Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, Liaoning Province, 110840, China.
Postgraduate College, Jinzhou Medical University, Jinzhou, P.R. China.
BMC Gastroenterol. 2023 Jun 26;23(1):219. doi: 10.1186/s12876-023-02766-8.
The optimal timing of endoscopy in liver cirrhosis with acute variceal bleeding (AVB) remains controversial in current guidelines and studies.
Consecutive patients with liver cirrhosis and AVB were screened. The timing of endoscopy was calculated from the last presentation of AVB or the admission to endoscopy. Early endoscopy was defined as the interval < 12 h, < 24 h, or < 48 h. A 1:1 propensity score matching (PSM) analysis was performed. Five-day failure to control bleeding and in-hospital mortality were evaluated.
Overall, 534 patients were included. When the timing of endoscopy was calculated from the last presentation of AVB, PSM analysis demonstrated that the rate of 5-day failure to control bleeding was significantly higher in early endoscopy group defined as < 48 h (9.7% versus 2.4%, P = 0.009), but not < 12 h (8.7% versus 6.5%, P = 1.000) or < 24 h (13.4% versus 6.2%, P = 0.091), and that the in-hospital mortality was not significantly different between early and delayed endoscopy groups (< 12 h: 6.5% versus 4.3%, P = 1.000; <24 h: 4.1% versus 3.1%, P = 1.000; <48 h: 3.0% versus 2.4%, P = 1.000). When the timing of endoscopy was calculated from the admission, PSM analyses did not demonstrate any significant difference in the rate of 5-day failure to control bleeding (< 12 h: 4.8% versus 12.7%, P = 0.205; <24 h: 5.2% versus 7.7%, P = 0.355; <48 h: 4.5% versus 6.0%, P = 0.501) or in-hospital mortality (< 12 h: 4.8% versus 4.8%, P = 1.000; <24 h: 3.9% versus 2.6%, P = 0.750; <48 h: 2.0% versus 2.5%, P = 1.000) between early and delayed endoscopy groups.
Our study could not support any significant association of timing of endoscopy with cirrhotic patients with AVB.
目前的指南和研究对肝硬化伴急性静脉曲张出血（AVB）患者内镜检查的最佳时机仍存在争议。
连续筛选出肝硬化伴 AVB 的患者。内镜检查的时间从 AVB 的最后一次发作或内镜检查入院开始计算。早期内镜检查定义为间隔时间<12 小时、<24 小时或<48 小时。进行了 1:1 倾向评分匹配（PSM）分析。评估 5 天内出血控制失败和住院死亡率。
总体而言，共纳入 534 例患者。当从 AVB 的最后一次发作开始计算内镜检查的时间时，PSM 分析显示，早期内镜检查组（<48 小时）5 天内出血控制失败的发生率明显较高（9.7%比 2.4%，P=0.009），但<12 小时（8.7%比 6.5%，P=1.000）或<24 小时（13.4%比 6.2%，P=0.091）差异无统计学意义，早期和延迟内镜检查组的住院死亡率无显著差异（<12 小时：6.5%比 4.3%，P=1.000；<24 小时：4.1%比 3.1%，P=1.000；<48 小时：3.0%比 2.4%，P=1.000）。当从入院开始计算内镜检查的时间时，PSM 分析并未显示 5 天内出血控制失败的发生率存在任何显著差异（<12 小时：4.8%比 12.7%，P=0.205；<24 小时：5.2%比 7.7%，P=0.355；<48 小时：4.5%比 6.0%，P=0.501）或住院死亡率（<12 小时：4.8%比 4.8%，P=1.000；<24 小时：3.9%比 2.6%，P=0.750；<48 小时：2.0%比 2.5%，P=1.000）在早期和延迟内镜检查组之间。
本研究不能支持内镜检查时间与肝硬化伴 AVB 患者之间存在任何显著关联。
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