Urgent endoscopy is associated with lower mortality in high-risk but not low-risk nonvariceal upper gastrointestinal bleeding

Endoscopy. 2011 Apr;43(4):300-6. doi: 10.1055/s-0030-1256110. Epub 2011 Feb 28.


Background and study aims: The role of urgent endoscopy in high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) is unclear. The aim of this study was to determine whether esophagogastroduodenoscopy (EGD) performed sooner than the currently recommended 24 h in high-risk patients presenting with NVUGIB is associated with lower all-cause in-hospital mortality.

Methods: All adult patients undergoing EGD for the indications of coffee-grounds vomitus, hematemesis or melena at a university hospital over an 18-month period were enrolled. Patients with variceal and lower gastrointestinal bleeding were excluded. Data were prospectively collected.

Results: A total of 934 patients were included. The area under the receiver operating characteristic curve (AUROC) for the Glasgow-Blatchford score (GBS) was 0.813 for predicting all-cause in-hospital mortality, with a cut-off score of ≥ 12 resulting in 90 % specificity. In low-risk patients with GBS < 12, presentation-to-endoscopy time in those who died and in those who survived was similar. In high-risk patients with GBS of ≥ 12, presentation-to-endoscopy time was significantly longer in those who died than in those who survived. Multivariate analysis of the high-risk cohort showed presentation-to-endoscopy time to be the only factor associated with all-cause in-hospital mortality. For high-risk patients, the AUROC for presentation-to-endoscopy time in predicting all-cause in-hospital mortality was 0.803, with a sensitivity of 100 % at the cut-off time of 13 h. All-cause in-hospital mortality in high-risk patients was significantly higher in those with presentation-to-endoscopy time of > 13 h compared with those undergoing endoscopy in < 13 h from presentation (44 % vs. 0 %; P < 0.001).

Conclusions: Endoscopy within 13 h of presentation was associated with lower mortality in high-risk but not low-risk NVUGIB.

MeSH terms

  • Acute Disease
  • Aged
  • Emergencies
  • Endoscopy, Gastrointestinal*
  • Female
  • Gastrointestinal Hemorrhage / mortality*
  • Gastrointestinal Hemorrhage / therapy
  • Hemostasis, Endoscopic*
  • Hospital Mortality*
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Survival Analysis