Sarin N, Monga N, Adams P C
University of Western Ontario, London, Canada.
Can J Gastroenterol. 2009 Jul;23(7):489-93. doi: 10.1155/2009/604639.
Upper gastrointestinal bleeding (UGIB) is a common problem associated with significant morbidity and mortality. Previous studies show that immediate endoscopies do not affect outcomes in patients; however, endoscopic interventions have evolved. The present retrospective review of endoscopies performed at a large teaching hospital assessed the timing of endoscopy with respect to the morbidity and mortality of UGIB.
Diagnostic billing codes were used to assess all inpatients of gastroenterologists at the University Hospital of the London Health Sciences Centre, London, Ontario, from July 2004 to June 2006, using a centralized data recording system. Time to endoscopy (within 6 h, 6 h to 24 h and beyond 24 h) were compared for the outcomes of mortality, need for surgery and transfusion requirements.
From July 2004 to June 2006, there were 502 upper endoscopies performed for the indication of suspected UGIB and 375 for overt acute nonvariceal UGIB. Approximately 10% of cases revealed variceal bleeding. When comparing endoscopy within 6 h with endoscopy at 6 h to 24 h, there were no significant differences in mortality, need for surgery (OR 3.6 and 2.8, respectively, compared with endoscopy beyond 24 h) or transfusion requirements. Even when assessing the group that received endoscopic hemostasis, time to endoscopy was not associated with better outcomes. Multivariate analysis did not demonstrate any advantages for early endoscopy (less than 6 h) compared with endoscopy within 24 h.
Most patients with acute gastrointestinal bleeding can be effectively managed with endoscopy within 24 h.
上消化道出血（UGIB）是一个常见问题，伴有较高的发病率和死亡率。既往研究表明，即时内镜检查对患者的预后并无影响；然而，内镜干预技术已经有所发展。本研究对一家大型教学医院所进行的内镜检查进行回顾性分析，评估内镜检查时机对上消化道出血发病率和死亡率的影响。
采用诊断计费代码，通过集中数据记录系统，对2004年7月至2006年6月期间安大略省伦敦市伦敦健康科学中心大学医院的所有胃肠病科住院患者进行评估。比较内镜检查时间（6小时内、6至24小时以及24小时后）与死亡率、手术需求和输血需求等结局指标之间的关系。
2004年7月至2006年6月期间，因疑似上消化道出血而进行了502例上消化道内镜检查，因明显急性非静脉曲张性上消化道出血进行了375例检查。约10%的病例显示为静脉曲张出血。将6小时内的内镜检查与6至24小时的内镜检查进行比较，死亡率、手术需求（与24小时后的内镜检查相比，比值比分别为3.6和2.8）或输血需求方面均无显著差异。即使在评估接受内镜止血的患者组时，内镜检查时间与更好的结局也无关联。多因素分析未显示早期内镜检查（少于6小时）相较于24小时内的内镜检查有任何优势。
大多数急性胃肠道出血患者可在24小时内通过内镜检查得到有效治疗。
