title: Urgent endoscopy is associated with lower mortality in high-risk but not low-risk nonvariceal upper gastrointestinal bleeding.
abstract: OBJECTIVE
  The role of urgent endoscopy in high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) is unclear. The aim of this study was to determine whether esophagogastroduodenoscopy (EGD) performed sooner than the currently recommended 24 h in high-risk patients presenting with NVUGIB is associated with lower all-cause in-hospital mortality.
  
  
  METHODS
  All adult patients undergoing EGD for the indications of coffee-grounds vomitus, hematemesis or melena at a university hospital over an 18-month period were enrolled. Patients with variceal and lower gastrointestinal bleeding were excluded. Data were prospectively collected.
  
  
  RESULTS
  A total of 934 patients were included. The area under the receiver operating characteristic curve (AUROC) for the Glasgow-Blatchford score (GBS) was 0.813 for predicting all-cause in-hospital mortality, with a cut-off score of ≥ 12 resulting in 90 % specificity. In low-risk patients with GBS < 12, presentation-to-endoscopy time in those who died and in those who survived was similar. In high-risk patients with GBS of ≥ 12, presentation-to-endoscopy time was significantly longer in those who died than in those who survived. Multivariate analysis of the high-risk cohort showed presentation-to-endoscopy time to be the only factor associated with all-cause in-hospital mortality. For high-risk patients, the AUROC for presentation-to-endoscopy time in predicting all-cause in-hospital mortality was 0.803, with a sensitivity of 100 % at the cut-off time of 13 h. All-cause in-hospital mortality in high-risk patients was significantly higher in those with presentation-to-endoscopy time of > 13 h compared with those undergoing endoscopy in < 13 h from presentation (44 % vs. 0 %; P < 0.001).
  
  
  CONCLUSIONS
  Endoscopy within 13 h of presentation was associated with lower mortality in high-risk but not low-risk NVUGIB.
authors.affiliation: Department of Gastroenterology and Hepatology, National University Health System, Singapore.
authors.forename: L G
authors.initials: LG
authors.lastname: Lim
authors.forename: K Y
authors.initials: KY
authors.lastname: Ho
authors.forename: Y H
authors.initials: YH
authors.lastname: Chan
authors.forename: P L
authors.initials: PL
authors.lastname: Teoh
authors.forename: C J
authors.initials: CJ
authors.lastname: Khor
authors.forename: L L
authors.initials: LL
authors.lastname: Lim
authors.forename: A
authors.initials: A
authors.lastname: Rajnakova
authors.forename: T Z
authors.initials: TZ
authors.lastname: Ong
authors.forename: K G
authors.initials: KG
authors.lastname: Yeoh
mesh_terms: D000208:Acute Disease; D000368:Aged; D004630:Emergencies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000628:therapy; D016558:Hemostasis, Endoscopic; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis