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Year 2022, Volume: 8 Issue: 3, 440 - 449, 31.08.2022

Osman İnan Muhammed Fatih Acehan Buket Karsavuranoğlu Enes Seyda Şahiner Meryem Aslan İhsan Ateş

https://doi.org/10.19127/mbsjohs.1130292

Abstract

References

  • 1. Fallah MA, Prakash C, Edmundowicz S. Acute gastrointestinal bleeding. Med Clin North Am 2000;84(5):1183–208.
  • 2. Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60:1327–1335.
  • 3. Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 1995; 311:222–226.
  • 4. Rosenstock SJ, Møller MH, Larsson H, Johnsen SP, Madsen AH, Bendix J, et al. Improving quality of care in peptic ulcer bleeding: nationwide cohort study of 13,498 consecutive patients in the Danish Clinical Register of Emergency Surgery. Am J Gastroenterol 2013; 108:1449–1457.
  • 5. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000; 356:1318–1321.
  • 6. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38:316–321.
  • 7. Aquarius M, Smeets FG, Konijn HW, Stassen PM, Keulen ET, Van Deursen CT, at al. Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department. Eur J Gastroenterol Hepatol 2015; 27:1011–1016.
  • 8. Bryant RV, Kuo P, Williamson K, Yam C, Schoeman MN, Holloway RH, et al. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc 2013; 78:576–583.
  • 9. Lim LG, Ho KY, Chan YH, Teoh PL, Khor CJ, Lim LL, et al. Urgent endoscopy is associated with lower mortality in high-risk but not low-risk nonvariceal upper gastrointestinal bleeding. Endoscopy 2011;43: 300–306.
  • 10. Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol 2012; 107: 345-60.
  • 11. NICE. Acute upper gastrointestinal bleeding in over 16s: management. Available from: https://www.nice.org.uk/ guidance/cg141. (2012, accessed 20 February 2018).
  • 12. Sacks HS, Chalmers TC, Blum AL, Berrier J, Pagano D. Endoscopic hemostasis: an effective therapy for bleeding peptic ulcers. JAMA 1990; 264:494-9.
  • 13. Bleau BL, Gostout CJ, Shaw MJ, Keate RF, Harford WV, Bracy W Jr, et al. Final results: rebleeding from peptic ulcers associated with adherent clots [abstract]. Gastrointest Endosc 1997;45: AB87.
  • 14. Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992; 102:139-48.
  • 15. Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47(10): a1–46.
  • 16. Joint Advisory Group on Gastrointestinal Endoscopy. Joint Advisory Group on Gastrointestinal Endoscopy (JAG) Global Rating Scale (GRS): Version for acute services (all nations) – April 2016; 2016: 10.
  • 17. Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med 2019; 171: 805-22.
  • 18. Lin HJ, Wang K, Perng CL, Chua RT, Lee FY, Lee CH, et al. Early or delayed endoscopy for patients with peptic ulcer bleeding: a prospective randomized study. J Clin Gastroenterol 1996; 22: 267-71.
  • 19. Lee JG, Turnipseed S, Romano PS, Vigil H, Azari R, Melnikoff N, et al. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 1999; 50: 755-61.
  • 20. Bjorkman DJ, Zaman A, Fennerty MB, Lieberman D, Disario JA, Guest-Warnick G. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc 2004; 60: 1-8.
  • 21. Spiegel BMR, Vakil NB, Ofman JJ. Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Arch Intern Med 2001; 161: 1393-404.
  • 22. Tsoi KK, Ma TK, Sung JJ. Endoscopy for upper gastrointestinal bleeding: how urgent is it? Nat Rev Gastroenterol Hepatol 2009; 6: 463-9.
  • 23. Lau JYW, Yu Y, Tang RSY, Chan HCH, Yip HC, Chan SM, at al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. N Engl J Med. 2020 Apr 2;382(14):1299-1308. doi: 10.1056/NEJMoa1912484. PMID: 32242355.
  • 24. Cho SH, Lee YS, Kim YJ, Sohn CH, Ahn S, Seo DW, et al. Outcomes and role of urgent endoscopy in high-risk patients with acute nonvariceal gastrointestinal bleeding. Clin Gastroenterol Hepatol 2018; 16: 370-7.
  • 25. Laursen SB, Leontiadis GI, Stanley AJ, Møller MH, Hansen JM, Schaffalitzky de Muckadell OB. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest Endosc 2017; 85(5): 936-944.e3.
  • 26. Lau JY, Leung WK, Wu JC, Chan FK, Wong VW, Chiu PW, at al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med. 2007 Apr 19;356(16):1631-40. doi: 10.1056/NEJMoa065703. PMID: 17442905.

Upper Gastrointestinal Bleeding: Do Emergency Endoscopic Evaluations Affect Clinical Outcomes?

Year 2022, Volume: 8 Issue: 3, 440 - 449, 31.08.2022

Osman İnan Muhammed Fatih Acehan Buket Karsavuranoğlu Enes Seyda Şahiner Meryem Aslan İhsan Ateş

https://doi.org/10.19127/mbsjohs.1130292

Abstract

Objective: We aimed to reveal the effect of time from admission to endoscopy on clinical outcomes such as mortality, rebleeding, and prolonged hospitalization among patients with acute upper gastrointestinal bleeding.
Methods: Patients aged ≥18 years with acute upper gastrointestinal bleeding were enrolled in the study. Those who had variceal bleeding during endoscopy, those whose hospital stay was shorter than 24 hours, those who did not undergo endoscopy, and those who underwent endoscopy after 24 hours were excluded from the study. Clinical findings, routine laboratory test results, and imaging findings of the patients were retrospectively reviewed through the hospital’s records system.
Results: A total of 252 patients were enrolled in the study. At admission, 30.2% (76) of patients were at clinically high risk of death or rebleeding, 71.8% had melena, and 51.2% had hematemesis. While 72 (28.6%) of the patients had high-risk endoscopic stigmata, 89 (35.3%) had low-risk endoscopic stigmata. The median hospital stay was 6 (1-91) days. In-hospital mortality occurred in 8 (3.2%) cases, rebleeding developed in 16 (6.3%) cases, endoscopic intervention was required in 103 (40.9%) cases, and prolonged hospital stay was required in 43 (17.1%) cases. High-risk endoscopic stigmata were identified in 63 (34.1%) cases in the urgent group and in 9 (13.4%) in the early group (p=0.001). Endoscopic intervention was required in 47.0% cases in the urgent group, while the incidence was 23.9% in the early group (p=0.001).
Conclusion: While no significant difference was found between the urgent and early groups in terms of mortality and re-bleeding, the need for endoscopic intervention and the incidence of high-risk endoscopic stigmata were found to be significantly higher in the urgent group.

Keywords

Endoscopy Outcome Upper gastrointestinal bleeding

References

  • 1. Fallah MA, Prakash C, Edmundowicz S. Acute gastrointestinal bleeding. Med Clin North Am 2000;84(5):1183–208.
  • 2. Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60:1327–1335.
  • 3. Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 1995; 311:222–226.
  • 4. Rosenstock SJ, Møller MH, Larsson H, Johnsen SP, Madsen AH, Bendix J, et al. Improving quality of care in peptic ulcer bleeding: nationwide cohort study of 13,498 consecutive patients in the Danish Clinical Register of Emergency Surgery. Am J Gastroenterol 2013; 108:1449–1457.
  • 5. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000; 356:1318–1321.
  • 6. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38:316–321.
  • 7. Aquarius M, Smeets FG, Konijn HW, Stassen PM, Keulen ET, Van Deursen CT, at al. Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department. Eur J Gastroenterol Hepatol 2015; 27:1011–1016.
  • 8. Bryant RV, Kuo P, Williamson K, Yam C, Schoeman MN, Holloway RH, et al. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc 2013; 78:576–583.
  • 9. Lim LG, Ho KY, Chan YH, Teoh PL, Khor CJ, Lim LL, et al. Urgent endoscopy is associated with lower mortality in high-risk but not low-risk nonvariceal upper gastrointestinal bleeding. Endoscopy 2011;43: 300–306.
  • 10. Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol 2012; 107: 345-60.
  • 11. NICE. Acute upper gastrointestinal bleeding in over 16s: management. Available from: https://www.nice.org.uk/ guidance/cg141. (2012, accessed 20 February 2018).
  • 12. Sacks HS, Chalmers TC, Blum AL, Berrier J, Pagano D. Endoscopic hemostasis: an effective therapy for bleeding peptic ulcers. JAMA 1990; 264:494-9.
  • 13. Bleau BL, Gostout CJ, Shaw MJ, Keate RF, Harford WV, Bracy W Jr, et al. Final results: rebleeding from peptic ulcers associated with adherent clots [abstract]. Gastrointest Endosc 1997;45: AB87.
  • 14. Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992; 102:139-48.
  • 15. Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47(10): a1–46.
  • 16. Joint Advisory Group on Gastrointestinal Endoscopy. Joint Advisory Group on Gastrointestinal Endoscopy (JAG) Global Rating Scale (GRS): Version for acute services (all nations) – April 2016; 2016: 10.
  • 17. Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med 2019; 171: 805-22.
  • 18. Lin HJ, Wang K, Perng CL, Chua RT, Lee FY, Lee CH, et al. Early or delayed endoscopy for patients with peptic ulcer bleeding: a prospective randomized study. J Clin Gastroenterol 1996; 22: 267-71.
  • 19. Lee JG, Turnipseed S, Romano PS, Vigil H, Azari R, Melnikoff N, et al. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 1999; 50: 755-61.
  • 20. Bjorkman DJ, Zaman A, Fennerty MB, Lieberman D, Disario JA, Guest-Warnick G. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc 2004; 60: 1-8.
  • 21. Spiegel BMR, Vakil NB, Ofman JJ. Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Arch Intern Med 2001; 161: 1393-404.
  • 22. Tsoi KK, Ma TK, Sung JJ. Endoscopy for upper gastrointestinal bleeding: how urgent is it? Nat Rev Gastroenterol Hepatol 2009; 6: 463-9.
  • 23. Lau JYW, Yu Y, Tang RSY, Chan HCH, Yip HC, Chan SM, at al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. N Engl J Med. 2020 Apr 2;382(14):1299-1308. doi: 10.1056/NEJMoa1912484. PMID: 32242355.
  • 24. Cho SH, Lee YS, Kim YJ, Sohn CH, Ahn S, Seo DW, et al. Outcomes and role of urgent endoscopy in high-risk patients with acute nonvariceal gastrointestinal bleeding. Clin Gastroenterol Hepatol 2018; 16: 370-7.
  • 25. Laursen SB, Leontiadis GI, Stanley AJ, Møller MH, Hansen JM, Schaffalitzky de Muckadell OB. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest Endosc 2017; 85(5): 936-944.e3.
  • 26. Lau JY, Leung WK, Wu JC, Chan FK, Wong VW, Chiu PW, at al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med. 2007 Apr 19;356(16):1631-40. doi: 10.1056/NEJMoa065703. PMID: 17442905.
There are 26 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research articles
Authors

Osman İnan 0000-0002-8717-3013

Muhammed Fatih Acehan 0000-0001-8469-0907

Buket Karsavuranoğlu 0000-0002-7358-0507

Enes Seyda Şahiner 0000-0003-4552-0387

Meryem Aslan 0000-0003-0144-2217

İhsan Ateş 0000-0003-2858-6229

Publication Date August 31, 2022
Published in Issue Year 2022 Volume: 8 Issue: 3

Cite

Vancouver İnan O, Acehan MF, Karsavuranoğlu B, Şahiner ES, Aslan M, Ateş İ. Upper Gastrointestinal Bleeding: Do Emergency Endoscopic Evaluations Affect Clinical Outcomes?. Mid Blac Sea J Health Sci. 2022;8(3):440-9.
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