Optimal endoscopy timing in elderly patients presenting with acute non-variceal upper gastrointestinal bleeding

• Published in: BMC gastroenterology 2024-12, Vol.24 (1), p.444-9, Article 444
• Main Authors: Cagir, Yavuz, Durak, Muhammed Bahaddin, Yuksel, Ilhami
• Format: Article
• Language: English
• Subjects: 30-day mortality; Acute Disease; Age Factors; Aged; Aged patients; Aged, 80 and over; Bleeding; Blood transfusions; Cardiovascular disease; Care and treatment; Chi-square test; Chronic illnesses; Clinical outcomes; Colonoscopy; Comorbidity; Diagnosis; Early endoscopy; Elderly patient; Embolization; Endoscopy; Endoscopy, Gastrointestinal - statistics & numerical data; Female; Gastrointestinal bleeding; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - therapy; Health aspects; Heart failure; Hematocrit; Hemodynamics; Hemoglobin; Hospital utilization; Hospitalization; Hospitals; Humans; Intervention; Length of stay; Length of Stay - statistics & numerical data; Lung diseases; Male; Medical imaging; Middle Aged; Morbidity; Mortality; Nonsteroidal anti-inflammatory drugs; Older people; Outpatient care facilities; Patient outcomes; Patients; Population studies; Radiology; Recurrence; Regression analysis; Retrospective Studies; Risk factors; Time Factors; Time-to-Treatment - statistics & numerical data; Treatment Outcome; Upper gastrointestinal bleeding; Variables
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-024-03541-z

To evaluate the optimal endoscopy time in elderly patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) based on clinical outcomes. Patients over 65 years of age presenting with NVUGIB are three patient groups based on endoscopy timing: very early endoscopy ( 24 h). Endoscopic intervention was undertaken during the first 12 h for patients who had unstable hemodynamic settings, ongoing bleeding, or a low hematocrit despite transfusion. The clinical outcomes investigated were: The primary endpoint was 30-day mortality, with the need for endoscopic intervention, rebleeding, and length of hospital stay considered as secondary endpoints. The study population was 468, 260 of whom were ≥ 65 years. Based on the timing of endoscopy, very early endoscopy (within 12 h) was performed in 180 (69.2%) patients aged > 65 years and 150 (72.1%) younger patients (p > 0.05). Early endoscopy (12-24 h) was performed in patients aged > 65 years and younger patients 53 (20.4%) vs. 41 (19.7%), respectively, while late endoscopy (24-48 h) was performed in 27 (10.4%) vs. 17 (8.2%) patients, respectively (p > 0.05, for all parameters). The clinical results of subgroups based on endoscopy time in the ≥ 65 population and comparisons between groups. When groups were compared, it was found that the very early endoscopy group had a considerably lower likelihood of need for surgical/radiological intervention than the late endoscopy group [3 (1,7) vs. (3,7), p = 0.016], and 30-day mortality rates by the endoscopy timing were statistically significantly different in the very early group (15.6%), early endoscopy group (7.5%), and late endoscopy group (29.6%) (p