Abstract
BackgroundFew studies have reported whether a biopsy in emergency gastroscopy (EG) increased the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) combined with suspected malignant gastric ulcer (SMGU). This study aims to conduct a multicenter retrospective cohort study using propensity score matching to verify whether a biopsy in EG increases the risk of rebleeding in patients diagnosed with Forrest I ANVUGIB combined with SMGU.MethodsUsing the data for propensity-matched patients, logistic regression models were fitted using rebleeding as the dependent variable. Survival time was defined as the length of time the patient experienced from visiting the emergency department to rebleeding. We used the Kaplan–Meier (KM) method to analyze the 30-day survival of the patients with and without a biopsy after matching, and the log-rank test was performed to examine the differences in survival.ResultsWith the use of propensity score matching, 308 patients who underwent a biopsy in EG were matched with 308 patients who did not. In the five logistic regression models, there were no significant group differences in the risk of rebleeding in patients with Forrest I ANVUGIB combined with SMGU between the biopsy and no-biopsy groups. The probability of survival was not significantly different between the no-biopsy and biopsy groups.ConclusionsIn this multicenter, retrospective propensity score matching cohort study, compared with patients without a biopsy, patients with a biopsy during EG had no increased risk of rebleeding, and there was no significant difference in the rate of rebleeding.
Highlights
Few studies have reported whether a biopsy in emergency gastroscopy (EG) increased the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) combined with suspected malignant gastric ulcer (SMGU)
A total of 39 (0.3%) patients were less than 18 years old; 3695 (29.3%) had esophagogastric variceal bleeding; 2172 (17.2%) did not have gastric ulcers found during EG; 4499 (35.6%) were Forrest II III ANVUGIB combined with gastric ulcer; 1002 (7.9%) presented benign gastric ulcer in EG; 122 (1.0%) were treated with an antithrombotic other than aspirin or clopidogrel or a combination of the two drugs (23 were treated with warfarin and 99 were treated with both aspirin and clopidogrel); and the vital signs and clinical data of 80 (0.6%) were incomplete
Primary outcome In the cohort before and after matching, there were no significant differences in the risk of rebleeding in patients with Forrest I ANVUGIB combined with SMGU during EG between a biopsy and no biopsy (Table 3)
Summary
Few studies have reported whether a biopsy in emergency gastroscopy (EG) increased the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) combined with suspected malignant gastric ulcer (SMGU). This study aims to conduct a multicenter retrospective cohort study using propensity score matching to verify whether a biopsy in EG increases the risk of rebleeding in patients diagnosed with Forrest I ANVUGIB combined with SMGU. A retrospective largescale case analysis in China showed that compared with 1997–1998, peptic ulcer bleeding (52.7%) was still the most important cause of upper gastrointestinal bleeding (UGIB) in 2012–2013, the detection rate of highrisk ulcers (Forrest Ia, Ib, IIa and IIb) increased (28.2% vs.15.7%), and the overall mortality did not decrease significantly (1.7% vs 1.1%) [3]. Part of the reason for rebleeding was due to suspected malignant gastric ulcer (SMGU) [7]
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