Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España.
Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España.
Gastroenterol Hepatol. 2023 Oct;46(8):612-620. doi: 10.1016/j.gastrohep.2023.01.013. Epub 2023 Feb 15.
The main clinical practice guidelines recommend endoscopy within 24hours after admission to the Emergency Department in patients with non-variceal upper gastrointestinal bleeding. However, it is a wide time frame and the role of urgent endoscopy (<6hours) is controversial.
Prospective observational study carried out at La Paz University Hospital, where all patients were selected, from January 1, 2015 to April 30, 2020, who attended the Emergency Room and underwent endoscopy for suspected upper gastrointestinal bleeding. Two groups of patients were established: urgent endoscopy (<6hours) and early endoscopy (6-24hours). The primary endpoint of the study was 30-day mortality.
A total of 1096 were included, of whom 682 underwent urgent endoscopy. Mortality at 30days was 6% (5% vs 7.7%, P=.064) and rebleeding was 9.6%. There were no statistically significant differences in mortality, rebleeding, need for endoscopic treatment, surgery and/or embolization, but there were differences in the necessity for transfusion(57.5% vs 68.4%, P<.001) and the number of concentrates of transfused red blood cells (2.85±4.01 vs 3.51±4.09, P=.008).
Urgent endoscopy, in patients with acute upper gastrointestinal bleeding, as well as the high-risk subgroup (GBS ≥12), was not associated with lower 30-day mortality than early endoscopy. However, urgent endoscopy in patients with high-risk endoscopic lesions (ForrestI-IIB), was a significant predictor of lower mortality. Therefore, more studies are required for the correct identification of patients who benefit from this medical approach (urgent endoscopy).
主要的临床实践指南建议，在非静脉曲张性上消化道出血患者入院后 24 小时内进行内镜检查。然而，这一时间范围很宽，紧急内镜检查（<6 小时）的作用存在争议。
这是一项在拉帕兹大学医院进行的前瞻性观察研究，研究对象为 2015 年 1 月 1 日至 2020 年 4 月 30 日期间因疑似上消化道出血而入住急诊室并接受内镜检查的所有患者。研究建立了两组患者：紧急内镜检查（<6 小时）和早期内镜检查（6-24 小时）。研究的主要终点是 30 天死亡率。
共纳入 1096 例患者，其中 682 例行紧急内镜检查。30 天死亡率为 6%（5%比 7.7%，P=0.064），再出血率为 9.6%。死亡率、再出血率、内镜治疗、手术和/或栓塞的需求无统计学差异，但输血的必要性（57.5%比 68.4%，P<.001）和输注红细胞浓缩物的数量（2.85±4.01 比 3.51±4.09，P=0.008）有差异。
在急性上消化道出血患者中，以及高危亚组（GBS≥12）中，与早期内镜检查相比，紧急内镜检查并未降低 30 天死亡率。然而，对于高危内镜病变（ForrestI-IIB）的患者，紧急内镜检查是降低死亡率的显著预测因素。因此，需要更多的研究来正确识别从这种医疗方法（紧急内镜检查）中获益的患者。
