Cardiovascular disease, hypertension, polyp size, and polyp location were associated with delayed PPB. More caution is needed when removing polyps in patients with these risk factors. Future studies are warranted to determine appropriate preventive hemostatic measures in these patients.

The shock index is a good tool to identify patients with the potential for short-term adverse outcomes when they present with UGIB. It performs as well as other risk-scoring tools for GI bleeding and has the potential for serial use during hospitalization to identify changes in the clinical course.

Background and Aim Same‐visit colonoscopy and esophagogastroduodenoscopy (EGD) have become common. Recent studies showed conflicting results regarding the performance, safety, and efficacy of different sequences. We conducted this meta‐analysis to determine the most favorable performance and discomfort between an EGD followed by colonoscopy (E‐C) and colonoscopy followed by EGD (C‐E). Methods The authors searched the databases of MEDLINE and EMBASE. Outcomes of interest were performance (including cecal intubation time, adenoma detection rate, and polyp detection rate), discomfort score (patients and endoscopists; Likert scale), and sedation uses. Pooled mean differences (MD) or odds ratios (OR) were calculated with 95% confidence intervals (CI). Results Six randomized controlled trials were included in the meta‐analysis. The authors found that there was significantly lower sedative use including fentanyl (14.70; 95% Cl: 8.20–21.20) and propofol (15.58; 95% Cl: 3.27–27.89) in the E‐C group compared with the C‐E group. There was a significantly better discomfort score in patients and endoscopists after both procedures in the E‐C group than in the C‐E group with pooled MD of 0.64 points (95% Cl: 0.09–1.20) and 0.47 (95% Cl: 0.05–0.90), respectively. There were no differences in cecal intubation time, adenoma detection rate, or polyp detection rate between the two groups. Conclusion The present study found that the discomfort score was better in the E‐C group. However, there was no difference in polyp and adenoma detection. Therefore, the E‐C group is the optimal sequence.