A team from the USA determined whether early versus delayed endoscopy improves patient and economic outcomes, for all risk groups with non-variceal upper gastrointestinal tract hemorrhage.
A systematic review of 3 computerized databases was performed, along with hand-searching of published abstracts, to identify English-language citations from 1980 to 2000.
The researchers found 23 studies that met explicit inclusion criteria.
|Early endoscopy significantly reduces length of stay.
|Archives of Internal Medicine|
The highest-quality study examined outcomes in low-risk patients. It found no significant complications at 1-month follow-up, for any outpatients managed with early endoscopy.
The largest randomized trial of high-risk patients showed no mortality benefit with early endoscopy. However, a significant decrease in transfusion requirements was noted.
Eight studies examined the effect of early endoscopy on length of stay, as a measure of resource utilization. Of these, 7 demonstrated a significant reduction in the duration of stay, compared with that of delayed endoscopy.
The majority of the studies included were, however, found to suffer from one or more potentially significant methodological shortcomings.
Dr Brennan Spiegel, of the Cedars-Sinai Medical Center, Los Angeles, California, said on behalf of fellow authors, "The overwhelming majority of existing data suggest that early endoscopy is safe and effective for all risk groups.
"The clinical and economic outcomes of early endoscopy should be confirmed, in additional well-designed, randomized controlled trials.
"Given the strength of the evidence, efforts to develop a more standardized and time-sensitive approach to acute non-variceal upper gastrointestinal tract hemorrhage should be undertaken," it was concluded.