Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding

Abstract

AIMTo examine the association between the timing of endoscopy and the short-term outcomes of acute variceal bleeding in cirrhotic patients.METHODSThis retrospective study included 274 consecutive patients admitted with acute esophageal variceal bleeding of two tertiary hospitals in Korea. We adjusted confounding factors using the Cox proportional hazards model and the inverse probability weighting (IPW) method. The primary outcome was the mortality of patients within 6 wk.RESULTSA total of 173 patients received urgent endoscopy (i.e., ≤ 12 h after admission), and 101 patients received non-urgent endoscopy (> 12 h after admission). The 6-wk mortality rate was 22.5% in the urgent endoscopy group and 29.7% in the non-urgent endoscopy group, and there was no significant difference between the two groups before (P = 0.266) and after IPW (P = 0.639). The length of hospital stay was statistically different between the urgent group and non-urgent group (P = 0.033); however, there was no significant difference in the in-hospital mortality rate between the two groups (8.1% vs 7.9%, P = 0.960). In multivariate analyses, timing of endoscopy was not associated with 6-wk mortality (hazard ratio, 1.297; 95% confidence interval, 0.806-2.089; P = 0.284).CONCLUSIONIn cirrhotic patients with acute variceal bleeding, the timing of endoscopy may be independent of short-term mortality.

Optimal endoscopy timing in patients with acute variceal bleeding: A systematic review and meta-analysis

“…However, the severity index was not significantly different between the urgent and non-urgent groups in each study (Supplementary Table 2). In addition, the main outcomes, such as mortality and rebleeding rates, did not show significant differences between the two groups after propensity score matching in the two studies 5,7 . Although randomized controlled trials are recognized as the best way for overcoming this limitation, it would be difficult because of obvious ethical issues.…”

“…However, they included only patients who presented with hemodynamically www.nature.com/scientificreports www.nature.com/scientificreports/ stable variceal bleeding. More recently, in two studies published in Korea, endoscopy timing was not associated with morality or rebleeding in patients with AVB 5,7 . They included more patients than the previous studies and adjusted for various confounders by performing propensity score matching.…”

“…The proportion of patients with oesophageal varix bleeding was greater than that of the patients with gastric varix bleeding in the pooled analysis. All the studies included in the meta-analysis showed 6-week mortality 5,7,8 or in-hospital mortality 6,9 as main outcomes. The cause of death was reported in two studies 6,8 .…”

Emergent Transjugular Intrahepatic Portosystemic Shunt Creation in Acute Variceal Bleeding

“…57 Timing remains debated, as others report no overall impact on mortality with delayed endoscopy in stable patients. 56,58,59 While EV hemorrhage is typically treated by combination EVL and splanchnic vasoconstriction, 3,4,25,48 GV hemorrhage is often difficult to ameliorate by EVL secondary to anatomic considerations, and suboptimal EVL can lead to ulceration and subsequent bleeding. 31,60 While a meta-analysis has shown that cyanoacrylate glue is associated with lower rebleeding rates in GVs, EVL and EIS have comparable rates of hemostasis.…”

Hemorragia digestiva alta por hipertensão portal em crianças: descrição e análise dos atendimentos em Emergência Pediátrica

“…Na literatura até o momento existem poucos estudos 16,33,34,35,36 ; além do nosso que avaliaram pacientes pediátricos com hemorragia gastrointestinal em pronto socorro, sendo que o presente estudo é o único a avaliar crianças com hipertensão portal com foco na realização das EDAs de urgência. 41,42 . De fato, alguns estudos em adultos demonstraram associação negativa entre mortalidade/recorrência de sangramento e EDA precoce, especialmente em pacientes com hematêmese como queixa inicial de entrada, porém na população pediátrica presente em nosso estudo, não encontramos essa associação 43 .…”