State University of New York Upstate Medical University Syracuse, NY
Pujitha Kudaravalli, MBBS1, Tehseen Hammad, MBBS2, Venkata Satish Pendela, MD3, Hammad Ur Rahman, MD1; 1State University of New York Upstate Medical University, Syracuse, NY; 2Services Hospital, Lahore, Punjab, Pakistan; 3Rochester General Hospital, Rochester, NY
Introduction: Acute upper gastrointestinal non-variceal bleeding (AUGIB) is a medical emergency with a mortality rate of around 10% and is responsible for extensive resource utilization. The optimal timing of upper endoscopy in patients with AUGIB to achieve maximal benefit remains unclear. Urgent endoscopy (UE) is argued to identify and treat high-risk lesions that can re-bleed, although 75-80% of AUGIB stops spontaneously. We conducted this meta-analysis of randomized controlled trials (RCTs) to investigate the efficacy and safety of UE versus (vs.) early endoscopy (EE) in patients with AUGIB. Methods: 4 RCTs investigating UE vs. EE in patients with AUGIB were selected using PubMed, EMBASE, and MEDLINE databases (inception April 2020). Among the included trials, urgent endoscopy timing ranged from 0-12 hours after the initial assessment, whereas early endoscopy ranged from 6-48 hours. Patients with persistent hemodynamic instability were excluded. Follow up duration was 30 days. The primary outcome was all-cause mortality. The secondary outcomes were further bleeding, length of hospital stay (LOS), Intensive Care Unit (ICU) admissions, need for additional interventions (surgery & embolization) and blood transfusions (mean number of units). There was insufficient data to assess for the resource utilization with UE and EE. The outcomes were measured as relative risk (RR) and standardized mean difference (SMD) with a 95% confidence interval (CI) using the random effect model. Results: The analysis comprising of 1044 patients with a mean age of 59.13±9.78 years revealed no significant difference in the all-cause mortality among patients undergoing UE vs. EE as shown in figure 1 (4.8% vs. 3.8%; RR: 1.29, 95% Cl, 0.73-2.29, P=0.38). There was no significant difference between the two groups in terms of further bleeding (RR: 1.23, 95% CI 0.78-1.95, P=0.37), LOS (SMD:-0.09, 95% CI, -0.21-0.03, P=0.16), ICU admissions (RR: 1.42, 95% CI 0.92-2.20, P= 0.12), blood transfusions (SMD: 0.04 , 95% CI -0.08-0.16, P=0.50), and additional interventions (RR: 1.09, 95% CI 0.46-2.62, P= 0.84). Discussion: Our meta-analysis showed that urgent endoscopy did not reduce all-cause mortality as compared to early endoscopy in patients with AUGIB.
Figure 1, Forest plot demonstrating all-cause mortality associated with Urgent Endoscopy (UE) and Early endoscopy (EE) in patients with acute upper gastrointestinal bleeding
Disclosures: Pujitha Kudaravalli indicated no relevant financial relationships. Tehseen Hammad indicated no relevant financial relationships. Venkata Satish Pendela indicated no relevant financial relationships. Hammad Ur Rahman indicated no relevant financial relationships.