Upper gastrointestinal bleeding: Do emergency endoscopic evaluations affect clinical outcomes?

Abstract

Background: 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. Result: 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.