Introduction Acute upper GI Bleed (AUGIB) is one of the most common presentations in UK hospitals and is associated with significant morbidity and mortality. Current guidelines recommend early endoscopic intervention (i.e. Within 24 hours) for patients presenting with UGIB.1 Early endoscopy can be beneficial in achieving hemostasis more quickly & decreasing need for transfusions.2 However aggressive resuscitation before rushing towards an endoscopy has its own importance as Inadequate early resuscitation is believed to be a major factor in the persistently high mortality rate in patients with UGIB.3
Methods We conducted a retrospective study of 696 patients who were admitted to Cardiff and Vale university health board & subsequently treated in endoscopy unit for non variceal upper GI bleed between September 2010 and September 2013. Patients were divided into 3 groups depending upon the time to scope from admission (Within 6 hours, 6–24 hours and more than 24 hours).
Results Our study found that very early endoscopy (i.e. <6 hours) compared to rapid endoscopy (6–24 hours), did not improve outcome and in fact had a significantly worse mortality rate of 16.67% vs 4.62% . Though it can be argued that patients who had a very early endoscopy were more unwell comparatively. When we compared patients in high risk group only i.e. GBS (Glasgow Blatchford >10); results were identical.
Conclusion Our study reinforced the importance of access to rapid endoscopic intervention within 24 hours, but did not demonstrate the need for very early gastroscopy. This was likely due to the fact that organising very early endoscopy within 6 h would slow intensive resuscitative efforts leading to worse outcome.
References 1 https://www.nice.org.uk/Guidance/CG141
2 Cooper GS, et al. Early endoscopy in upper gastrointestinal haemorrhage. Gastrointest Endosc 1999;49:145–52.
3 Baradarian R, Ramdhaney S, Chapalamadugu R, et al. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastroenterol 2004;99:619–22.
Disclosure of Interest None Declared