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  • Review Article
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Endoscopy for upper gastrointestinal bleeding: how urgent is it?

Nature Reviews Gastroenterology & Hepatology volume 6, pages 463–469 (2009)Cite this article

Abstract

Early endoscopy has been advocated for the management of upper gastrointestinal bleeding, but the optimal timing for early endoscopy is still uncertain. The aim of this Review is to evaluate the optimal timing of early endoscopy by examining the findings of randomized clinical trials and retrospective cohort studies that used comparable outcome measures and have been reported in the literature. Outcome measurements included recurrent bleeding, surgery, mortality, length of hospital stay, and blood transfusion. Studies were categorized into those in which endoscopy was performed within 2–3 h, 6–8 h, 12 h or 24 h of the patient's presentation to hospital. We conclude that early endoscopy aids risk stratification of patients and reduces the need for hospitalization. However, it may also expose additional cases of active bleeding and hence increase the use of therapeutic endoscopy. No evidence exists that very early endoscopy (within a few hours of presentation) can reduce the risk of rebleeding or improve survival.

Key Points

  • Endoscopy within 12 h of presentation leads to increased use of endoscopic therapy for advanced stigmata of hemorrhage, which may not be necessary

  • No evidence exists for any clinical benefit of endoscopy performed within 12 h of presentation

  • Early endoscopy within 12 h of presentation does not reduce the rebleeding rate or improve survival of patients

  • Endoscopy within 24 h of presentation is recommended for management of upper gastrointestinal bleeding, because it has clinical benefits

  • Endoscopy within 24 h of hospitalization aids risk assessment and reduces the length of hospital stay

  • In health-care practices where a 24 h endoscopy service is not available, endoscopy should be offered to patients the next day

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Acknowledgements

K. K. F. Tsoi's work is supported by a Chief Executive's Commission Grant of the Hong Kong Special Administration Region Government.

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  1. Institute of Digestive Disease and Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China

    Kelvin K. F. Tsoi, Terry K. W. Ma & Joseph J. Y. Sung

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Correspondence to Joseph J. Y. Sung.

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J. J. Y. Sung serves on the Advisory Board of AstraZeneca, and is a member of the speakers' bureaux for AstraZeneca, Nycomed, Roche, GlaxoSmithKline and Bristol-Myers Squibb. The other authors declare no competing interests.

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Tsoi, K., Ma, T. & Sung, J. Endoscopy for upper gastrointestinal bleeding: how urgent is it?. Nat Rev Gastroenterol Hepatol 6, 463–469 (2009). https://doi.org/10.1038/nrgastro.2009.108

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