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http://dx.doi.org/10.3904/kjim.2014.099

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)
Publication Information
The Korean journal of internal medicine / v.31, no.3, 2016 , pp. 470-478 More about this Journal
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
Acute nonvariceal gastrointestinal bleeding; Endoscopic hemostasis; Primary hemostasis; Rebleeding; Urgent esophagogastroduodenoscopy;
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