High-risk ED patients with nonvariceal upper gastrointestinal hemorrhage undergoing emergency or urgent endoscopy: a retrospective analysis

Tai, Chi-Ming; Huang, Shih-Pei; Wang, Hsiu-Po; Lee, Tsung-Chun; Chang, Chi-Yang; Tu, Chia-Hung; Lee, Ching-Tai; Chiang, Tsung-Hsien; Lin, Jaw-Town; Wu, Ming-Shiang

doi:10.1016/j.ajem.2006.07.014

« Previous Next »American Journal of Emergency Medicine
Volume 25, Issue 3 , Pages 273-278, March 2007

High-risk ED patients with nonvariceal upper gastrointestinal hemorrhage undergoing emergency or urgent endoscopy: a retrospective analysis

Chi-Ming Tai, MD
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung 824, Taiwan
Shih-Pei Huang, MD, PhD
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
Hsiu-Po Wang, MD
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
Tsung-Chun Lee, MD
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan
Chi-Yang Chang, MD
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung 824, Taiwan
Chia-Hung Tu, MD
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung 824, Taiwan
Ching-Tai Lee, MD
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung 824, Taiwan
Tsung-Hsien Chiang, MD
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung 824, Taiwan
Jaw-Town Lin, MD, PhD
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
Ming-Shiang Wu, MD, PhD
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Corresponding author. Tel.: +886 2 23123456x5410; fax: +886 2 23947899.

Received 13 June 2006; received in revised form 27 June 2006; accepted 2 July 2006.

Abstract

Objectives

The optimal timing of interventional endoscopy within the initial 24 hours remains controversial. We designed a retrospective study to compare the outcomes between emergency endoscopy (EE) and urgent endoscopy (UE) for high-risk patients with nonvariceal upper gastrointestinal hemorrhage presenting to the emergency department (ED).

Methods

The medical records of 189 patients with nonvariceal upper gastrointestinal hemorrhage who underwent endoscopy within 24 hours of admission to the ED were reviewed. Patients were divided into 2 groups: EE group (<8 hours) or UE group (8-24 hours). We compared the endoscopic findings, hemostatic procedures, rate of hemostasis, rebleeding, need for transfusion, length of hospitalization, and mortality between the 2 groups.

Results

There were 88 patients (47%) in the EE group and 101 patients (53%) in the UE group. Ulcers with active bleeding or exposed vessel were found more frequently in the EE group than in the UE group (19% vs 8%, P = .03; 34% vs 12%, P < .001). Fifty patients had blood retention in the stomach, especially in the EE group (40% vs 15%, P < .001). Forty-four (50%) patients in the EE group and 21 (21%) patients in the UE group received endoscopic interventions. Combination modalities of endoscopic hemostasis were more commonly used in the EE group than in the UE group (40% vs 15%, P < .001). Primary hemostasis was achieved at a rate of 95% in both groups. There was no statistical difference regarding the rate of recurrent bleeding, total amount of transfusion, length of hospital stay, and mortality rate in both groups.

Conclusions

Although more active lesions were detected and more therapeutic attempts were performed in the EE group, the outcome showed no difference in both groups. Emergency endoscopy performed less than 8 hours after arrival to the ED showed no definite benefit in comparison with UE performed within 8 to 24 hours.