CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(05): E376-E386
DOI: 10.1055/s-0042-121665
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Early esophagogastroduodenoscopy is associated with better Outcomes in upper gastrointestinal bleeding: a nationwide study

Sushil K. Garg
1  Department of Internal Medicine, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
,
Chimaobi Anugwom
1  Department of Internal Medicine, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
,
James Campbell
1  Department of Internal Medicine, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
,
Vaibhav Wadhwa
2  Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, Ohio, United States
,
Nancy Gupta
3  Department of Gastroenterology, University of Iowa, Iowa City, Iowa, United States
,
Rocio Lopez
4  Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States
,
Sukhman Shergill
5  All India Institute of Medical Sciences, Medicine, New Delhi, India
,
Madhusudhan R. Sanaka
6  Digestive Disease Institute, Department of Gastroenterology & Hepatology, The Cleveland Clinic, Cleveland, Ohio, United States
› Author Affiliations
Further Information

Publication History

submitted 08 July 2016

accepted after revision 02 November 2016

Publication Date:
12 May 2017 (online)

Abstract

Background and study aims We analyzed NIS (National Inpatient Sample) database from 2007 – 2013 to determine if early esophagogastroduodenoscopy (EGD) (24 hours) for upper gastrointestinal bleeding improved the outcomes in terms of mortality, length of stay and costs.

Patients and methods Patients were classified as having upper gastrointestinal hemorrhage by querying all diagnostic codes for the ICD-9-CM codes corresponding to upper gastrointestinal bleeding. For these patients, performance of EGD during admission was determined by querying all procedural codes for the ICD-9-CM codes corresponding to EGD; early EGD was defined as having EGD performed within 24 hours of admission and late EGD was defined as having EGD performed after 24 hours of admission.

Results A total of 1,789,532 subjects with UGIH were identified. Subjects who had an early EGD were less likely to have hypovolemia, acute renal failure and acute respiratory failure. On multivariable analysis, we found that subjects without EGD were 3 times more likely to die during the admission than those with early EGD. In addition, those with late EGD had 50 % higher odds of dying than those with an early EGD. Also, after adjusting for all factors in the model, hospital stay was on average 3 and 3.7 days longer for subjects with no or late EGD, respectively, then for subjects with early EGD.

Conclusion Early EGD (within 24 hours) is associated with lower in-hospital mortality, morbidity, shorter length of stay and lower total hospital costs.