The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy

  • Ahn, Dong-Won (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Park, Young Soo (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Lee, Sang Hyub (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Shin, Cheol Min (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Hwang, Jin-Hyeok (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Kim, Jin-Wook (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Jeong, Sook-Hyang (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Kim, Nayoung (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Lee, Dong Ho (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine)
  • Received : 2014.04.17
  • Accepted : 2014.12.23
  • Published : 2016.05.01
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Abstract

Background/Aims: This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours. Methods: A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010. Results: A total of 158 patients visited the emergency unit for ANVUGIB after hours. Among them, 60 underwent urgent EGD (within 8 hours) and 98 underwent early EGD (8 to 24 hours) by experienced endoscopists. The frequencies of hemodynamic instability, fresh blood aspirate on the nasogastric tube, and high-risk endoscopic findings were significantly higher in the urgent EGD group. Primary hemostasis was achieved in all except two patients. There were nine cases of recurrent bleeding, and 30-day mortality occurred in three patients. There were no significant differences between the two groups in primary hemostasis, recurrent bleeding, and 30-day mortality. In a multiple linear regression analysis, urgent EGD significantly reduced the hospital stay compared with early EGD. In patients with a high clinical Rockall score (more than 3), urgent EGD tended to decrease the hospital stay, although this was not statistically significant (7.7 days vs. 12.0 days, p > 0.05). Conclusions: Urgent EGD after hours by experienced endoscopists had an excellent endoscopic success rate. However, clinical outcomes were not significantly different between the urgent and early EGD groups.

Keywords

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