High-risk ED patients with nonvariceal upper gastrointestinal hemorrhage undergoing emergency or urgent endoscopy: a retrospective analysis
Journal
American Journal of Emergency Medicine
Journal Volume
25
Journal Issue
3
Pages
273-278
Date Issued
2007
Author(s)
Tai C.-M.
Huang S.-P.
TSUNG-CHUN LEE
Chang C.-Y.
Lee C.-T.
Lin J.-T.
Abstract
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. ? 2007 Elsevier Inc. All rights reserved.
SDGs
Other Subjects
adult; article; blood transfusion; digestive system ulcer; emergency ward; gastrointestinal endoscopy; hemostasis; high risk patient; hospital admission; human; intermethod comparison; length of stay; major clinical study; mortality; priority journal; recurrence risk; retrospective study; upper gastrointestinal bleeding; Aged; Comorbidity; Emergency Service, Hospital; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Hospital Mortality; Humans; Length of Stay; Male; Medical Records; Middle Aged; Retrospective Studies; Taiwan; Time Factors; Treatment Outcome
Type
journal article