Timing of Urgent Endoscopy for Upper Gastrointestinal Bleeding According to Clinical Criteria: A Prospective Study

Abstract

Background: Although it is widely accepted that urgent endoscopy for upper gastrointestinal bleeding (UGIB) should be performed within 24 hours, optimal timing has not yet been established. Aim of this prospective study was to test the validity of a simple clinical score in order to select those UGIB patients who may gain benefit from an early (within 2 hours) urgent endoscopy. Methods: All consecutive UGIB patients referred to a single endoscopic center during a 16 months period were enrolled. Before endoscopy patients were stratified according to a simple clinical score (T-score), including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk) (Table 1). Endoscopy was performed in all cases within 2 hours, and high-risk stigmata were considered for further analysis. Results: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2, and 175 (40%) T3. High-risk endoscopic stigmata were detected in 118 cases (27%). High-risk endoscopic stigmata occurred significantly more frequently in T1 patients than in T2/T3 cases (85% vs. 3.2%; p < 0.001). Older age and presence of comorbidities were more frequently detected in T1 than in T2/T3 patients (Table 2). Conclusions: Timing of urgent endoscopy following an episode of UGIB may be differentiated according to a simple score purely reflecting clinical conditions of the patients. Table 1Numerical values for each parameter of the clinical index adopted in the study (T-Score) Score ∗ Sum ≤6 = T1; 7-9 = T2; ≥10 = T3 clinical parameter 1 2 3 general conditions bad intermediate good pulse beats/min >110 90-110 <90 systolic blood pressure <90 90-110 >110 Hb (g/dl) ≤8 9-10 >10 ∗ Sum ≤6 = T1; 7-9 = T2; ≥10 = T3 Open table in a new tab Table 2Demographical and clinical characteristics of the UGIB patients according to T-score classes variable T1 (N = 201) T2 (N = 217) T3 (N = 278) p mean age ± SD; years 69 ± 13 63 ± 16 64 ± 12 <0.01 ∗ T1 versus T2 or T3 male sex, % 66 62 60 NS comorbidities, % 49 20 31 <0.01 ∗ T1 versus T2 or T3 systolic blood pressure,mmHg 85 ± 15 106 ± 22 139 ± 37 <0.01 T1 versus T2 or T3 and T2 versus T3 hemoglobin level, g/dl 7.2 ± 1.3 9.7 ± 2.3 13.8 ± 3 <0.01 T1 versus T2 or T3 and T2 versus T3 ∗ T1 versus T2 or T3 ∗∗ T1 versus T2 or T3 and T2 versus T3 Open table in a new tab