TIMING OF ENDOSCOPY FOR UPPER GASTROINTESTINAL BLEEDING IN PATIENTS WITH CIRRHOSIS: IS URGENT ENDOSCOPY REALLY NECESSARY?

Aims Current recommendations suggest that patients with cirrhosis presenting with acute upper gastrointestinal bleeding (UGIB) should perform endoscopy as soon as possible within the first 12 hours after admission.

Aim To evaluate whether urgent endoscopy (≤12hours) improves outcomes in patients with cirrhosis complicated with UGIB and to assess it in patients with variceal UGIB versus non-variceal UGIB.

Methods Retrospective cohort study that included consecutive patients with cirrhosis admitted for UGIB between January 2011 and June 2020. Demographic, clinical, laboratory and endoscopy data were obtained. Patients were stratified regarding the timing of endoscopy in urgent (≤12 hours) and early groups (12-24 hours).

Results One hundred forty-nine patients were included, of whom 74.5% were male, with mean age of 57.4±12.1 years, and 65.8% with variceal UGIB. Endoscopy was performed within 12hours in 62.4% of patients, with a median timing of endoscopy of 10.3±6.7hours. Performing endoscopy within 12hours was associated with higher need of endoscopic treatment (44.3% vs 32.9%;p=0.02). There were no significant differences in need for transfusion (p=0.19), length of stay (p=0.84), rebleeding (p=0.15), in-hospital mortality (p=0.59), 30-day mortality (p=0.75) and 30-day readmission (p=0.92), between performing endoscopy within 12 hours versus 12-24hours. Regarding patients with variceal UGIB versus non-variceal UGIB, there were no statistically significant differences in UGIB outcomes in performing endoscopy within 12hours in the two groups.

Conclusions In our cohort, in patients with cirrhosis admitted for acute UGIB, urgent endoscopy was associated with higher need of endoscopic treatment but was not associated with improved outcomes, when compared to early endoscopy.

Publication History

Article published online:
14 April 2022