Optimal timing of endoscopy for acute upper gastrointestinal bleeding: a systematic review and meta-analysis

Merola, Elettra; Michielan, Andrea; Pretis, G. De

doi:10.1007/s11739-020-02563-1

Cited by 5 publications

(2 citation statements)

References 27 publications

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“…To date, there are no RCTs designed to randomly allocate endoscopy timing in UGIB patients based on their likelihood of harboring HRS [ 26 ]. Nonetheless, in certain high-risk groups (e.g.…”

Section: Discussionmentioning

confidence: 99%

Superiority of urgent vs early endoscopic hemostasis in patients with upper gastrointestinal bleeding with high-risk stigmata

Horibe

Iwasaki

Matsuzaki

et al. 2021

Gastroenterology Report

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Background Guidelines recommend that all patients with upper gastrointestinal bleeding (UGIB) undergo endoscopy within 24 h. It is unclear whether a subgroup may benefit from an urgent intervention. We aimed to evaluate the influence of endoscopic hemostasis and urgent endoscopy on mortality in UGIB patients with high-risk stigmata (HRS). Methods Consecutive patients with suspected UGIB were enrolled in three Japanese hospitals with a policy to perform endoscopy within 24 h. The primary outcome was 30-day mortality. Endoscopic hemostasis and endoscopy timing (urgent, ≤6 h; early, >6 h) were evaluated in a regression model adjusting for age, systolic pressure, heart rate, hemoglobin, creatinine, and variceal bleeding in multivariate analysis. A propensity score of 1:1 matched sensitivity analysis was also performed. Results HRS were present in 886 of 1966 patients, and 35 of 886 (3.95%) patients perished. Median urgent-endoscopy time (n = 769) was 3.0 h (interquartile range [IQR], 2.0–4.0 h) and early endoscopy (n = 117) was 12.0 h (IQR, 8.5–19.0 h). Successful endoscopic hemostasis and urgent endoscopy were significantly associated with reduced mortality in multivariable analysis (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.09–0.52; P = 0.0006, and OR, 0.37; 95% CI, 0.16–0.87; P = 0.023, respectively). In a propensity-score-matched analysis of 115 pairs, adjusted comparisons showed significantly lower mortality of urgent vs early endoscopy (2.61% vs 7.83%, P < 0.001). Conclusions A subgroup of UGIB patients, namely those harboring HRS, may benefit from endoscopic hemostasis and urgent endoscopy rather than early endoscopy in reducing mortality. Implementing triage scores that predict the presence of such lesions is important.

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Section: Discussionmentioning

confidence: 99%

Superiority of urgent vs early endoscopic hemostasis in patients with upper gastrointestinal bleeding with high-risk stigmata

Horibe

Iwasaki

Matsuzaki

et al. 2021

Gastroenterology Report

View full text Add to dashboard Cite

show abstract

“…One review found that early endoscopy was safe and helpful in patients with acute UGIB, while others showed that it did not enhance clinical outcomes such as recurrent bleeding, mortality, or length of stay (LOS). [22][23][24][25] Furthermore, four recent randomized controlled studies (RCTs) with varied definitions of time have also yielded conflicting findings. Only one study by Lee et al 26 concluded that the early procedure performed within 2 hours after admission was associated with a significant reduction in hospitalization, but there was a lack of consensus among the other three studies as to whether or not patients would benefit from very early procedures within 6 or 12 hours.…”

Section: Introductionmentioning

confidence: 99%

Does Early Endoscopy Affect the Clinical Outcomes of Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding? A Systematic Review and Meta-Analysis

et al. 2022

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Background/Aims: In patients with acute nonvariceal upper gastrointestinal bleeding (ANVU-GIB), the optimal timing of endoscopy is still a matter of dispute. We conducted a systematic review and meta-analysis to determine the clinical benefit of early endoscopy. Methods:A literature search of the MEDLINE, Embase, and Cochrane databases was conducted to identify publications from inception to March 1, 2022. Eligible studies included observational cohort studies and randomized controlled trials that reported clinical outcomes of endoscopy in patients with ANVUGIB. ANVUGIB patients who underwent endoscopy within 24 hours of admission were considered to have had an early endoscopy. The primary outcome was the mortality rate in ANVUGIB patients who had early or nonearly endoscopy. Results:The final analysis included five randomized controlled studies (RCTs) and 20 observational studies from the 1,206 identified articles. The mortality rate was not significantly reduced among patients who received endoscopy performed within 24 hours, whether in cohort studies nor in RCTs. For subgroup analysis, a higher mortality rate was found only among patients who received very early endoscopy within 12 hours (odds ratio, 1.66; p<0.001, I 2 =0) in cohort studies. No significant difference in mortality rates was found among patients at high risk of bleeding who received early versus nonearly endoscopy. Conclusions:Early endoscopy within 24 hours does not appear to significantly reduce the mortality rates of patients with ANVUGIB. Further well-designed studies are warranted to address if very early endoscopy within 12 hours can provide a clinical benefit for patients at high risk of bleeding.

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The interaction of patients’ physical status and time to endoscopy on mortality risk in patients with upper gastrointestinal bleeding: A national prospective cohort study

Bucci,

Marmo,

Soncini

et al. 2023

Digestive and Liver Disease

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Optimal timing of endoscopy for acute upper gastrointestinal bleeding: a systematic review and meta-analysis

Cited by 5 publications

References 27 publications

Superiority of urgent vs early endoscopic hemostasis in patients with upper gastrointestinal bleeding with high-risk stigmata

Superiority of urgent vs early endoscopic hemostasis in patients with upper gastrointestinal bleeding with high-risk stigmata

Does Early Endoscopy Affect the Clinical Outcomes of Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding? A Systematic Review and Meta-Analysis

The interaction of patients’ physical status and time to endoscopy on mortality risk in patients with upper gastrointestinal bleeding: A national prospective cohort study

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