Endoscopy for upper gastrointestinal bleeding: how urgent is it?

Tsoi, Kelvin K.F.; Terry, K W; Sung, Joseph J.Y.

doi:10.1038/nrgastro.2009.108

Cited by 67 publications

(40 citation statements)

References 38 publications

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“…Studies of urgent endoscopy 16,17 (ie, endoscopy performed within only a few hours of patient presentation) have not shown any differences in patient outcomes compared with routine timed performance of endoscopy. Several randomized, controlled trials and retrospective cohort studies have examined "very early endoscopy" at less than 2 to 3, less than 6, less than 8, or less than 12 hours compared with endoscopy performed at less than 24 to 48 hours.…”

Section: Timing Of Endoscopymentioning

confidence: 98%

Nonvariceal Upper Gastrointestinal Bleeding

Khamaysi

Gralnek

2015

Gastrointestinal Endoscopy Clinics of North America

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Section: Timing Of Endoscopymentioning

confidence: 98%

Nonvariceal Upper Gastrointestinal Bleeding

Khamaysi

Gralnek

2015

Gastrointestinal Endoscopy Clinics of North America

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“…However, observational studies do not document a benefi t in clinical outcomes of endoscopy performed within 2 -12 h of presentation ( 33,34 ). Observational studies do suggest a benefi t of endoscopy within 24 h aft er admission in terms of decreased length of stay ( 35,36 ) and surgical intervention ( 35 ).…”

Section: Recommendationsmentioning

confidence: 99%

“…Studies of early endoscopy consistently show that patients undergoing endoscopy within 8 h of presentation have more highrisk stigmata (active bleeding, visible vessels, or adherent clots) than those with later endoscopies ( 34 ), thereby increasing the proportion who requires endoscopic therapy. However, observational studies do not document a benefi t in clinical outcomes of endoscopy performed within 2 -12 h of presentation ( 33,34 ).…”

Section: Recommendationsmentioning

confidence: 99%

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Management of Patients With Ulcer Bleeding

Laine

Jensen

2012

American Journal of Gastroenterology

648

547

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Ulcers are the most common cause of hospitalization for upper gastrointestinal bleeding (UGIB), and the vast majority of clinical trials of therapy for nonvariceal UGIB focus on ulcer disease. Th is guideline provides recommendations for the management of patients with overt UGIB due to gastric or duodenal ulcers. "Overt" indicates that patients present with symptoms of hematemesis, melena, and/or hematochezia. We fi rst discuss the initial management of UGIB in patients without known portal hypertension, including initial assessment and risk stratifi cation, pre-endoscopic use of medications and gastric lavage, and timing of endoscopy. We then focus on the endoscopic and medical management of ulcer disease, including endoscopic fi ndings and their prognostic implications, endoscopic hemostatic therapy, post-endoscopic medical therapy and disposition, and prevention of recurrent ulcer bleeding.Each section of the document presents the key recommendations related to the section topic, followed by a summary of the supporting evidence. A summary of recommendations is provided in Table 1 .A search of MEDLINE via the OVID interface using the MeSH term " gastrointestinal hemorrhage " limited to " all clinical trials " and " meta-analysis " for years 1966 -2010 without language restriction as well as review of clinical trials and reviews known to the authors were performed for preparation of this document. Th e GRADE system was used to grade the strength of recommendations and the quality of evidence ( 1 ). Th e quality of evidence, which infl uences the strength of recommendation, ranges from " high " (further research is very unlikely to change our confi dence in the estimate of eff ect) to " moderate " (further research is likely to have an important impact on our confi dence in the estimate of eff ect and may change the estimate) to " low " (further research is very likely to have an important impact on our confi dence in the estimate of eff ect and is likely to change the estimate), and " very low " (any estimate of eff ect is very uncertain). Th e strength of a recommendation is graded as strong when the desirable eff ects of an intervention clearly outweigh the undesirable eff ects and is graded as conditional when uncertainty exists about the trade-off s ( 1 ). In addition to quality of evidence and balance between desirable and undesirable eff ects, other factors aff ecting the strength of recommendation include variability in values and preferences of patients, and whether an intervention represents a wise use of resources ( 1 ). 2. Blood transfusions should target hemoglobin ≥ 7 g / dl, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or comorbidities, such as coronary artery disease (Conditional recommendation). Management of Patients With Ulcer Bleeding3. Risk assessment should be performed to stratify patients into higher and lower risk categories and may assist in initial decisions such as timing of endoscopy, time of discharge, and level of care (Cond...

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“…[17][18][19] A general consensus has emerged that, in acute gastrointestinal bleeding, endoscopy should be performed within 24 h of presentation. Although the outcomes of these studies have provided a framework and resulted in guidelines for the general management of gastrointestinal bleeding, they cannot provide the answers to all specific problems that arise in clinical decision making centred on individual patients.…”

Section: Discussionmentioning

confidence: 99%

Timing of endoscopy in gastrointestinal bleeding

Sonnenberg

2014

UEG Journal

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Background: In gastrointestinal bleeding, a physician often has to make a decision between two possible choices. Endoscopic management of the bleeding could be initiated immediately, or it could be delayed until the patient has become haemodynamically stable or the conditions for a successful endoscopy have otherwise improved. Objective: The present article serves to present such situations and highlights their characteristic features. Methods: The choice between immediate and delayed endoscopy is analysed in terms of a decision tree, comparing the expected results of the two management alternatives. The decision tree is applied to three different clinical scenarios associated with gastrointestinal bleeding, where performing endoscopy later rather than sooner represents the preferred management option. Results: The work up of chronic iron-deficient anaemia in patients with serious cardiac problems should be deferred until resolution of their reduced cardiovascular status. It is also recommended that, even in acute bleeding, endoscopy is deferred until the patient has become haemodynamically stable. Lastly, for nonemergency treatment of oesophageal varices bleeding, a long rather than short interval between consecutive banding sessions appears more beneficial. Conclusions:The results illustrate how to use threshold analysis as a simple bedside tool to solve seemingly complex decisions associated with management of gastrointestinal bleeding.

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Endoscopy for upper gastrointestinal bleeding: how urgent is it?

Cited by 67 publications

References 38 publications

Nonvariceal Upper Gastrointestinal Bleeding

Nonvariceal Upper Gastrointestinal Bleeding

Management of Patients With Ulcer Bleeding

Timing of endoscopy in gastrointestinal bleeding

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