, early endoscopy improved the outcome in patients with bleeding peptic ulcer.

Most of these studies defined “early” as endoscopy performed within 24 hours after admission.

Dr Schacher and colleagues from Switzerland conducted a retrospective analysis of endoscopy done immediately after admission, that is, early endoscopy in the emergency room.

The researchers considered the length of hospital stay as the primary criterion for the clinical outcome.

The research team compared the results of the emergency room endoscopy with endoscopy postponed to a time within the first 24 hours after hospitalization, but still during normal working hours, termed ”delayed” endoscopy in the endoscopy unit.

The investigators included data from 81 consecutive patients with bleeding peptic ulcer that were admitted in 1997 and 1998, between 16 - 90 years of age.

Of these 81 patients, 38 underwent delayed endoscopy, the standard therapy at the hospital, and 43 underwent early endoscopy in the emergency room.

The need for surgery was 8% with delayed endoscopy versus 9% in early endoscopy
Endoscopy

Patients in the 2 groups were comparable with regard to admission criteria and differed only in the treatment they received

The team reported that patients were also equally distributed with respect to their risk of adverse outcome, assessed using the Baylor bleeding score and the Rockall score.

The researchers performed endoscopic hemostasis whenever possible in all patients with Forrest types I, IIa, and IIb ulcer bleeding.

The investigators found similar rates in the two groups for recurrent bleeding, with 16 % in delayed endoscopy patients versus 14 % in early endoscopy patients.

Persistent bleeding occurred in 8 % of patients receiving delayed endoscopy versus none in early endoscopy patients.

The team observed that medical complications were 21 % in delayed endoscopy patient versus 26 % in early endoscopy patients.

In addition, the need for surgery was 8 % in delayed endoscopy patients versus 9 % in early endoscopy patients, and the length of hospital stay was 5 days for delayed endoscopy versus 6 days for early endoscopy.

The investigative team reported that none of the differences between the 2 groups in these parameters were statistically significant and that no patients died.

Dr “Schacher’s team concludes, “Early endoscopy in an emergency room does not improve the clinical outcome in our 81 consecutive patients with bleeding peptic ulcer.”

Endoscopy 2005; 37: 324-328
18 April 2005

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