BACKGROUND

Endoscopy is a critical tool in the management of acute variceal bleeding (AVB). However, the optimal timing for its implementation remains controversial, with varying recommendations across different clinical guidelines. This study aims to evaluating the impact of endoscopy timing on patient outcomes.

METHODS

PubMed, the Cochrane Library, and Embase were searched from the earliest available publication to January 31, 2024. Both fixed-effect and random-effect models were employed to calculate the odds ratio (OR) and 95% confidence intervals (CIs), based on the levels of heterogeneity. Newcastle-Ottawa Scale was used to assess the quality of each included studies. The mortality, incidence of rebleeding and other secondary outcomes were compared between urgent and early endoscopy groups. Subgroup analysis was performed based on the endoscopy time defined in each included studies and the reporting time of primary outcomes. The publication bias was examined through Egger’s test and Begg’s test.

RESULTS

Our analysis showed no significant difference in overall mortality (OR = 0.99, 95% CI, 0.60–1.62,  = 0.96) and rebleeding (OR = 1.06, 95% CI, 0.77–1.47,  = 0.71) as well as secondary outcomes between the two groups. Subgroup analysis indicated that the mortality in the 6–24 h endoscopy group was significantly lower than in the < 6 h endoscopy group (OR = 2.05, 95% CI, 1.29–3.26,  = 0.002). However, no statistical difference between the other groups.

CONCLUSION

Endoscopy performed within 6 h might be associated with higher mortality. Furthermore, urgent and early endoscopy did not significantly affect other outcomes in AVB patients. Therefore, the timing for endoscopy would be more appropriate based on each patient’s condition within 24 h.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12876-025-04088-3.