Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study.
OBJECTIVE
The optimal timing of endoscopy in patients with peptic ulcer bleeding (PUB) remains unclear. The aim of this study was to examine the association between timing of endoscopy and mortality in PUB.


METHODS
In a nationwide cohort study based on a database of consecutive patients admitted to the hospital with PUB in Denmark, patients were stratified according to the presence of hemodynamic instability at presentation and American Society of Anesthesiologists (ASA) score. Using descriptive statistics and logistic regression analyses, we identified optimal time frames for endoscopy and analyzed the association between timing of endoscopy and in-hospital mortality after adjusting for confounding factors.


RESULTS
In total, 12,601 patients were included. We did not find any universal association between timing of endoscopy and mortality in hemodynamically stable patients with an ASA score of 1 to 2. In hemodynamically stable patients with an ASA score of 3 to 5, endoscopy 12 to 36 hours after admission to the hospital was associated with lower in-hospital mortality (OR, .48; 95% CI, .34-.67) compared with endoscopy outside this time frame. In patients with hemodynamic instability, endoscopy 6 to 24 hours after admission to the hospital was associated with lower in-hospital mortality (OR, .73; 95% CI, .54-.98) compared with endoscopy outside this time frame.


CONCLUSIONS
Timing of endoscopy is associated with mortality in patients with PUB and an ASA score of 3 to 5 or hemodynamic instability. Our findings suggest that in these patients, a period of time to optimize resuscitation and manage comorbidities before endoscopy may improve outcome.
Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.
Stig B
SB
Laursen
Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada.
Grigorios I
GI
Leontiadis
Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom.
Adrian J
AJ
Stanley
Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Morten H
MH
Møller
Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.
Jane M
JM
Hansen
Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.
Ove B
OB
Schaffalitzky de Muckadell
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D003718:Denmark; D019468:Disease Management; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D016558:Hemostasis, Endoscopic / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D012042:Registries; D012151:Resuscitation; D012189:Retrospective Studies; D013997:Time Factors