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

Abstract

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.

Examining the Frequency of Second Endoscopy and Its Effect on Patient Outcomes With Upper Gastrointestinal Bleeding in Southeast of Iran

“…However, it is worth noting that some reports indicate variations in the acceptability of endoscopy performed at closely spaced intervals, such as within 12 hours, or longer intervals, such as 72 hours. 24 In the absence of sufficient visibility, it is not possible to diagnose the underlying cause of bleeding and it will be difficult to design a treatment plan. Also, some causes, including hemorrhagic tumors, may be confused with other pathologies in the absence of proper vision, and the diagnosis and treatment of the tumor may be delayed for an even longer time.…”

“…By spacing out the endoscopies, patients generally exhibited improved tolerance, facilitating a more accurate evaluation of the condition. However, it is worth noting that some reports indicate variations in the acceptability of endoscopy performed at closely spaced intervals, such as within 12 hours, or longer intervals, such as 72 hours 24 …”

Endoscopy for acute upper gastrointestinal bleeding: a protocol for systematic review and network meta-analysis of randomized controlled trials

“…However, meta-analyses 11 – 13 published to date have not reached consistent conclusions regarding the timing of endoscopic approaches in managing individuals with AUGIB. Meanwhile, these previous meta-analyses had the following shortcomings: (a) There was very high heterogeneity between studies 12 , 13 . (b) The number of included studies was very small 11 .…”

“…(c) The definitions of ‘very early’ endoscopy and ‘early’ endoscopy were inconsistent 11 . (d) The included studies were published over a 35-years period 11 , 12 . During this time, endoscopic devices improved, and guidelines changed, which may represent a further limitation of these meta-analyses.…”