Urgent endoscopy is associated with lower mortality in high-risk but not low-risk nonvariceal upper gastrointestinal bleeding

Lim, Lee Yong; Ho, Khek Yu; Chan, Yi‐Hsin; Teoh, Pui Li; Khor, Christopher Jen Lock; Lim, Li Lin; Rajnakova, Andrea; Ong, Tze-Zen; Yeoh, Khay Guan

doi:10.1055/s-0030-1256110

Cited by 160 publications

(130 citation statements)

References 14 publications

(20 reference statements)

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“…27 On the other hand, another study from Singapore demonstrated that endoscopy within 13 hours reduced mortality by 44% in patients with high-risk nonvariceal bleeding. 28 Youn et al 10 also found that if endoscopy was performed within 24 hours of admission, the mortality due to peptic ulcer bleeding would be reduced to 1.8% as compared to 6%7% in previous reports. However, the sample size of these studies was relatively small; fewer than 1000 patients were included for analysis.…”

Section: Discussionmentioning

confidence: 91%

The effect of off-hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta-analysis of 20 cohorts

Xia

Chiu

Tsoi

et al. 2017

United European Gastroenterology Journal

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Objective: The objective of this article is to evaluate the relationship between off-hours hospital admission (weekends, public holidays or nighttime) and mortality for upper gastrointestinal hemorrhage (UGIH). Methods: Medline, Embase, Scopus, and the Chinese Biomedical Literature were searched through December 2016 to identify eligible records for inclusion in this meta-analysis. A random-effects model was applied. Results: Twenty cohort studies were included for analysis. Patients with UGIH who were admitted during off-hours had a significantly higher mortality and were less likely to receive endoscopy within 24 hours of admission. In comparison to variceal cases, patients with nonvariceal bleeding showed a higher mortality when admitted during off-hours. However, for studies conducted in hospitals that provided endoscopy outside normal hours, off-hours admission was not associated with an increased risk of mortality. Conclusion: Our study showed a higher mortality for patients with nonvariceal UGIH who were admitted during off-hours, while this effect might be offset in hospitals with a formal out-of-hours endoscopy on-call rotation.

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Section: Discussionmentioning

confidence: 91%

The effect of off-hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta-analysis of 20 cohorts

Xia

Chiu

Tsoi

et al. 2017

United European Gastroenterology Journal

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“…As mentioned above, a majority of these patients with a bloody aspirate had systolic blood pressure < 100 mm Hg and pulse > 100 beats / minute. A recent observational study also found a signifi cantly higher mortality in high-risk UGIB patients (Blatchford score ≥ 12) having endoscopy > 13 h aft er presentation (44 % ) than in those having earlier endoscopy (0 % , P < 0.001) ( 39 ). Multivariate analysis found that presentation-to-endoscopy time was the only variable signifi cantly associated with mortality.…”

Section: Patients With Ugib Should Generally Undergo Endoscopy Withinmentioning

confidence: 89%

Management of Patients With Ulcer Bleeding

Laine

Jensen

2012

American Journal of Gastroenterology

638

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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“…Erythromycin has been also compared to nasogastric tube with gastric lavage and associated with satisfactory endoscopic conditions (38). Contrarily, the benefit of using metoclopramide has been questioned by some authors who report no improvement in the visualization of the gastric mucosa (39). Taking these results into account, erythromycin (single dose, 250 mg given 30-120 minutes prior to endoscopy) seems to be the preferred prokinetic and should be used when a large amount of blood is expected in the stomach (7).…”

Section: Pre-endoscopic Treatmentmentioning

confidence: 99%

New insights on an old medical emergency: non-portal hypertension related upper gastrointestinal bleeding

Cúrdia-Gonçalves¹,

Rosa²,

Cotter³

2016

Rev Esp Enferm Dig

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Upper gastrointestinal bleeding (UGIB) is a potentially life-threatening condition and the most common medical emergency managed by gastroenterologists. Despite being one of the most antique medical problems, recent studies have been slowly changing the management of these patients, which should nowadays include not only initial resuscitation, but also risk stratification, pre-endoscopic therapy, endoscopy treatment, and post-procedure care. The aim of this paper is to review the extended approach to the patient with non-portal hypertension related UGIB.

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Urgent endoscopy is associated with lower mortality in high-risk but not low-risk nonvariceal upper gastrointestinal bleeding

Abstract: Endoscopy within 13 h of presentation was associated with lower mortality in high-risk but not low-risk NVUGIB.

Cited by 160 publications

References 14 publications

The effect of off-hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta-analysis of 20 cohorts

The effect of off-hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta-analysis of 20 cohorts

Management of Patients With Ulcer Bleeding

New insights on an old medical emergency: non-portal hypertension related upper gastrointestinal bleeding

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