Background and study aims: The role of urgent endoscopy in high-risk nonvariceal upper gastrointestinal bleeding
(NVUGIB) is unclear. The aim of this study was to determine whether esophagogastroduodenoscopy
(EGD) performed sooner than the currently recommended 24 h in high-risk patients presenting
with NVUGIB is associated with lower all-cause in-hospital mortality.
Methods: All adult patients undergoing EGD for the indications of coffee-grounds vomitus,
hematemesis or melena at a university hospital over an 18-month period were enrolled.
Patients with variceal and lower gastrointestinal bleeding were excluded. Data were
prospectively collected.
Results: A total of 934 patients were included. The area under the receiver operating characteristic
curve (AUROC) for the Glasgow-Blatchford score (GBS) was 0.813 for predicting all-cause
in-hospital mortality, with a cut-off score of ≥ 12 resulting in 90 % specificity.
In low-risk patients with GBS < 12, presentation-to-endoscopy time in those who died
and in those who survived was similar. In high-risk patients with GBS of ≥ 12, presentation-to-endoscopy
time was significantly longer in those who died than in those who survived. Multivariate
analysis of the high-risk cohort showed presentation-to-endoscopy time to be the only
factor associated with all-cause in-hospital mortality. For high-risk patients, the
AUROC for presentation-to-endoscopy time in predicting all-cause in-hospital mortality
was 0.803, with a sensitivity of 100 % at the cut-off time of 13 h. All-cause in-hospital
mortality in high-risk patients was significantly higher in those with presentation-to-endoscopy
time of > 13 h compared with those undergoing endoscopy in < 13 h from presentation
(44 % vs. 0 %; P < 0.001).
Conclusions: Endoscopy within 13 h of presentation was associated with lower mortality in high-risk
but not low-risk NVUGIB.
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K. G. YeohMD
Department of Gastroenterology and Hepatology
University Medicine Cluster
National University Health System
5 Lower Kent Ridge Road
Main Building 1, Level 6
Singapore 119074
Fax: +65-67751518
eMail: khay_guan_yeoh@nuhs.edu.sg
