title: Predictive Factors for Endoscopic Visibility and Strategies for Pre-endoscopic Prokinetics Use in Patients with Upper Gastrointestinal Bleeding.
abstract: BACKGROUND
  Although current guideline recommends selective use of pre-endoscopic prokinetics to increase diagnostic yield in upper gastrointestinal bleeding (UGIB) patients, no data to guide the use of these drugs are available.
  
  
  OBJECTIVE
  We aimed to investigate predictive factors for endoscopic visibility and develop simple and useful strategies for pre-endoscopic prokinetics use in UGIB patients.
  
  
  METHODS
  A total of 220 consecutive patients who underwent upper endoscopy for suspicious UGIB were enrolled. Patients were randomly allocated to either a training or a validation set at a 2:1 ratio. Significant parameters on univariate analysis were subsequently tested by a classification and regression tree (CART) analysis.
  
  
  RESULTS
  Time to endoscopy and nasogastric aspirate findings were independently related to endoscopic visibility. The CART analysis generated algorithms proposed sequential use of time to endoscopy (≤5.2 vs. >5.2 h) and nasogastric aspirate findings (red blood or coffee rounds vs. clear aspirate) for predicting endoscopic visibility. Prediction of unacceptable visibility in the validation set produced sensitivity, specificity, positive predictive value, and negative predictive value of 75.8, 67.5, 65.8, and 77.1 %, respectively. Accurate prediction for visibility was identified in 52 of 73 patients (71.2 %).
  
  
  CONCLUSIONS
  Time to endoscopy and nasogastric aspirate findings were independently related to endoscopic visibility in patients with UGIB. A decision-tree model incorporating these two variables may be useful for selecting UGIB patients who benefit from pre-endoscopic prokinetics use.
authors.affiliation: Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Jun Uk
authors.initials: JU
authors.lastname: Lim
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Park
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Youn
authors.forename: Sunyong
authors.initials: S
authors.lastname: Kim
authors.forename: Jung Won
authors.initials: JW
authors.lastname: Jeon
authors.forename: Sung Won
authors.initials: SW
authors.lastname: Jung
authors.forename: Hyun Phil
authors.initials: HP
authors.lastname: Shin
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Cha
authors.forename: Kwang Ro
authors.initials: KR
authors.lastname: Joo
authors.forename: Joung Il
authors.initials: JI
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D003663:Decision Trees; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D041742:Upper Gastrointestinal Tract / Q000187:drug effects*
chemical_list: D005765:Gastrointestinal Agents