GI Journal Conference

KO SUNG WOO
2017.05.25

Clinical Endoscopy

Background

  • Acute nonvariceal upper GI bleeding (UGIB)
    Current guideline: upper endoscopy within 24 hours

  • Urgent Endoscopy (<12 hours) :Controversial
    alt text

Aim

  • Relationship

    • Timing of endoscopy and clinical outcome

  • Different outcomes?

    • Lower risk versus high-risk bleeding
    • Urgent compared with nonurgent endoscopy

Study Cohort

  • 2004 ~ 2014

  • Briaghm and Women's hospital

  • via ER and admitted

  • “Upper Gastrointestinal Bleed”

  • 361 Patients

Data Collection

  • Glasgow-Blatchfold score
  • Risk Group

Composite Outcome

  • Death from any cause

  • Inpatient rebleeding

  • Surgical intervention

  • Radiologic intervention

  • Endsocopic reintervention

Patients Characteristics

Overall patient outcomes

  • 1 or more primary outcome: 37 cases plot of chunk unnamed-chunk-1

Predictors of the outcome

  • Univariate analysis

    • Time to endoscopy : OR 0.77
    • Systolic BP : 0R 0.78

  • Multivariate analysis

    • Weekend/holiday presentation OR 2.27
    • Systolic BP : OR 0.82
    • Time to endoscopy: OR 0.81

Urgent VS Non-urgent EGD


  • Urgent EGD
    • 5-fold risk outcome
    • Death: No difference
    • Rebleed (11% vs 4%)
    • Surgery (4% vs 0%)
    • Intervention (6% vs 1%)
    • Re EGD (10% VS 1%)

Timing of EGD in Low-Risk


Outcome: Low Risk

Timing of EGD in High-Risk


Outcome: High Risk

Discussion

  • 응급 내시경
    • 사 망 에 영 향 은 없다
    • 골치 아픈일이 생긴다 (ex.재 출 혈, 수술..)
    • 특히 저위험군에서 ..


  • 저자들의 짐작
    • 저 위험군:멀쩡해 보이니 오히려 방치..?
    • 고 위험군: 내시경 전에 수액 ,PPI 도 잘 주고..
    • 주말에 오는 고 위험군: 잘 봤으면 좋겠다

Disccusion

  • 한계
    • 응급 내시경 : 상태가 좋지 않을 가능성 큼
    • 차 트 리 뷰로 만 연 구 진 행
    • Primary 아 닌 Composite outcome 사용


  • 전 향 적 연구를 하면 좋겠다