High-risk ED patients with nonvariceal upper gastrointestinal hemorrhage undergoing emergency or urgent endoscopy: a retrospective analysis

Tai, Chi‐Ming; Huang, Shih-Pei; Wang, Hsiu-Po; Lee, Tsung-Chun; Chang, Chi‐Yang; Tu, Chia‐Hung; Lee, Ching‐Tai; Chiang, Tung‐Liang; Lin, Jaw‐Town; Wu, Ming–Shiang

doi:10.1016/j.ajem.2006.07.014

Cited by 69 publications

(63 citation statements)

References 17 publications

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“…Although there was no evidence of a better clinical outcome-i.e. rebleeding and mortality-after a very early endoscopy in some retrospective series [19][20][21][22] , our study shows that endoscopic therapy is necessary in most of the clinically severe cases. Since an effective endoscopic haemostasis has been associated with a better outcome for both variceal and non-variceal UGIB [8,9] , it may be conservatively advised to perform a very early endoscopy, at least in patients in more severe conditions.…”

Section: Discussionmentioning

confidence: 99%

“…However, within this period of time, it is still unclear whether it should be performed either very early-i.e. within 2 h-or in a more delayed interval, such as after 6, 12 or 24 h. In particular, some retrospective series did not show a clear advantage for early versus delayed urgent endoscopy [19][20][21][22] . However, in clinical practice, the endoscopist may be expected to be called by the emergency department immediately after the hospital admission of the bleeding patient, making it his responsibility to proceed towards an immediate procedure or delaying it up to 12 or 24 h. Legal aspects are clearly entailed in this decisional process, so that, in the absence of clear data, endoscopists may be expected to rush in the endoscopic units, even in low-risk cases.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic findings in patients with upper gastrointestinal bleeding clinically classified into three risk groups prior to endoscopy

Tammaro,

Paolo,

Zullo

et al. 2008

WJG

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AIM:To investigate in a prospective study whether a simplified clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy. METHODS: All consecutive UGIB patients referred to a single endoscopic center during a 16 mo period were enrolled. Before endoscopy patients were stratified according to a simple clinical score (T-score), including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk). Endoscopy was performed in all cases within 2 h, and high-risk stigmata were considered for further analysis. RESULTS: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2, and 175 (40%) T3. Overall, stigmata of recent haemorrhage (SRH) were detected in 118 cases (27%). SRH occurred more frequently in T1 patients than in T2/T3 cases (85% vs 3.2%; c 2 = 304.5309, P < 0.001). Older age (t = 3.311; P < 0.01) and presence of comorbidities (c 2 = 14.7458; P < 0.01) were more frequently detected in T1 than in T2/T3 patients. CONCLUSION: Our simplified clinical score appeared to be associated with the detection of endoscopic findings which may deserve urgent endoscopy. A further, randomised study is needed to assess its accuracy in safely scheduling endoscopy in UGIB patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic findings in patients with upper gastrointestinal bleeding clinically classified into three risk groups prior to endoscopy

Tammaro,

Paolo,

Zullo

et al. 2008

WJG

View full text Add to dashboard Cite

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“…Randomized controlled trials [2][3][4] and observational studies [5][6][7] have compared the outcome of endoscopy performed within 2 to 24 hours with a later endoscopy, without finding any difference in M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT mortality. Limitations of existing randomized controlled trials include insufficient inclusion of highrisk patients resulting in low mortality rates (0%-3.7%), [2][3][4] small sample sizes (n=93-325), [2][3][4] exclusion of patients with hemodynamic instability, 2 lack of use of proton pump inhibitors, 4 and lack of power calculation.…”

Section: Introductionmentioning

confidence: 99%

Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study

Laursen

Leontiadis

Stanley

et al. 2017

Gastrointestinal Endoscopy

121

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“…Trois essais randomisés et contrôlés et une méta-analyse n'ont pas montré de bénéfice à la réalisation plus précoce (< 12 heures) d'une EOGD pour ce qui concerne la récidive hémorragique (odds ratio [1,[16][17][18][19][20][21][22][23][24]. L'endoscopie très précoce pourrait toutefois s'avérer utile pour les patients à haut risque dans certains travaux [15,19,21,24].…”

Section: Hémorragie Digestive Et Patients à Haut Risqueunclassified

Quand et dans quel délai faut-il faire une endoscopie en urgence pour hémorragie digestive haute ?

Nahon

2012

Acta Endosc

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Quand et dans quel délai faut-il faire une endoscopie en urgence pour hémorragie digestive haute ?When and how soon an emergency endoscopy for upper gastrointestinal bleeding must be done? S. Nahon © Springer-Verlag France 2012 Résumé L'utilité de l'endoscopie au cours des hémorragies digestives hautes (HDH) n'est plus à démontrer. Elle doit être réalisée dans les 24 heures suivant l'admission selon les recommandations des sociétés savantes et de la dernière conférence de consensus internationale. Tout d'abord, elle n'est pas associée à un risque accru de complications quand elle est réalisée précocement. De plus, une endoscopie pré-coce permet, dans la plupart des études, une diminution de la durée d'hospitalisation, du recours à la chirurgie et probablement de la mortalité. Dans le sous-groupe des patients chez lesquels une hémorragie digestive par rupture de varices oesophagiennes est suspectée, l'endoscopie est préconisée dans les 12 heures suivant l'admission. Enfin, chez les patients à haut risque, une endoscopie la plus précoce possible doit être envisagée, car elle permettrait d'améliorer le pronostic. Afin de minimiser un éventuel impact négatif du week-end sur le délai de réalisation de l'endoscopie, et donc d'induire un pronostic plus défavorable, une astreinte endoscopique sept jours sur sept (idéalement, un endoscopiste confirmé et une aide spécialisée dans un local adapté) paraît nécessaire. Mots clésHémorragie digestive haute · Endoscopie · Pronostic · Délai · Week-end Abstract The usefulness of endoscopy in upper gastrointestinal bleeding is well established. It must be done within 24 hours of admission, according to the recommendations of scientific societies and the last international consensus conference. First of all, early endoscopy is not associated with an increased risk of complications. In addition, early endoscopy, in most studies, allows a decrease in the duration of hospitalization, the use of surgery and probably mortality. In the subgroup of patients with suspected digestive hemorrhage by variceal rupture, endoscopy is advocated within 12 hours of admission. Finally, in high-risk patients, early endoscopy has to be considered, because it would improve the prognosis. To minimize a possible negative impact of the weekend on the use of endoscopy and thus a worse prognosis, an on-call endoscopy seven days a week (a confirmed endoscopist and specialized assistance) seems necessary.

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High-risk ED patients with nonvariceal upper gastrointestinal hemorrhage undergoing emergency or urgent endoscopy: a retrospective analysis

Cited by 69 publications

References 17 publications

Endoscopic findings in patients with upper gastrointestinal bleeding clinically classified into three risk groups prior to endoscopy

Endoscopic findings in patients with upper gastrointestinal bleeding clinically classified into three risk groups prior to endoscopy

Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study

Quand et dans quel délai faut-il faire une endoscopie en urgence pour hémorragie digestive haute ?

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