Endoscopy for upper gastrointestinal bleeding: how urgent is it?

Early endoscopy has been advocated for the management of upper gastrointestinal bleeding, but the optimal timing for early endoscopy is still uncertain. The aim of this Review is to evaluate the optimal timing of early endoscopy by examining the findings of randomized clinical trials and retrospective cohort studies that used comparable outcome measures and have been reported in the literature. Outcome measurements included recurrent bleeding, surgery, mortality, length of hospital stay, and blood transfusion. Studies were categorized into those in which endoscopy was performed within 2–3 h, 6–8 h, 12 h or 24 h of the patient's presentation to hospital. We conclude that early endoscopy aids risk stratification of patients and reduces the need for hospitalization. However, it may also expose additional cases of active bleeding and hence increase the use of therapeutic endoscopy. No evidence exists that very early endoscopy (within a few hours of presentation) can reduce the risk of rebleeding or improve survival.

[1]  G. Longstreth,et al.  Successful outpatient management of acute upper gastrointestinal hemorrhage: use of practice guidelines in a large patient series. , 1998, Gastrointestinal endoscopy.

[2]  D. Graham,et al.  A scoring system to predict rebleeding after endoscopic therapy of nonvariceal upper gastrointestinal hemorrhage, with a comparison of heat probe and ethanol injection. , 1993, The American journal of gastroenterology.

[3]  T C Chalmers,et al.  Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers. , 1990, JAMA.

[4]  J. Tsai,et al.  Arterial oxygen desaturation during emergent nonsedated upper gastrointestinal endoscopy in the emergency department. , 1997, The American journal of emergency medicine.

[5]  James A Smith,et al.  Selective outpatient management of upper gastrointestinal bleeding in the elderly , 1999, American Journal of Gastroenterology.

[6]  F. Schmidt.  Meta-Analysis , 2008 .

[7]  H. Stähelin.  Guidelines , 1994, Communicating Science.

[8]  H B Devlin,et al.  Risk assessment after acute upper gastrointestinal haemorrhage. , 1996, Gut.

[9]  D. Graham,et al.  Prospective validation of the Baylor bleeding score for predicting the likelihood of rebleeding after endoscopic hemostasis of peptic ulcers. , 1995, Gastrointestinal Endoscopy.

[10]  A. Ferguson,et al.  Gut lavage fluid protein concentrations: objective measures of disease activity in inflammatory bowel disease. , 1993, Gastroenterology.

[11]  A. Barkun,et al.  The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): Endoscopic Hemostasis and Proton Pump Inhibition are Associated with Improved Outcomes in a Real-Life Setting , 2004, American Journal of Gastroenterology.

[12]  A. Barkun,et al.  Management of acute bleeding from a peptic ulcer. , 2008, The New England journal of medicine.

[13]  Robert N. Stavins,et al.  ENVIRONMENTAL REGULATION IN THE 1990 S : A RETROSPECTIVE ANALYSIS , 2003 .

[14]  K. Lai,et al.  A retrospective and prospective study on the safety of discharging selected patients with duodenal ulcer bleeding on the same day as endoscopy. , 1997, Gastrointestinal endoscopy.

[15]  A. Chak,et al.  Early endoscopy in upper gastrointestinal hemorrhage: associations with recurrent bleeding, surgery, and length of hospital stay. , 1999, Gastrointestinal endoscopy.

[16]  Ananya Das,et al.  Prediction of outcome of acute GI hemorrhage: a review of risk scores and predictive models. , 2004, Gastrointestinal endoscopy.

[17]  G. Guyatt,et al.  Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. , 1992, Gastroenterology.

[18]  P. Romano,et al.  Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. , 1999, Gastrointestinal endoscopy.

[19]  K. Palmer,et al.  Non-variceal upper gastrointestinal haemorrhage: guidelines , 2002, Gut.

[20]  L. Ger,et al.  When to discharge patients with bleeding peptic ulcers: a prospective study of residual risk of rebleeding. , 1996, Gastrointestinal endoscopy.

[21]  M. Andreu,et al.  Applicability of the Rockall score in patients undergoing endoscopic therapy for upper gastrointestinal bleeding. , 2006, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[22]  O. Blatchford,et al.  A risk score to predict need for treatment for uppergastrointestinal haemorrhage , 2000, The Lancet.

[23]  X. Calvet,et al.  A randomized study of the safety of outpatient care for patients with bleeding peptic ulcer treated by endoscopic injection. , 2004, Gastrointestinal endoscopy.

[24]  A. Sanabria,et al.  Randomized controlled trial. , 2005, World journal of surgery.

[25]  A. Chak,et al.  The effectiveness of early endoscopy for upper gastrointestinal hemorrhage: a community-based analysis. , 1998, Medical care.

[26]  G. Longstreth,et al.  Outpatient care of selected patients with acute non-variceal upper gastrointestinal haemorrhage , 1995, The Lancet.

[27]  Y. Nakajima,et al.  A Prospective, Randomized Study , 2006 .

[28]  T. Rockall,et al.  Influencing the practice and outcome in acute upper gastrointestinal haemorrhage , 1997, Gut.

[29]  S. D. Lee,et al.  Early or delayed endoscopy for patients with peptic ulcer bleeding. A prospective randomized study. , 1996, Journal of clinical gastroenterology.

[30]  T. Chiba,et al.  Autoimmune related pancreatitis , 2002, Gut.

[31]  L. Targownik,et al.  The role of rapid endoscopy for high-risk patients with acute nonvariceal upper gastrointestinal bleeding. , 2007, Canadian journal of gastroenterology = Journal canadien de gastroenterologie.

[32]  B. Spiegel,et al.  Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. , 2001, Archives of internal medicine.

[33]  D. Lieberman,et al.  Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. , 2004, Gastrointestinal endoscopy.

[34]  S. Peiró,et al.  Outpatient management of upper digestive hemorrhage not associated with portal hypertension: a large prospective cohort , 2001, American Journal of Gastroenterology.

[35]  A. Blum,et al.  Is early endoscopy in the emergency room beneficial in patients with bleeding peptic ulcer? A "fortuitously controlled" study. , 2005, Endoscopy.

[36]  L. Camellini,et al.  Comparison of three different risk scoring systems in non-variceal upper gastrointestinal bleeding. , 2004, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[37]  Elizabeth Rajan,et al.  ASGE guideline: The role of endoscopy in acute non-variceal upper-GI hemorrhage. , 2004, Gastrointestinal endoscopy.

[38]  C. Hassan,et al.  Endoscopic findings in patients with upper gastrointestinal bleeding clinically classified into three risk groups prior to endoscopy. , 2008, World journal of gastroenterology.

[39]  Hsiu‐Po Wang,et al.  High-risk ED patients with nonvariceal upper gastrointestinal hemorrhage undergoing emergency or urgent endoscopy: a retrospective analysis. , 2007, The American journal of emergency medicine.

[40]  Alan Barkun,et al.  Consensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding , 2003, Annals of Internal Medicine.

[41]  R. Marmo,et al.  Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial. , 2002, Gastrointestinal endoscopy.