Superiority of urgent vs early endoscopic hemostasis in patients with upper gastrointestinal bleeding with high-risk stigmata  

作　　者：Masayasu Horibe Eisuke Iwasaki Juntaro Matsuzaki Fateh Bazerbachi Tetsuji Kaneko Kazuhiro Minami Seiichiro Fukuhara Tatsuhiro Masaoka Naoki Hosoe Yuki Ogura Shin Namiki Yasuo Hosoda Haruhiko Ogata Takanori Kanai 

机构地区：[1]Division of Gastroenterology and Hepatology,Department of Internal Medicine,Keio University School of Medicine,Tokyo,Japan [2]Division of Gastroenterology and Hepatology,Mayo Clinic,MN,USA [3]Interventional Endoscopy Program,CentraCare,St Cloud Hospital,MN,USA [4]Department of Clinical Trial,Tokyo Metropolitan Children’s Medical Center,Tokyo,Japan [5]Teikyo Academic Research Center,Teikyo University,Tokyo,Japan [6]Center for Diagnostic and Therapeutic Endoscopy,Keio University Hospital,Tokyo,Japan [7]Department of Gastroenterology and Hepatology,Tokyo Metropolitan Tama Medical Center,Tokyo,Japan [8]Division of Gastroenterology,Department of Internal Medicine,National Hospital Organization Saitama National Hospital,Saitama,Japan

出　　处：《Gastroenterology Report》2021年第6期543-551,共9页胃肠病学报道（英文）

摘　　要：Background Guidelines recommend that all patients with upper gastrointestinal bleeding(UGIB)undergo endoscopy within 24 h.It is unclear whether a subgroup may benefit from an urgent intervention.We aimed to evaluate the influence of endoscopic hemostasis and urgent endoscopy on mortality in UGIB patients with high-risk stigmata(HRS).Methods Consecutive patients with suspected UGIB were enrolled in three Japanese hospitals with a policy to perform endoscopy within 24 h.The primary outcome was 30-day mortality.Endoscopic hemostasis and endoscopy timing(urgent,6h;early,>6h)were evaluated in a regression model adjusting for age,systolic pressure,heart rate,hemoglobin,creatinine,and variceal bleeding in multivariate analysis.A propensity score of 1:1 matched sensitivity analysis was also performed.Results HRS were present in 886 of 1966 patients,and 35 of 886(3.95%)patients perished.Median urgent-endoscopy time(n=769)was 3.0h(interquartile range[IQR],2.0–4.0 h)and early endoscopy(n紏117)was 12.0h(IQR,8.5–19.0 h).Successful endoscopic hemostasis and urgent endoscopy were significantly associated with reduced mortality in multivariable analysis(odds ratio[OR],0.22;95%confidence interval[CI],0.09–0.52;P=0.0006,and OR,0.37;95%CI,0.16–0.87;P=0.023,respectively).In a propensity-score-matched analysis of 115 pairs,adjusted comparisons showed significantly lower mortality of urgent vs early endoscopy(2.61%vs 7.83%,P<0.001).Conclusions A subgroup of UGIB patients,namely those harboring HRS,may benefit from endoscopic hemostasis and urgent endoscopy rather than early endoscopy in reducing mortality.Implementing triage scores that predict the presence of such lesions is important.

关 键 词：UGIB urgent endoscopy non-variceal bleeding variceal bleeding HARBINGER GBS upper gastrointestinal bleeding 

分 类 号：R573.2[医药卫生—消化系统]