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.
- KMID: 2163503
- DOI: http://doi.org/10.3904/kjim.2014.099
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.
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