Contribution of Gastroscopy in Non-Variceal Upper Gastrointestinal Bleeding and Predictive Factors for the Need for Endoscopic Treatment

Aims Upper gastrointestinal bleeding (UGIB) remains a frequent cause of emergency hospitalization in hepatogastroenterology. UGIB can be broadly classified into variceal and non-variceal types, with the latter being more common and the focus of our study.The aim of this study was to assess the role of gastroscopy in non-variceal UGIB and to identify predictive factors for the need for endoscopic hemostasis.

Methods This was a prospective, monocentric, cross-sectional study involving 261 patients, conducted over one year from June 2023 to August 2024 in the emergency endoscopy unit of our hospital.Data regarding demographic, clinical, endoscopic, and therapeutic characteristics were collected and analyzed using SPSS software version 22.0.

Results The mean age of the patients was 58±17 years (range: 17–90 years), with a marked male predominance (72%; sex ratio: 2.57). Comorbidities were present in 28.7% of patients, with 19.9% having a history of antithrombotic use.Proton pump inhibitors (PPIs) via a syringe pump (SP) were administered to 91% of patients before endoscopy.The primary etiologies identified by esophagogastroduodenoscopy (EGD) were duodenal ulcer (24.1%), gastric ulcer (11.9%), esophagitis (16.1%), erosive gastritis/duodenitis (31%), gastric malignancy (7.7%), esophageal malignancy (3.1%), duodenal malignancy (1.9%), and angiodysplasia (3.1%).Active bleeding during endoscopy was observed in 11.9% of cases, and endoscopic hemostasis was performed in 6.5% of cases. However, surgery was required in three patients due to bleeding that was not amenable to endoscopic treatment.Multivariate analysis, adjusting for variables such as age, sex, comorbidities, active bleeding, and pre-endoscopy PPI administration via SP, revealed that active bleeding and SP-PPI administration significantly influenced the need for endoscopic hemostasis. Active bleeding during endoscopy increased the risk of requiring endoscopic hemostasis by a factor of 15.17 (OR: 15.17; CI: 6.08–67.87; p<0.001), whereas SP-PPI use appeared to reduce this risk (OR: 0.249; CI: 0.093–0.668; p=0.006).

Conclusions Non-variceal UGIB remains predominantly ulcer-related. Pre-endoscopy PPI administration appears to improve the quality of the endoscopic procedure. Active bleeding during EGD is a strong predictor of the need for endoscopic hemostasis, while SP-PPI use prior to EGD may reduce the likelihood of requiring this intervention.

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Artikel online veröffentlicht:
27. März 2025