Timing of upper endoscopy influences outcomes in patients with acute nonvariceal upper GI bleeding.
OBJECTIVE
Current guidelines advise that upper endoscopy be performed within 24 hours of presentation in patients with acute nonvariceal upper GI bleeding (UGIB). However, the role of urgent endoscopy (<12 hours) is controversial. Our aim was to assess whether patients admitted with acute nonvariceal UGIB with lower-risk versus high-risk bleeding have different outcomes with urgent compared with nonurgent endoscopy.


METHODS
A retrospective cohort study was conducted of patients admitted to an academic hospital with nonvariceal UGIB. The primary outcome was a composite of inpatient death from any cause, inpatient rebleeding, need for surgical or interventional radiologic intervention, or endoscopic reintervention. The Glasgow-Blatchford score (GBS) was calculated; lower risk was defined as a GBS < 12, and high risk was defined as a GBS ≥ 12.


RESULTS
Of 361 patients, 37 patients (10%) experienced the primary outcome. Patients who underwent urgent endoscopy had a greater than 5-fold increased risk of reaching the composite outcome (unadjusted odds ratio [OR], 5.6; 95% confidence interval [CI], 2.8-11.4; P < .001). Lower-risk patients who were taken urgently to endoscopy were more likely to reach the composite outcome (adjusted OR, 0.71 per 6 hours; 95% CI, 0.55-0.91; P = .008). However, in the high-risk patients, time to endoscopy was not a significant predictor of the primary outcome (adjusted OR, 0.93 per 6 hours; 95% CI, 0.77-1.13; P = .47; adjusted P for interaction = .039).


CONCLUSIONS
Urgent endoscopy is a predictor of worse outcomes in select patients with acute nonvariceal UGIB.
Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
Navin L
NL
Kumar
Harvard Medical School, Boston, Massachusetts, USA.
Aaron J
AJ
Cohen
Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
Jennifer
J
Nayor
Harvard Medical School, Boston, Massachusetts, USA.
Brian L
BL
Claggett
Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
John R
JR
Saltzman
D000368:Aged; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors