Korean J Intern Med.  2016 May;31(3):470-478. 10.3904/kjim.2014.099.

Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy

Affiliations
  • 1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. gidoctor@korea.com
  • 2Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
  • 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 4Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

Abstract

BACKGROUND/AIMS
This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours.
METHODS
A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010.
RESULTS
A total of 158 patients visited the emergency unit for ANVUGIB after hours. Among them, 60 underwent urgent EGD (within 8 hours) and 98 underwent early EGD (8 to 24 hours) by experienced endoscopists. The frequencies of hemodynamic instability, fresh blood aspirate on the nasogastric tube, and high-risk endoscopic findings were significantly higher in the urgent EGD group. Primary hemostasis was achieved in all except two patients. There were nine cases of recurrent bleeding, and 30-day mortality occurred in three patients. There were no significant differences between the two groups in primary hemostasis, recurrent bleeding, and 30-day mortality. In a multiple linear regression analysis, urgent EGD significantly reduced the hospital stay compared with early EGD. In patients with a high clinical Rockall score (more than 3), urgent EGD tended to decrease the hospital stay, although this was not statistically significant (7.7 days vs. 12.0 days, p > 0.05).
CONCLUSIONS
Urgent EGD after hours by experienced endoscopists had an excellent endoscopic success rate. However, clinical outcomes were not significantly different between the urgent and early EGD groups.

Keyword

Acute nonvariceal gastrointestinal bleeding; Endoscopic hemostasis; Primary hemostasis; Rebleeding; Urgent esophagogastroduodenoscopy

MeSH Terms

Emergency Service, Hospital
Endoscopy*
Endoscopy, Digestive System
Hemodynamics
Hemorrhage*
Hemostasis
Hemostasis, Endoscopic
Humans
Length of Stay
Linear Models
Mortality
Retrospective Studies
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