High-risk ED patients with nonvariceal upper gastrointestinal hemorrhage undergoing emergency or urgent endoscopy: a retrospective analysis

Am J Emerg Med. 2007 Mar;25(3):273-8. doi: 10.1016/j.ajem.2006.07.014.


Objectives: The optimal timing of interventional endoscopy within the initial 24 hours remains controversial. We designed a retrospective study to compare the outcomes between emergency endoscopy (EE) and urgent endoscopy (UE) for high-risk patients with nonvariceal upper gastrointestinal hemorrhage presenting to the emergency department (ED).

Methods: The medical records of 189 patients with nonvariceal upper gastrointestinal hemorrhage who underwent endoscopy within 24 hours of admission to the ED were reviewed. Patients were divided into 2 groups: EE group (<8 hours) or UE group (8-24 hours). We compared the endoscopic findings, hemostatic procedures, rate of hemostasis, rebleeding, need for transfusion, length of hospitalization, and mortality between the 2 groups.

Results: There were 88 patients (47%) in the EE group and 101 patients (53%) in the UE group. Ulcers with active bleeding or exposed vessel were found more frequently in the EE group than in the UE group (19% vs 8%, P = .03; 34% vs 12%, P < .001). Fifty patients had blood retention in the stomach, especially in the EE group (40% vs 15%, P < .001). Forty-four (50%) patients in the EE group and 21 (21%) patients in the UE group received endoscopic interventions. Combination modalities of endoscopic hemostasis were more commonly used in the EE group than in the UE group (40% vs 15%, P < .001). Primary hemostasis was achieved at a rate of 95% in both groups. There was no statistical difference regarding the rate of recurrent bleeding, total amount of transfusion, length of hospital stay, and mortality rate in both groups.

Conclusions: Although more active lesions were detected and more therapeutic attempts were performed in the EE group, the outcome showed no difference in both groups. Emergency endoscopy performed less than 8 hours after arrival to the ED showed no definite benefit in comparison with UE performed within 8 to 24 hours.

MeSH terms

  • Aged
  • Comorbidity
  • Emergency Service, Hospital / statistics & numerical data*
  • Endoscopy, Gastrointestinal / statistics & numerical data*
  • Female
  • Gastrointestinal Hemorrhage / diagnosis*
  • Gastrointestinal Hemorrhage / physiopathology
  • Gastrointestinal Hemorrhage / therapy
  • Hospital Mortality
  • Humans
  • Length of Stay
  • Male
  • Medical Records
  • Middle Aged
  • Retrospective Studies
  • Taiwan
  • Time Factors
  • Treatment Outcome