scholarly journals How Can Patient’s Risk Dictate the Timing of Endoscopy in Upper Gastrointestinal Bleeding?

2021 ◽  
pp. 1-10
Author(s):  
Marta Freitas ◽  
Vítor Macedo Silva ◽  
Tiago Cúrdia Gonçalves ◽  
Carla Marinho ◽  
José Cotter
Keyword(s):  
Gastrointestinal Bleeding ◽  
Endoscopic Treatment ◽  
Lower Risk ◽  
Upper Gastrointestinal Bleeding ◽  
Positive Impact ◽  
Outcome Data ◽  
Optimal Timing ◽  
Early Endoscopy ◽  
The Impact ◽  
Upper Gastrointestinal

<b><i>Introduction:</i></b> Although upper gastrointestinal bleeding (UGIB) management has improved substantially in the last decades, there is still much controversy regarding the optimal timing for performance of endoscopy. Recent guidelines suggest performing an early endoscopy within 24 h of nonvariceal UGIB (NVUGIB) presentation, although its impact on patients with different bleeding risks remains unclear. <b><i>Aim:</i></b> To evaluate the impact of performing endoscopy within 24 h on NVUGIB outcomes and to compare it in patients with lower-risk vs. higher-risk bleeding. <b><i>Methods:</i></b> This is a retrospective cohort study including consecutive patients undergoing upper endoscopy for suspected NVUGIB over 4 years. Demographic, clinical, biochemical, endoscopic, and outcome data were collected. Lower-risk bleeding was defined as a Glasgow-Blatchford score (GBS) &#x3c;12 and higher-risk bleeding was defined as a GBS ≥12. <b><i>Results:</i></b> A total of 298 patients with suspected NVUGIB were included, 55% of whom had higher-risk bleeding. Endoscopy was performed within 24 h in 62.1% of the patients. In lower-risk bleeding patients, performance of endoscopy within 24 h was associated with a higher need for endoscopic treatment (OR = 2.6; 95% CI 1.2–5.7; <i>p</i> = 0.004), a lower 30-day mortality (OR = 0.41; 95% CI 0.27–0.63; <i>p</i> = 0.03), and a lower need for transfusion (OR = 0.58; 95% CI 0.36–0.92; <i>p</i> = 0.02). In higher-risk bleeding patients, there were no statistically significant differences in NVUGIB outcomes in performing endoscopy within 24 h. <b><i>Conclusion:</i></b> Endoscopy within 24 h of presentation was associated with a lower need for transfusion, a higher need for endoscopic treatment, and a lower 30-day mortality in lower-risk NVUGIB patients. Thus, performing endoscopy within the first 24 h of presentation can have a positive impact on NVUGIB outcomes even in lower-risk bleeding.

scholarly journals Ūmino nevarikozinio kraujavimo įvertinimo ir stabdymo protokolas

2005 ◽  
Vol 3 (1) ◽  
pp. 0-0
Author(s):  
Jonas Valantinas
Keyword(s):  
Helicobacter Pylori ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Eradication Therapy ◽  
Optimal Timing ◽  
Practical Recommendation ◽  
Early Endoscopy ◽  
Management Recommendations ◽  
Upper Gastrointestinal

Jonas ValantinasVilniaus universiteto Medicinos fakultetoGastroenterologijos, nefrologijos, urologijosir abdominalinės chirurgijos klinika,Santariškių g. 2, LT-08661, VilniusEl paštas: [email protected] Per pastaruosius dešimt metų ūminio nevarikozinio kraujavimo stabdymo metodai pasikeitė. Straipsnyje apžvelgiame šiuolaikinius viršutinės virškinimo trakto dalies kraujavimo metodus, kurie patvirtinti klinikiniais tyrimais grįstomis išvadomis. Esant viršutinės virškinimo trakto dalies kraujavimui, pirmiausia tenka atkurti cirkuliuojančio kraujo tūrį ir, pasikonsultavus su internistu bei chirurgu, nustatyti ankstyvo endoskopinio tyrimo indikacijas. Nors endoskopinio tyrimo reikšme šiuo metu niekas neabejoja, jo atlikimo laikas turi būti nustatomas individualiai. Endoskopinė hemostazė atliekama pacientams, kuriems pakartotinio kraujavimo rizika yra didelė. Sustabdžius kraujavimą, gydymas protonų siurblio inhibitoriais naudingas tik daliai ligonių, kuriems nustatomi ankstyvo pakartotinio kraujavimo endoskopiniai požymiai (matoma nekraujuojanti kraujagyslė, krešulys opos dugne ar aktyvus kraujavimas atliekant endoskopiją). Kraujuojantys ligoniai turi būti ištirti ieškant Helicobacter pylori infekcijos. Nustačius infekciją skiriamas eradikacinis gydymas. Ši apžvalga yra rekomenduojamojo pobūdžio ir gydymo įstaigos turi sudaryti joms priimtinus kraujavimo stabdymo protokolus, atsižvelgdamos į savo išteklius. Reikšminiai žodžiai: ūminis nevarikozinis kraujavimas, kraujavimo stabdymas, endoskopinis tyrimas Acute non-variceal bleeding assessment and hemostasis protocol (A PRACTICAL RECOMMENDATION) Jonas ValantinasVilnius University, Faculty of Medicine Clinic of Gastroenterology,Nephrology, Urology and Abdominal Surgery,Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] The management of patients with acute non-variceal upper gastrointestinal bleeding has evolved substantially over the past ten years. This article reviews the currently available treatment methods in cases of upper gastrointestinal bleeding and provides evidence-based management recommendations that address clinically relevant issues. We emphasise an appropriate initial resuscitation of the patient and a multidisciplinary approach to clinical risk stratification that determines the need for early endoscopy. A soon as the effectiveness of upper endoscopy has been established, its optimal timing has to be clearly defined. Endoscopic hemostasis is reserved for patients with high rebleeding risk endoscopic lesions. Routine second look endoscopy is not recommended. Proton pomp inhibitors therapy is useful only in a selected group of patients, namely those with ulcers having endoscopic high risk stigmata of rebleeding (nonbleeding visible vessel, adherent clot or active bleeding at the time of endoscopy). Patients with upper gastrointestinal bleeding should be tested for Helicobacter pylori infection and receive eradication therapy if infection is present. This review should be considered as a recommendation and hospitals should develop institution-specific protocols according to their resources. Keywords: acute non-variceal bleeding, haemostasis, endoscopy

scholarly journals Endoscopic treatment modalities and outcomes in nonvariceal upper gastrointestinal bleeding

2020 ◽  
Vol 12 (2) ◽  
pp. 72-82
Author(s):  
Benjamin Cherng Hann Yip ◽  
Hossain Sayeed Sajjad ◽  
Jie-Xun Wang ◽  
Constantinos P Anastassiades
Keyword(s):  
Gastrointestinal Bleeding ◽  
Endoscopic Treatment ◽  
Upper Gastrointestinal Bleeding ◽  
Treatment Modalities ◽  
Upper Gastrointestinal

A simplified clinical risk score predicts the need for early endoscopy in non-variceal upper gastrointestinal bleeding

2014 ◽  
Vol 46 (9) ◽  
pp. 783-787 ◽  
Author(s):  
Leonardo Tammaro ◽  
Andrea Buda ◽  
Maria Carla Di Paolo ◽  
Angelo Zullo ◽  
Cesare Hassan ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Risk Score ◽  
Upper Gastrointestinal Bleeding ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Early Endoscopy ◽  
Upper Gastrointestinal
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