Abstract
Upper gastrointestinal (UGI) bleeding includes bleeding into the lumen from anywhere between the upper part of the esophagus and the ligament of Treitz. A patient with UGI bleeding may present to the emergency department with hematemesis, melena, or hematochezia. It is the standard approach to perform endoscopy within the first 24 hours in patients with acute UGI bleeding. However, there is no common opinion on the definition of early endoscopy. According to various studies, this definition varies between 2 hours and 24 hours after admission to the emergency department. In our study, 115 patients who applied to the emergency department with UGI bleeding were included. When the patients are divided into 3 groups according to the duration of endoscopy (<8 hours, 8-24 hours, >24 hours), there are differences between the groups regarding endoscopic findings, Forrest classification, need for endoscopic or surgical treatment, need for replacement, recurrent bleeding during follow-up, need for repeat endoscopy and the outcome of the patients. No significant difference was detected. As a result, there is no common opinion on the definition of early endoscopy in UGI bleeding, when it should be performed within the first 24 hours, and its benefits. Prospective randomized studies should also be taken into consideration in determining the benefit and harm ratio of early endoscopy.
Keywords
upper gastrointestinal tract bleeding approach to the patient with upper gastrointestinal tract bleeding early endoscopy.
References
- 1. İçme, F. Non Varisiyel Üst Gastrointestinal Sistem Kanaması ile acil servise başvuran hastaların endoskopik ve demografik verilerinin incelenmesi. Türk Tıp Dergisi. 2011;5:5-11.
- 2. Braunwald E, Fauci AS, Kasper DL, editors. Harrison‘s principals of internal medicine. 15th ed. New York; Mc Graw-Hill; 2001. 252.
- 3. Raţiu I, Lupuşoru R, Popescu A, et al. Acute gastrointestinal bleeding: A comparison between variceal and nonvariceal gastrointestinal bleeding. Medicine (Baltimore). 2022;101:1-6.
- 4. Guo CLT, Wong SH, Lau LHS, et al. Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study. Gut. 2022;71:1544-50.
- 5. Barkun A, Bardou M, Marshall JK. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann İntern Med 2003;139:843-57.
- 6. Tsibouris P, Zintzaras E, Lappas C, et al. High-dose pantoprazole continuous infusion is superiorto somatostatin after endoscopic hemostasis in patients with peptic ulcer bleeding. Am J Gastroenterol 2007;102:1192–9.
- 7. Adler DG, Leighton JA, Davila RE, et al. ASGE guideline: The role of endoscopy in acute nonvariceal upper-GI hemorrhage. Gastrointest Endosc 2004;60:497–504.
- 8. Rockall TA, Logan RF, Devlin HB, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316-21.
- 9. Köksal Ö, Özeren G, Özdemır F, et al. Prospective validation of the Glasgow Blatchford scoring system in patients with upper gastrointestinal bleeding in the emergency department. Turk J Gastroenterol. 2012;23:448-55.
- 10. Adamopoulos AB, Baibas NM, Efstathiou SP, et al. Differentiation between patients with acute upper gastrointestinal bleeding who need early urgent upper gastrointestinal endoscopy and those who do not. A prospective study. European J Gastroenterol and Hepatol 2003;15: 381-7.
- 11. Barkun A, Bardon M, Marshall JK. Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleedind. Ann Intern Med 2003;139: 843-57.
- 12. Cooper GS, Chak A, Way LE. Early endoscopy in upper gastrointestinal hemorrhage: Assosiations with recurrent bleeding, surgery and lenght of hospital stay. Gastrointest Endosc 1999; 49:145-52.
- 13. Lau JY, Leung WK, Wu JC, et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 2007;356:1631-40.
- 14. Lindenauer PK, Roll FJ, Gebredsadik T, Terdiman JP. Endoscopy improves outcome and reduces lenght of stay in elderly patients with upper gastrointestinal bleeding: Results of a state-wide population analysis. Am J Gastroenterol 1999;116:76.
- 15. Bai L, Jiang W, Cheng R, et al. Does Early Endoscopy Affect the Clinical Outcomes of Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding? A Systematic Review and Meta-Analysis. Gut Liver. 2023;17:566-80.
- 16. Choudari CP, Palmer KR. Timing of endoscopy for severe peptic ulcer hemorrhage: out of hours emergency endoscopy is unnecesarry. Gastroenterology 1993;104:55.
- 17. Targownik LE, Murthy S, Keyvani L, et al. The role of rapid endoscopy for high risk patients with acute non variceal upper gastrointestinal bleeding. Can J Gastroenterol 2007; 21: 425-9.
- 18. Kim J, Gong EJ, Seo M, et al. Timing of endoscopy in patients with upper gastrointestinal bleeding. Sci Rep. 2022;12:1-6.
- 19. Sarin N, Monga N, Adams PC. Time to endoscopy and outcomes in upper gastrointestinal bleeding. Can J Gastroenterol 2009; 23: 489-93.
- 20. Barkun AN, Bardou M, Kuipers EJ, et al. International Consensus Upper Gastrointestinal Bleeding Conference Group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152:101-13.
- 21. A.S.G.E. Standarts of Practice Committee. The role of endoscopy in the management of non-variceal acute upper gastrointestinal bleeding. Guidelines for clinical application. Gastrointest Endosc 1992;38:760-4.
- 22. Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med 1994; 331:717-27.
- 23. Bjorkman DJ, Zaman A, Fennerty MB, et al. Urgent vs. elective endoscopy for acute non-variceal uper GI bleeding: An effectiveness study. Gastrointestinal Endoscopy 2004;60: 1-8.
- 24. Rockall TA, Logan RFA, Devlin HB, et al. National audit of acute upper gastrointestinal haemorrhage. Selection of patients of early discharge or outpatient care after acute upper gastrointestinal haemorrhage. Lancet 1996;347:1138-40.
- 25. Longstreth GF, Feitelberg S. Outpatient care of selected patients with aute non-variceal uper gastrointestinal haemorrhage. Lancet 1995;345:108- 11.
- 26. Lai KC, Hui WM, Wong BCY, et al. A retrospective and prospective study on the safety of discharging selected patients with duedonal ulcer bleeding on the same day as endoscopy. Gastrointest Endosc 1997;45: 26-30.
- 27. Lee JG, Turnipseed S, Romano PS, et al. Endoscopy based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 1999;50:755- 61.
- 28. Laine L, Cohen H, Brodhead J, et al. Prospective evaluation of immediate versus delayed refeding and prognostic value of endoscopy in patients with upper gastrointestinal hemorrhage. Gastroenterology 1992;102:314-6.
- 29. Kodali VP, Peterson BT, Balm R, et al. Clean based peptic ulcer: implications for cost effective management of acute upper gastrointestinal bleeding. Am J Gastroenterol 1995;90: 1584-5.
- 30. Tai C, Huang S, Wang H, et al. High risk ED patients with nonvariceal upper gastrointestinal hemorrhage undergoing emergency or urgent endoscopy: A retrospective analysis. Am J Med 2007;25:273-8.
- 31.Lin HJ, Wang K, Perng CL, et al. Early or delayed endoscopyfor patients with pept,c ulcer bleeding. A retrospective randomized study. J Clin Gastroenterol 1996;22:267-71.
- 32.Yen D, Hu S, Chen L, et al. Arterial oxygen desaturation during emergent nonsedated upper gastrointestinal endoscopy in the emergency department. Am J Emerg Med 1997;15: 644-6.
Abstract
Üst gastrointestinal sistem (ÜGİS) kanamaları özofagusun üst kısmı ile Treitz ligamanı arasındaki herhangi bir yerden lümen içine olan kanamaları kapsar. ÜGİS kanaması olan hasta acil servise hematemez, melena veya hematokezya ile başvurabilir. Akut ÜGİS kanamalı hastalara ilk 24 saat içinde endoskopi uygulamak standart yaklaşımdır. Bununla birlikte erken endoskopinin tanımı konusunda ortak bir görüş yoktur. Çeşitli çalışmalara göre bu tanım acil servise başvurudan sonra 2 saat ile 24 saat arasında çeşitlilik gösterir. Bizim çalışmamızda ÜGİS kanaması ile acil servise başvuran 115 hasta alındı. Hastalar endoskopi yapılma sürelerine göre 3 gruba ayrıldığında (<8 saat, 8- 24 saat, >24 saat) gruplar arasında endoskopik bulgu, Forrest sınıflandırması, endoskopik veya cerrahi tedavi ihtiyacı, replasman ihtiyacı, takiplerde tekrarlayan kanama, tekrarlayan endoskopi ihtiyacı ve hastaların akıbeti konusunda anlamlı fark saptanmadı. Sonuç olarak ÜGİS kanamalarında erken endoskopinin tanımı, ilk 24 saat içinde ne zaman yapılacağı ve faydaları konusunda ortak bir görüş yoktur, yapılan prospektif randomize çalışmalar da erken endoskopinin kar zarar oranını belirlemede göz önünde bulundurulmalıdır.
Keywords
üst gastrointestinal sistem kanamaları üst gastrointestinal sistem kanamalı hastaya yaklaşım erken endoskopi.
References
- 1. İçme, F. Non Varisiyel Üst Gastrointestinal Sistem Kanaması ile acil servise başvuran hastaların endoskopik ve demografik verilerinin incelenmesi. Türk Tıp Dergisi. 2011;5:5-11.
- 2. Braunwald E, Fauci AS, Kasper DL, editors. Harrison‘s principals of internal medicine. 15th ed. New York; Mc Graw-Hill; 2001. 252.
- 3. Raţiu I, Lupuşoru R, Popescu A, et al. Acute gastrointestinal bleeding: A comparison between variceal and nonvariceal gastrointestinal bleeding. Medicine (Baltimore). 2022;101:1-6.
- 4. Guo CLT, Wong SH, Lau LHS, et al. Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study. Gut. 2022;71:1544-50.
- 5. Barkun A, Bardou M, Marshall JK. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann İntern Med 2003;139:843-57.
- 6. Tsibouris P, Zintzaras E, Lappas C, et al. High-dose pantoprazole continuous infusion is superiorto somatostatin after endoscopic hemostasis in patients with peptic ulcer bleeding. Am J Gastroenterol 2007;102:1192–9.
- 7. Adler DG, Leighton JA, Davila RE, et al. ASGE guideline: The role of endoscopy in acute nonvariceal upper-GI hemorrhage. Gastrointest Endosc 2004;60:497–504.
- 8. Rockall TA, Logan RF, Devlin HB, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316-21.
- 9. Köksal Ö, Özeren G, Özdemır F, et al. Prospective validation of the Glasgow Blatchford scoring system in patients with upper gastrointestinal bleeding in the emergency department. Turk J Gastroenterol. 2012;23:448-55.
- 10. Adamopoulos AB, Baibas NM, Efstathiou SP, et al. Differentiation between patients with acute upper gastrointestinal bleeding who need early urgent upper gastrointestinal endoscopy and those who do not. A prospective study. European J Gastroenterol and Hepatol 2003;15: 381-7.
- 11. Barkun A, Bardon M, Marshall JK. Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleedind. Ann Intern Med 2003;139: 843-57.
- 12. Cooper GS, Chak A, Way LE. Early endoscopy in upper gastrointestinal hemorrhage: Assosiations with recurrent bleeding, surgery and lenght of hospital stay. Gastrointest Endosc 1999; 49:145-52.
- 13. Lau JY, Leung WK, Wu JC, et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 2007;356:1631-40.
- 14. Lindenauer PK, Roll FJ, Gebredsadik T, Terdiman JP. Endoscopy improves outcome and reduces lenght of stay in elderly patients with upper gastrointestinal bleeding: Results of a state-wide population analysis. Am J Gastroenterol 1999;116:76.
- 15. Bai L, Jiang W, Cheng R, et al. Does Early Endoscopy Affect the Clinical Outcomes of Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding? A Systematic Review and Meta-Analysis. Gut Liver. 2023;17:566-80.
- 16. Choudari CP, Palmer KR. Timing of endoscopy for severe peptic ulcer hemorrhage: out of hours emergency endoscopy is unnecesarry. Gastroenterology 1993;104:55.
- 17. Targownik LE, Murthy S, Keyvani L, et al. The role of rapid endoscopy for high risk patients with acute non variceal upper gastrointestinal bleeding. Can J Gastroenterol 2007; 21: 425-9.
- 18. Kim J, Gong EJ, Seo M, et al. Timing of endoscopy in patients with upper gastrointestinal bleeding. Sci Rep. 2022;12:1-6.
- 19. Sarin N, Monga N, Adams PC. Time to endoscopy and outcomes in upper gastrointestinal bleeding. Can J Gastroenterol 2009; 23: 489-93.
- 20. Barkun AN, Bardou M, Kuipers EJ, et al. International Consensus Upper Gastrointestinal Bleeding Conference Group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152:101-13.
- 21. A.S.G.E. Standarts of Practice Committee. The role of endoscopy in the management of non-variceal acute upper gastrointestinal bleeding. Guidelines for clinical application. Gastrointest Endosc 1992;38:760-4.
- 22. Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med 1994; 331:717-27.
- 23. Bjorkman DJ, Zaman A, Fennerty MB, et al. Urgent vs. elective endoscopy for acute non-variceal uper GI bleeding: An effectiveness study. Gastrointestinal Endoscopy 2004;60: 1-8.
- 24. Rockall TA, Logan RFA, Devlin HB, et al. National audit of acute upper gastrointestinal haemorrhage. Selection of patients of early discharge or outpatient care after acute upper gastrointestinal haemorrhage. Lancet 1996;347:1138-40.
- 25. Longstreth GF, Feitelberg S. Outpatient care of selected patients with aute non-variceal uper gastrointestinal haemorrhage. Lancet 1995;345:108- 11.
- 26. Lai KC, Hui WM, Wong BCY, et al. A retrospective and prospective study on the safety of discharging selected patients with duedonal ulcer bleeding on the same day as endoscopy. Gastrointest Endosc 1997;45: 26-30.
- 27. Lee JG, Turnipseed S, Romano PS, et al. Endoscopy based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 1999;50:755- 61.
- 28. Laine L, Cohen H, Brodhead J, et al. Prospective evaluation of immediate versus delayed refeding and prognostic value of endoscopy in patients with upper gastrointestinal hemorrhage. Gastroenterology 1992;102:314-6.
- 29. Kodali VP, Peterson BT, Balm R, et al. Clean based peptic ulcer: implications for cost effective management of acute upper gastrointestinal bleeding. Am J Gastroenterol 1995;90: 1584-5.
- 30. Tai C, Huang S, Wang H, et al. High risk ED patients with nonvariceal upper gastrointestinal hemorrhage undergoing emergency or urgent endoscopy: A retrospective analysis. Am J Med 2007;25:273-8.
- 31.Lin HJ, Wang K, Perng CL, et al. Early or delayed endoscopyfor patients with pept,c ulcer bleeding. A retrospective randomized study. J Clin Gastroenterol 1996;22:267-71.
- 32.Yen D, Hu S, Chen L, et al. Arterial oxygen desaturation during emergent nonsedated upper gastrointestinal endoscopy in the emergency department. Am J Emerg Med 1997;15: 644-6.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Gastroenterology and Hepatology |
| Journal Section | Research Article |
| Authors | |
| Publication Date | May 17, 2024 |
| Submission Date | April 2, 2024 |
| Acceptance Date | May 3, 2024 |
| Published in Issue | Year 2024 Volume: 50 Issue: 1 |
Cite
Journal of Uludag University Medical Faculty is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.