Non-variceal Upper Gastrointestinal Bleeding Research Articles

Hemostatic Powders in Non-Variceal Upper Gastrointestinal Bleeding: The Open Questions.

Hemostatic powder (HP) is a relatively recent addition to the arsenal of hemostatic endoscopic procedures (HEPs) for gastrointestinal bleeding (GIB) due to benign and malignant lesions. Five types of HP are currently available: TC-325 (Hemospray™), EndoClot™, Ankaferd Blood Stopper®, and, more recently, UI-EWD (NexpowderTM) and CEGP-003 (CGBio™). HP acts as a mechanical barrier and/or promotes platelet activation and coagulation cascade. HP may be used in combination with or as rescue therapy in case of failure of conventional HEPs (CHEPs) and also as monotherapy in large, poorly accessible lesions with multiple bleeding sources. Although the literature on HP is abundant, randomized controlled trials are scant, and some questions remain open. While HP is highly effective in inducing immediate hemostasis in GIB, the rates of rebleeding reported in different studies are very variable, and conditions affecting the stability of hemostasis have not yet been fully elucidated. It is not established whether HP as monotherapy is appropriate in severe GIB, such as spurting peptic ulcers, or should be used only as rescue or adjunctive therapy. Finally, as it can be sprayed on large areas, HP could become the gold standard in malignancy-related GIB, which is often nonresponsive or not amenable to treatment with CHEPs as a result of multiple bleeding points and friable surfaces. This is a narrative review that provides an overview of currently available data and the open questions regarding the use of HP in the management of non-variceal upper GIB due to benign and malignant diseases.

Risk Assessment in Non-Variceal Upper Gastrointestinal Bleeding: A Comprehensive Review of Scoring Systems

Non-variceal upper gastrointestinal bleeding (NVUGIB) is a critical medical emergency with significant morbidity and mortality rates. The primary cause of NVUGIB is peptic ulcers. Proper risk assessment is vital for the efficient management of NVUGIB patients, impacting both clinical decisions and healthcare resources. Established scoring systems like the Rockall score (RS), Glasgow-Blatchford score (GBS), and AIMS65 have been instrumental in guiding clinical decisions. Their strengths, limitations, and areas of application are discussed. The emerging ABC score, with its potential to outperform existing systems, is highlighted, emphasizing its relevance in both upper and lower GI bleedings. However, The ABC score, though promising, necessitates further research for broader clinical adoption.

Admission Hypocalcemia and the Need for Endoscopic and Clinical Interventions among Patients with Upper Gastrointestinal Bleeding

Introduction: Calcium is an essential co-factor in the coagulation cascade, and hypocalcemia is associated with adverse outcomes in bleeding patients, including trauma patients, women with postpartum hemorrhage, and patients with intracranial hemorrhage. In this retrospective, single-center, cohort study, we aimed to determine whether admission-ionized calcium (Ca⁺⁺) is associated with higher rates of therapeutic interventions among patients presenting with acute nonvariceal upper gastrointestinal bleeding (NV-UGIB). Methods: Adult patients admitted due to NV-UGIB between January 2009 and April 2020 were identified. The primary outcome was defined as a need for clinical intervention (two or more packed cell transfusions, need for endoscopic, surgical, or angiographic intervention). Univariate and multivariable logistic regression analyses were performed to determine whether Ca⁺⁺ was an independent predictor of the need for therapeutic interventions. Propensity score matching was performed to adjust the imbalances of covariates between the groups. Results: A total of 434 patients were included, of whom 148 (34.1%) had hypocalcemia (Ca⁺⁺ <1.15 mmol/L). Patients with hypocalcemia were more likely to require therapeutic interventions than those without hypocalcemia (48.0% vs. 18.5%, p < 0.001). Specifically, patients with hypocalcemia were more likely to require endoscopic intervention for control of bleeding (25.0% vs. 15.7%, p = 0.03) and multiple packed cell transfusions (6.8% vs. 0.3%, p < 0.001). Additionally, they had significantly longer hospital stay (5.0 days [IQR 3.0–8.0] vs. 4.0 days [IQR 3.0–6.0], p = 0.01). After adjusting for multiple covariates, Ca⁺⁺ was an independent predictor of the need for therapeutic intervention (aOR 1.62, 95% confidence interval [CI] 1.22–2.14, p < 0.001). The addition of Ca⁺⁺ to the Modified Glasgow Blatchford score improved its accuracy in the prediction of therapeutic intervention from AUC of 0.68 (95% CI 0.63–0.72) to 0.72 (95% CI 0.67–0.76), p = 0.02. After incorporation of the propensity score, the results did not change significantly. Conclusion: These findings suggest that hypocalcemia is common and is associated with an adverse clinical course in patients with NV-UGIB. Measurement of Ca⁺⁺ on admission may facilitate risk stratification in these patients. Trials are needed to assess whether the correction of hypocalcemia will lead to improved outcomes.

CHAMPS score in predicting mortality of patients with acute nonvariceal upper gastrointestinal bleeding

The aim of this study was to evaluate the performance of the Charlson Comorbidity Index ≥2, in-hospital onset, albumin <2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥2, steroid use score in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding and compare it with the Glasgow-Blatchford score; the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score; the age, blood tests, and comorbidities score; and Complete Rockall score. The data of patients with acute upper gastrointestinal bleeding who visited the emergency department during the study period were obtained from the hospital automation system by using the classification of disease codes and analyzed in this retrospective study. Adult patients with endoscopically confirmed nonvariceal upper gastrointestinal bleeding were included in the study. Patients with bleeding from the tumor, bleeding after endoscopic resection, or missing data were excluded. The prediction accuracy of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score was calculated using the area under the receiver operating characteristic curve and compared with that of Glasgow-Blatchford score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, the age, blood tests, and comorbidities score, and Complete Rockall score. A total of 805 patients were included in the study, and the in-hospital mortality rate was 6.6%. The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score (area under the receiver operating characteristic curve 0.812, 95%CI 0.783-0.839) was better than Glasgow-Blatchford score (area under the receiver operating characteristic curve 0.683, 95%CI 0.650-0.713, p=0.008), and similar to the the age, blood tests, and comorbidities score (area under the receiver operating characteristic curve 0.829, 95%CI 0.801-0.854, p=0.563), the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score (area under the receiver operating characteristic curve 0.794, 95%CI 0.764-0.821, p=0.672), and Complete Rockall score (area under the receiver operating characteristic curve 0.761, 95%CI 0.730-0.790, p=0.106). The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score in predicting in-hospital mortality for our study population is better than Glasgow-Blatchford score and similar to the the age, blood tests, and comorbidities score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, and Complete Rockall score.

Impact of left ventricular assist devices on 30-day readmission and outcomes in non-variceal upper gastrointestinal bleeding: a nationwide analysis

Impact of left ventricular assist devices on 30-day readmission and outcomes in non-variceal upper gastrointestinal bleeding: a nationwide analysis

Does Early Endoscopy Affect the Clinical Outcomes of Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding? A Systematic Review and Meta-Analysis.

In patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB), the optimal timing of endoscopy is still a matter of dispute. We conducted a systematic review and meta-analysis to determine the clinical benefit of early endoscopy. A literature search of the MEDLINE, Embase, and Cochrane databases was conducted to identify publications from inception to March 1, 2022. Eligible studies included observational cohort studies and randomized controlled trials that reported clinical outcomes of endoscopy in patients with ANVUGIB. ANVUGIB patients who underwent endoscopy within 24 hours of admission were considered to have had an early endoscopy. The primary outcome was the mortality rate in ANVUGIB patients who had early or nonearly endoscopy. The final analysis included five randomized controlled studies (RCTs) and 20 observational studies from the 1,206 identified articles. The mortality rate was not significantly reduced among patients who received endoscopy performed within 24 hours, whether in cohort studies nor in RCTs. For subgroup analysis, a higher mortality rate was found only among patients who received very early endoscopy within 12 hours (odds ratio, 1.66; p<0.001, I2=0) in cohort studies. No significant difference in mortality rates was found among patients at high risk of bleeding who received early versus nonearly endoscopy. Early endoscopy within 24 hours does not appear to significantly reduce the mortality rates of patients with ANVUGIB. Further well-designed studies are warranted to address if very early endoscopy within 12 hours can provide a clinical benefit for patients at high risk of bleeding.

Efficacy and safety of over-the-scope clips® com-pared to through-the-scope clips for initial bleeding control in non-variceal upper gastrointestinal bleeding: a multicenter randomized clinical trial

Introduction: Non-variceal upper gastrointestinal bleeding still poses a serious health problem due to high rebleeding rates, despite multiple treatment options. The relatively new over-the-scope clips® technique may be an effective alternative used in clinical practice and showed promising efficacy in predominantly observational studies. However, superiority over another mechanical technique as first-line therapy has not been established yet regarding initial hemostasis and recurring bleeding. Methods: The study will be a phase II, randomized, controlled, blinded, multicenter, parallel-group, superiority trial with a 1:1 allocation ratio. Adult patients with Ia-IIb Forrest classified ulcers will be randomized to either over-the-scope clips ® or through-the-scope clips. The primary outcome will be successful initial hemostasis and will be assessed by the endoscopist immediately after the procedure. Secondary outcomes will be rebleeding rate assessed by second-look endoscopy in case of substantial bleeding indicators, number of clips used, and mortality rate within 30 days. Further, the occurrence of adverse device effects will be assessed. Patient follow-up will occur periodically for a 3-month time frame. Discussion: By comparing two mechanical techniques for the treatment of common ulcers, our study will provide valuable grounds to deduce recommendations for first-line definite treatment and prevention of recurrent bleeding episodes. Trial registration: The trial will be registered at ClinicalTrials.gov (https://clinicaltrials.gov/). Keywords: upper gastrointestinal bleeding, hemostasis, bleeding control, OTSC, clinical trial

Role of multidetector computed tomography angiography in non-variceal upper gastrointestinal bleeding: A comprehensive review.

Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common gastroenterological emergency associated with significant morbidity and mortality. Upper gastrointestinal endoscopy is currently recommended as the gold standard modality for both diagnosis and treatment, with computed tomography traditionally playing a limited role in the diagnosis of acute NVUGIB. Following the introduction of multidetector computed tomography (MDCT), this modality is emerging as a promising tool in the diagnosis of NVUGIB. However, to date, evidence concerning the role of MDCT in the NVUGIB diagnosis is still lacking. The aim of our study was to review the current evidence concerning the role of MDCT in the diagnosis of acute NVUGIB.

Analysis of the patients with nonvariceal upper gastrointestinal bleeding and comparison of Rockall and Glasgow-Blatchford scores.

Nonvariceal upper gastrointestinal bleeding (UGB) has important morbidity and mortality. Predicting high-risk patients for mortality and rebleeding is necessary for a treatment plan. In the present study, we aimed to define the epidemiological and etiological characteristics of patients presenting with nonvariceal UGB and to observe mortality and morbidity rates. We also aimed to compare Rockall and Glasgow-Blatchford scoring systems in predicting rebleeding and mortality. Subjects presenting with nonvariceal UGB over a 3-year period were included. Demographic characteristics, symptoms, and signs on physical examination, laboratory data, endoscopic signs and diagnosis, interventions during hospitalization and follow-up period were recorded. Glasgow-Blatchford and Rockall scores were calculated for every participant at the first day of the admission. A total of 709 patients were enrolled in the study. A total of 490 of them (69.1%) were men. The mean age of the women and men was 60.7±1.2 and 58.6± 0.7 years, respectively. Melena was the most common presenting symptom. Duodenal ulcer (31%), gastric ulcer (20.7%), and erosive disease (17.6%) were the most common causes of bleeding. History of use of aspirin and/or nonsteroidal anti-inflammatory drug use were present in 63.7% of the subjects. All patients were followed up for 30th-day mortality. Overall, rebleeding and mortality rates were 11% and 7%, respectively. A Rockall score greater than 6 was the most important predictor of mortality (odds ratio:39.1) and rebleeding (odds ratio:4.7). Nonvariceal UGB patients with a Rockall score greater than 6 should undergo aggressive endoscopic treatment and inpatient care.

Glasgow-Blatchford score combined with nasogastric aspirate as a new diagnostic algorithm for patients with nonvariceal upper gastrointestinal bleeding.

The Glasgow-Blatchford score (GBS) is a widely used risk assessment tool for patients with upper gastrointestinal bleeding. However, it only identifies a relatively low proportion of patients at low risk for adverse events and poor outcomes. We developed a simple diagnostic algorithm combining the GBS and nasogastric aspirate and evaluated its diagnostic performance. A total of 115 consecutive patients with suspected nonvariceal upper gastrointestinal bleeding who underwent nasogastric tube placement and upper endoscopy at our emergency department were prospectively evaluated. We compared the diagnostic accuracy of the GBS and our algorithm for predicting high-risk endoscopic lesions (HRELs) using receiver operating characteristic curve analysis. Thirty-five patients had HRELs. Compared with the GBS, our algorithm showed superior performance with respect to the prediction of HRELs (area under the curve, 0.639 and 0.854, respectively; p<0.001). With set optimal threshold values, the algorithm identified a significantly higher proportion of patients who did not have HRELs than the GBS (23.5%vs. 2.6%, p<0.001). The novel algorithm has improved the diagnostic performance of the GBS and predicted more patients who did not have HRELs than the GBS alone. After further validation, it may be a useful tool for making clinical management decisions for patients with nonvariceal upper gastrointestinal bleeding.

Disparities in Access to Endoscopy for Patients With Upper Gastrointestinal Bleeding Presenting to Emergency Departments

In the United States, upper gastrointestinal bleeding (UGIB) accounts for approximately 311,000 admissions yearly.1 The standard of care in most patients hospitalized with acute UGIB is evaluation with esophagogastroduodenoscopy (EGD).2 For Black and Hispanic populations, access to endoscopic evaluation when presenting to the emergency department (ED) with a primary diagnosis of acute UGIB has not been clearly described. A previous study using a nationwide all-payer database found that among hospitalized patients with nonvariceal UGIB, uninsured and Black patients have lower odds of undergoing EGD, Black and Hispanic patients have lower odds of early endoscopic evaluation (<24 hours), and Native American patients have the highest odds of in-hospital mortality.

Role of Transcatheter Arterial Embolization in Acute Refractory Non-variceal Upper Gastrointestinal Bleeding Not Controlled by Endoscopy: A Single-Center Experience and a Literature Review.

Introduction Acute upper gastrointestinal bleeding (UGIB) is a medical emergency and a common cause of hospital admissions worldwide. It has traditionally been treated with resuscitation and endoscopic intervention as the first-line therapy. In this study, weassessed the adjunctive role of transcatheter arterial embolization (TAE) in patients with uncontrolled UGIB after an endoscopic intervention. Material and methods A retrospective chart review of patients requiring TAE of UGIB which was not controlled by endoscopic intervention in BronxCare Health System from 2018 to 2021 was done. Patients who were more than 18 years of age and required TAE during the time period of the study were included in the study. Patients' charts were reviewed for patients' demographics, comorbidities, hospital course, imaging findings, esophagogastroduodenoscopy findingsand intervention, and interventional radiology intervention and clinical outcome. Results A total of 10 patients were included in the study. A majority of the patients were male. Transcatheter atrial embolization was successful in all the 10 patients. Coils were used in seven patients while particulate polyvinyl alcohol 500 micronparticlewas used in two patients and vascular plug was used in two patients. Out of the 10 patients, four expired during the hospital course. None of the patients died secondary to UGIB. Three of the patients expired due to severe sepsis with septic shock secondary to pneumonia while one patient died because of respiratory failure due to lung collapse secondary to endobronchial lesion. Conclusion Refractory acute UGIB is associated with significant morbidity and mortality. TAE is a minimally invasive measure that should be considered early in the treatment of UGIB which is refractory to conventional endoscopic management. Our case highlights the importance of TAE in a patient with refractory UGIB after endoscopic intervention.

Results of therapeutic endoscopy in non-variceal upper gastrointestinal bleeding at Hue University of Medicine and Pharmacy Hospital

Background: Upper gastrointestinal bleeding is a frequent emergency in Viet Nam, most of them are non-variceal gastrointestinal bleeding. Despite of many improvements in diagnosis and management, the mortality rate of upper gastrointestinal bleeding is still significant high. In recent years, many endoscopic hemostasis techniques improved the prognosis of this emergency. This study was aimed at: 1. Describing characteristics and the endoscopic lesions in patients with non-variceal upper gastrointestinal bleeding. 2. Assessing efficacy of some endoscopic hemostasis techniques in non-variceal upper gastrointestinal bleeding. Subject and methods: Interventional study concludes 161 non-variceal upper gastrointestinal bleeding patients, 179 therapeutic upper endoscopy to get hemostasis in Gastroenterology - Endoscopy Center, Hue University of Medicine and Pharmacy Hospital from 11/2017 to 8/2020. Result: Mean age of the patients: 55.0 ± 17.3, minimum: 12, maximum: 94. Male/female ratio: 2.6. Positions of lesions: 10.6% in esophagus, 41.6% in stomach, 47.8% in duodenum. Causes of bleeding: peptic ulcer diseases (82.0%), esophago-gastric junction tear (9.9%), angiodysplasia (5.6%), and others (2.5%). Successful rate of initiating endoscopic hemostasis: 100%, permanent endoscopic hemostasis: 98.8%; recurrent bleeding rate: 4.3%, endoscopic hemostasis failure: 1.2%; operation rate: 1.2%. Conclusion: Endoscopic hemostasis techniques showed good safety and efficacy, failure and operation rate are very low. Key words: non-variceal upper gastrointestinal bleeding, endoscopic hemostasis

S661 Impact of Non-Alcoholic Fatty Liver Disease on In-Patient Outcomes in Non-Variceal Upper Gastrointestinal Bleeding: A Nationwide Analysis

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is the leading cause of liver disease globally with an estimated prevalence of 25%. The clinical and economic burden of NAFLD is expected to keep increasing. Upper gastrointestinal bleeding (UGIB) occurs in ∼100 out of 100,000 people per year. Our aim with this study is to determine the impact of NAFLD on mortality, in-patient complications, and utilization of resources in patients with UGIB. Methods: Using de-identified data from the National Inpatient Sample (NIS) database 2016-2019, we identified patients with non-variceal UGIB and then stratified them into those with and without NAFLD. Patient demographics, length of stay, hospital charges, comorbidities, complications and mortality outcome data were analyzed. Mann-Whitney tests with Bonferroni corrections were used for testing differences in continuous variables, while chi-squared tests with Bonferroni corrections were used for testing homogeneity of categorical variables. Multivariate logistic regression was conducted to analyze the relationship between mortality and NAFLD, while controlling for relevant covariates. Bidirectional stepwise regression was utilized to build the final model. All statistical analysis and hypothesis tests were performed at significance level, with p-value set at < 0.05. Analyses were conducted using R software (v. 4.0.4). Results: Multivariate logistic regression analysis (MLRA) was conducted, controlling for the multiple covariates.The primary outcome of interest, mortality, was found to be significantly higher in patients with NAFLD and GI bleeding [aOR: 1.88 (1.68-2.1)]. Secondary outcomes of interest, shock [aOR: 1.15 (1.07-1.22)], acute respiratory failure [aOR:1.28 (1.15-1.42)] and acute liver failure [aOR:5.58 (4.48-6.69)] were all more likely to occur in this cohort. Patients with NAFLD were also more likely to incur higher hospital charges [$2174 ($1677-$2618)] and have a longer length of stay [0.28 days (0.17-0.38)]. Interestingly, in our study the patients with NAFLD were less likely to suffer from acute myocardial infarction [aOR: 0.73 (0.64-0.85)]. Patients with NAFLD were not more likely to suffer AKI, shock requiring vasopressors, sepsis, blood transfusion, intubation or dialysis. Conclusion: Our analysis showed that patients with non-variceal UGIB have higher mortality, increased complications, longer length of stay and higher hospital charges pointing to the increased morbidity and economic burden of NAFLD.Figure 1.: A. Comparison of demographic and co-morbidities data between non-variceal UGIB with and without NAFLD.Figure 1B.: Forest Plot showing relation between presence of NAFLD with GI bleeding and co-variates.

S684 Assessing the Weekend Effect on Outcomes of Adults With Non-variceal Upper Gastrointestinal Hemorrhage as the Reason for Emergency Department Presentation in the United States

Introduction: Non-variceal upper gastrointestinal hemorrhage (NUGIH) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. This study assessed if there was a difference in outcomes among patients in the Emergency Department (ED) with non-variceal upper gastrointestinal hemorrhage who presented over the weekend compared to weekdays. We queried the US Nationwide Emergency Department Sample (NEDS) for 2018. The NEDS is coded using the International Classification of Diseases 10 th Revision coding system. The first listed diagnosis was taken as the reason for the ED encounter in keeping with NEDS research methods. Methods: The study population included all ED encounters with a principal encounter diagnosis of NVUGIH obtained from literature review. We excluded encounters less than 18 years from the study. Outcomes assessed included a comparison of ED discharge rates, the mean number of procedures in the ED (EDP), mean total ED charges in USD, inpatient length of hospital stay (IPLOS), and hospital mortality rates between weekday and weekend visits. Multivariable regression analysis was performed to adjust outcomes for age categories, sex, hospital teaching status, hospital region, income quartile, primary payer, and Elixhauser Comorbidity Index (ECI). Results: There were 229,920 presentations for NVUGIB to the ED in 2018, with 25% occurring over the weekend. The weekend encounters had a statistically significantly lower mean age (57.8 ±21.1 [standard deviation] vs 58.4 ±20.8 years, p=0.009), and a lower mean ECI (2.7 vs 2.8, p=0.010). There was no difference in sex, primary payer, and median income distribution. Among encounters for NVUGIH, a weekend visit was associated with a lower adjusted odds ratio (aOR) of ED discharge (aOR:0.94, p=0.011) and increased IPLOS (4.1 vs 4.0 days, p=0.028). There was no difference in mortality (0.9 vs 1.1%, aOR:0.88, p=0.200), mean EDP, and mean total ED charges when compared to weekday encounters. Conclusion: We postulate that the elderly, non-working population may have led to higher ECI and age in weekday presentations. The 6% decreased odds of being discharged from the ED over the weekend may be due to decreased availability of routine GI specialty services to properly triage patients. This likely impacted the duration of hospitalization, which was longer over the weekend. There is a need for prospective quality initiative projects to elucidate potential factors for the weekend effect on NVUGIH.

S710 Hyperthyroid State Is Associated with Reduced Mortality in Patients Admitted for Nonvariceal Upper Gastrointestinal Bleeding

Introduction: Through an uncertain mechanism, previous animal models proved that thyroid hormones act on mucosal lesions and reduce the formation of gastric stress ulcers. In this study, authors aim to investigate the influence of hyperthyroid state on outcomes of patients with non-variceal upper gastrointestinal bleeding (NVUGIB). Up to our knowledge, such association have never been studied in literature before. Methods: This is a retrospective cohort examining data from the National Inpatient Sample (NIS) Database of the years 2016 to 2019. Using ICD-10 codes, authors identified hyperthyroid and non-hyperthyroid patients who were principally hospitalized for NVUGIB. Univariate and Multivariate logistic regression analysis was performed to determine the risk of mortality and in-hospital complications. Baseline patients and facilities characteristics were incorporated into the analysis. Data was considered statistically significant with p-value < 0.05. Results: A total of 1,638,754 patients were identified with a principal diagnosis of non-variceal UGIB, among those 7,205 (0.43%) had a history of hyperthyroidism. Study groups baseline comorbidities are illustrated in Figure. After running a multivariate logistic analysis for inpatient mortality, patients with non-variceal UGIB and hyperthyroidism had a 38% reduction in risk of mortality (OR 0.62, 95% CI 0.40 – 0.97, P= 0.039) compared to non-hyperthyroid subjects. In term of secondary outcomes, both groups had no difference in risk of sepsis (OR 0.74, 95% CI 0.50 – 1.09, P= 0.135), hypovolemic shock (OR 1.03, 95% CI 0.74 – 1.43, p=0.853), acute kidney injury (OR 1.06, 95% CI 0.92 – 1.21, p=0.394), acute respiratory failure (OR 0.73, 95% CI 0.54 – 1.00, p=0.050), acute coronary syndrome (OR 1.27, 95% CI 0.95 – 1.71, p=0.097) and In-hospital cardiac arrest (OR 0.62, 95% CI 0.17 – 2.17, p=0.457). Length of stay (aMD 0.33 days, 95% CI -0.09– 0.77, p=0.124) and charges of care (aMD 6146$, 95% CI -852.3– 13145, p=0.085) were not affected by hyperthyroid state as well. Conclusion: Interestingly, our analysis concludes that hyperthyroid state can influence the mortality of patient with non-variceal UGIB. This beneficial effect is likely related to the modulatory effect of thyroid hormones on the responsiveness of the gastrointestinal mucosa to stress. Further studies are needed to investigate and confirm the clinical impact of thyroid state on the outcomes of patients with gastrointestinal bleeding.Figure 1.: Baseline comorbidities of NVUGIB patients stratified by past history of Hyperthyroidism.

S670 Use of an Endoscopic Doppler Probe by General Gastroenterologists and Trainees to Guide Hemostasis in Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB): Outcomes of a Large Academic Medical Center

S670 Use of an Endoscopic Doppler Probe by General Gastroenterologists and Trainees to Guide Hemostasis in Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB): Outcomes of a Large Academic Medical Center

S676 Outcomes in Non-Variceal Upper Gastrointestinal Bleeding With Use of the Endoscopic Over-the-Scope-Clip Device Deployed by General Gastroenterologists and Trainees: Experience From a Large Academic Medical Center

S676 Outcomes in Non-Variceal Upper Gastrointestinal Bleeding With Use of the Endoscopic Over-the-Scope-Clip Device Deployed by General Gastroenterologists and Trainees: Experience From a Large Academic Medical Center

Effect of Direct-acting Oral Anticoagulants and Warfarin on Hospital Outcomes in Upper Gastrointestinal Bleeding.

To evaluate the comparison of direct-acting oral anticoagulants (DOACs) and warfarin for their effects on major bleeding and hospital outcomes in patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB). An observational study. Tekirdag Namik Kemal University Hospital, Hitit University Erol Olçok Education and Research Hospital, between January and December 2021. Adult patients prescribed warfarin and DOACs were followed up for one year. Their length of hospital stay, need for intensive care unit admission, need for red blood cell transfusion, and major bleeding rates were compared. Thirty-two patients (61.5%) were user of DOACs (DOAC group), and 20 patients (38.5%) were users of warfarin (warfarin group). No statistically significant difference was determined between patients in warfarin group and DOAC group for the number of packed red blood cells transfused [median 3 (0-6) units, 3 (0-10) units, p=0.229, respectively], length of hospital stay [median 5 days (3-10), and 4.5 days (2-20), p=0.739, respectively], rate of intensive care unit admission [(n=9, 45%; and n=10 (31%), p=0.623, respectively] and the occurrence of major bleeding events (warfarin-70%; DOACs-78%; p=0.529). Major bleeding episodes and hospital outcomes of acute NVUGIB were similar between patients receiving warfarin and DOACs. Direct-acting oral anticoagulants, Warfarin, Gastrointestinal bleeding, Outcome, Mortality.

S675 Glasgow-Blatchford Score vs Glasgow-Blatchford Score Plus Additional Variables to Predict High-Risk Peptic Ulcers in Acute Nonvariceal Upper Gastrointestinal Bleed in a United Arab Emirates Tertiary Center

Introduction: Acute nonvariceal upper gastrointestinal bleeding (NVUGIB) is a medical emergency and one of the most common reasons for emergency GI care. The Glasgow-Blatchford score (GBS) has been developed for risk stratification. Our group has previously reported that GBS has very limited accuracy in Middle East North Africa (MENA) region. Our aim was to evaluate whether additional clinical variables improved the accuracy of GBS to predict actual high-risk stigmata or active bleeding during emergency endoscopy and to validate this in a large volume tertiary care setting in the MENA region. Methods: Data were collected retrospectively for a cohort of patients over the age of 16 years who attended the emergency department or were inpatients and underwent esophagogastroduodenoscopy (EGD) for acute NVUGIB from January 2020 through September 2021 at a tertiary hospital in the United Arab Emirates. Our predictor variables included GBS and other potential risk factors as listed in Table. GBS included patients' hemoglobin by gender, blood urea, heart rate, and systolic blood pressure from the time of admission as well as presentation with syncope or melena, and evidence of hepatic disease or cardiac failure. After assessing ability of the GBS to predict Forrest I- II classification by estimating the area under the receiver operating characteristic curve (AUROCC), we examined if other patient demographics and clinical characteristics might improve upon the ability of GBS to detect Forrest I-II classification by fitting several logistic regression models and calculating the AUROCC. Results: Among the 153 patients in our cohort, the median age was 58 years (IQR XMR 11 (IQR 7 to 13). In our cohort, 28 (18.3%) patients had Forrest I-II classification identified during endoscopy. The AUROCC for the ability of GBS to detect Forrest I-II classification was 0.49 (95% CI 0.37 to 0.62). AUROCC for the ability of each patient characteristic to detect Forrest I-II classification is shown in Table. Models that contained age, diastolic blood pressure and nationality/immigration status in addition to GBS provided the highest overall AUROC with confidence intervals significantly higher than GBS alone. Conclusion: Our study did not find evidence that GBS by itself was a useful tool at identifying patients with Forrest I-II classification during endoscopy. Our data suggested younger age, nationality / immigration status along with lower DBP may be better predictors of Forrest I-II classification when considered with GBS. Table 1. - Patients Demographics and Clinical Characteristics with Area under the Receiver Operating Characteristic Curve for Detection of Forrest I-II Classification AUC-1 AUC-2 AUROC-3 AUC-4 Predictor variable Unadjusted GBS-adjusted Age-adjusted GBS- and age-adjusted Glasgow-Blatchford score 0.493 0.704 Age 0.695 0.704 Gender 0.590 0.605 0.724 0.731 Nationality 0.630 0.634 0.737 0.745 Diabetes 0.563 0.565 0.697 0.705 Hypertension 0.609 0.627 0.696 0.706 Dyslipidemia 0.523 0.530 0.698 0.707 Chronic kidney disease 0.577 0.602 0.694 0.704 Ischemic heart disease 0.578 0.566 0.695 0.715 Atrial fibrillation 0.568 0.582 0.704 0.718 Congestive heart failure 0.510 0.519 0.696 0.706 Chronic liver disease 0.526 0.530 0.700 0.708 Cerebrovascular accident 0.563 0.575 0.691 0.702 Malignancy 0.508 0.522 0.696 0.705 Antiplatelets 0.533 0.537 0.696 0.706 Anticoagulant 0.527 0.548 0.699 0.709 Proton pump inhibitor 0.524 0.525 0.695 0.703 Steroid 0.506 0.514 0.695 0.702 NSAIDs 0.520 0.537 0.704 0.712 Admission unit 0.515 0.534 0.700 0.706 Admission time 0.538 0.533 0.699 0.711 Prior GI bleeding 0.517 0.513 0.693 0.705 Hematemesis 0.578 0.572 0.711 0.717 Melena 0.587 0.602 0.716 0.719 Drop in haemoglobin 0.519 0.504 0.693 0.706 PR Bleeding 0.528 0.541 0.698 0.705 Syncope 0.502 0.511 0.694 0.705 Urea 0.532 0.518 0.698 0.706 Initial Hgb 0.498 0.516 0.693 0.701 SBP 0.383 0.448 0.698 0.710 DBP 0.599 0.648 0.738 0.738 Heart rate 0.593 0.599 0.700 0.708 Unstable Pulse 0.570 0.607 0.700 0.705 Blood Transfusion 0.505 0.497 0.698 0.705 AUC=area under the receiver operating characteristic curve, GBS=Glasgow-Blatchford score.AUC-1 estimates were obtained from single variable logistic regression models separately for each predictor variable.AUC-2 estimates were obtained from logistic regression models separately for each predictor variable with GBS included as an additional predictor variable.AUC-3 estimates were obtained from logistic regression models separately for each predictor variable with age included as an additional predictor variable.AUC-4 estimates were obtained from logistic regression models separately for each predictor variable with GBS and age included as an additional predictor variables.