Original article
Clinical endoscopy
Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study

https://doi.org/10.1016/j.gie.2016.08.049Get rights and content

Background and Aims

The optimal timing of endoscopy in patients with peptic ulcer bleeding (PUB) remains unclear. The aim of this study was to examine the association between timing of endoscopy and mortality in PUB.

Methods

In a nationwide cohort study based on a database of consecutive patients admitted to the hospital with PUB in Denmark, patients were stratified according to the presence of hemodynamic instability at presentation and American Society of Anesthesiologists (ASA) score. Using descriptive statistics and logistic regression analyses, we identified optimal time frames for endoscopy and analyzed the association between timing of endoscopy and in-hospital mortality after adjusting for confounding factors.

Results

In total, 12,601 patients were included. We did not find any universal association between timing of endoscopy and mortality in hemodynamically stable patients with an ASA score of 1 to 2. In hemodynamically stable patients with an ASA score of 3 to 5, endoscopy 12 to 36 hours after admission to the hospital was associated with lower in-hospital mortality (OR, .48; 95% CI, .34-.67) compared with endoscopy outside this time frame. In patients with hemodynamic instability, endoscopy 6 to 24 hours after admission to the hospital was associated with lower in-hospital mortality (OR, .73; 95% CI, .54-.98) compared with endoscopy outside this time frame.

Conclusions

Timing of endoscopy is associated with mortality in patients with PUB and an ASA score of 3 to 5 or hemodynamic instability. Our findings suggest that in these patients, a period of time to optimize resuscitation and manage comorbidities before endoscopy may improve outcome.

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.

References (21)

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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].

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