Korean J Intern Med.  2018 Mar;33(2):304-312. 10.3904/kjim.2016.182.

Early versus late bedside endoscopy for gastrointestinal bleeding in critically ill patients

• Kim JH
• Kim JH
• Chun J
• Lee C
• Im JP
• Kim JS

• KMID: 2411542
• DOI: http://doi.org/10.3904/kjim.2016.182

Abstract

BACKGROUND/AIMS
Gastrointestinal (GI) bleeding is a life-threatening complication in critically ill patients. The aim of this study was to determine the efficacy of bedside endoscopy in an intensive care unit (ICU) setting, and to compare the outcomes of early endoscopy (within 24 hours of detecting GI bleeding) with late endoscopy (after 24 hours).
METHODS
We retrospectively reviewed the medical records of patients who underwent bedside endoscopy for nonvariceal upper GI bleeding and lower GI bleeding that occurred after ICU admission at Seoul National University Hospital from January 2010 to May 2015.
RESULTS
Two hundred and fifty-three patients underwent bedside esophagogastroduodenoscopy (EGD) for upper GI bleeding (early, 187; late, 66) and 69 underwent bedside colonoscopy (CS) for lower GI bleeding (early, 36; late, 33). Common endoscopic findings were peptic ulcer, and acute gastric mucosal lesion in the EGD group, as well as ischemic colitis and acute hemorrhagic rectal ulcers in the CS group. Early EGD significantly increased the rate of finding the bleeding focus (82% vs. 73%, p = 0.003) and endoscopic hemostasis (32% vs. 12%, p = 0.002) compared with late EGD. However, early CS significantly decreased the rate of identifying the bleeding focus (58% vs. 82%, p = 0.008) and hemostasis (19% vs. 49%, p = 0.011) compared with late CS due to its higher rate of poor bowel preparation and blood interference (38.9% vs. 6.1%, p = 0.035).
CONCLUSIONS
Early EGD may be effective for diagnosis and hemostatic treatment in ICU patients with GI bleeding. However, early CS should be carefully performed after adequate bowel preparation.

Keyword

Bedside endoscopy; Gastrointestinal bleeding; Early endoscopy

MeSH Terms

Colitis, Ischemic
Colonoscopy
Critical Illness*
Diagnosis
Endoscopy*
Endoscopy, Digestive System
Hemorrhage*
Hemostasis
Hemostasis, Endoscopic
Humans
Intensive Care Units
Medical Records
Peptic Ulcer
Retrospective Studies
Seoul
Ulcer