Original articleClinical endoscopyRelationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study
Section snippets
Study design and population
The study was conducted as a nationwide cohort study based on data from the Danish Clinical Register of Emergency Surgery (DCRES). The DCRES is a nationwide database that includes prospectively collected data on consecutive patients admitted to Danish hospitals with verified PUB since 2005. PUB was defined as presentation with hematemesis and/or melena, with subsequent upper endoscopy confirming the source to be peptic ulceration. Danish hospitals are required by law to report all PUB patients
Population
Based on the search in DCRES 13,569 cases were identified. We excluded cases without an exact/correct registered time of admission to the hospital (or time of clinical suspicion of upper GI bleeding in in-hospital bleeders; n = 85), known time of endoscopy (n = 211), missing values regarding hemodynamic instability (n = 18), and cases where the endoscopy was performed later than 1 week from time of hospital admission (or time of clinical suspicion of upper GI bleeding for patients
Discussion
The present study finds a U-shaped association between timing of endoscopy and mortality in hemodynamically stable patients with an ASA score of 3 to 5. Mortality seems to be lowest when endoscopy is performed between 12 and 36 hours from the time of admission to the hospital or from the time of development of symptoms of PUB in patients with in-hospital bleeding. According to our data, performance of endoscopy within this time interval is associated with a clinically significant reduction in
Acknowledgment
The present study was based on data from the DCRES. The authors are grateful to all who contributed data to the DCRES.
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DISCLOSURE: The following author received research support for this study from Odense University Hospital and Region of Southern Denmark: S. B. Laursen. All other authors disclosed no financial relationships relevant to this publication.
See CME section; p. 1086.
If you would like to chat with an author of this article, you may contact Dr Laursen at [email protected].