Urgent Endoscopy for Upper GI Bleeding does not lower mortality, finds NEJM study

Researchers have found that there was no observed benefit of Urgent Endoscopy for Upper GI Bleeding in a new study.

Gastrointestinal bleeding is the most common gastrointestinal diagnosis in which patients are subjected to endoscopy because endoscopic findings predict risk and guide management. 

It is recommended in general that patients with acute upper gastrointestinal bleeding undergo endoscopy within 24 hours after gastroenterology consultation. The role of endoscopy performed as an emergency measure within 24 hours has not been adequately defined.

Endoscopy performed within 6 hours of consultation for acute upper gastrointestinal bleeding does not appear to be better than slightly later endoscopy, according to a study in the New England Journal of Medicine.

Researchers evaluated whether urgent endoscopy improves outcomes in patients predicted to be at high risk for further bleeding or death.

Over 500a patients with overt signs of acute upper gastrointestinal bleeding and a Glasgow–Blatchford score of 12 or higher (scores range from 0 to 23, with higher scores indicating a higher risk of further bleeding or death) were randomly assigned to undergo endoscopy within 6 hours (urgent-endoscopy group) or between 6 and 24 hours (early-1endoscopy group) after gastroenterology consultation. The primary endpoint was death from any cause within 30 days after randomization.

The researchers found that the primary outcome -the rate of 30-day all-cause mortality — was similar in the two groups, roughly 7 to 9%. The incidence of further bleeding was also roughly similar between groups.

It was therefore concluded that patients with acute upper gastrointestinal bleeding who were at high risk for further bleeding or death, endoscopy performed within 6 hours after gastroenterology consultation was not associated with lower 30-day mortality than endoscopy performed between 6 and 24 hours after consultation.

The available evidence suggests that most patients hospitalized with upper gastrointestinal bleeding need not be rushed to immediate endoscopy.

For further reference log on to:

N Engl J Med 2020; 382:1299-1308

DOI: 10.1056/NEJMoa1912484