Timing Of Upper Endoscopy Affects The Outcome and Survival in Patients With Acute Variceal Bleeding: Breaking The Roles Whatever The Cost?

Aims The timing of endoscopy is important in the management of patients with upper GI bleeding (UGIB). The need for urgent endoscopy is still a matter of debate. The aim was to postulate predictable parameters of adverse outcomes if urgent endoscopy was delayed and if the outcome differs after urgent from non-urgent endoscopy.

Methods the patients were randomly assigned into a study group (n = 100) which were exposed to urgent endoscopy within 6 hours or a control group that was prepared for 24 hours. Glasgow Blatchford score (GBS) was used for risk stratification of UGIB. Inclusion criteria: Acute UGIB, systolic pressure ≥ 90 mmHg, hemoglobin ≥7gm/dl, creatinine <2 mg. Exclusion criteria were Hemodynamic instability after 3 hours of intravascular volume replacement, associated acute respiratory failure, acute myocardial infarction, acute renal failure. Laboratory investigations included liver, kidney function tests, complete blood count, D-dimer, serum lactate, and serum procalcitonin.

Results Death occurred in the control group despite stabilization (10/100, 10 %, p=0.000) and longer ICU stay. Urgent endoscopy in a short time 5.05±1.3 minutes due to esophageal varices grade 3-4 in (65/100), spurter on esophageal varices (17/100), subcardiac spurter (9/100), actively bleeding fundal varix in (5/100), death occurred in 4 (4 %) patients due to hypovolemic shock before endoscopy.Survival correlated with ALT(p=0.003), serum creatinine(p=0.026), D.dimer (p=0.000), serum lactate (p=0.000), procalcitonin (p=0.02), GBS(p=0.000), duration of procedure (p=0.000). Logistic regression showed that D.dimer [odd’s ratio (OR)9.9], serum lactate (OR 5.2), pro-calcitonin (OR 4.3), GBS (OR1.85) were associated with reduced survival if endoscopy was delayed (OR 2.1). Serum lactate at a cut off value of 3.6 mmol/l, D dimer at 350, procalcitonin at 3.8ng/ml, GBS at cutoff 14 necessitated doing urgent endoscopy.

Conclusions The decision for urgent endoscopy was guided by prognostic markers as serum lactate, procalcitonin, D dimer, and GBS which if increased above cutoff values are associated with poor survival.

Citation: Hanafy A OP194 TIMING OF UPPER ENDOSCOPY AFFECTS THE OUTCOME AND SURVIVAL IN PATIENTS WITH ACUTE VARICEAL BLEEDING: BREAKING THE ROLES WHATEVER THE COST?. Endoscopy 2021; 53: S80.

Publication History

Article published online:
19 March 2021