Introduction
Despite significant advances in the management of non-variceal upper gastrointestinal bleeding (NVUGIB), the optimal timing of endoscopy remains a subject of debate. Current guidelines recommend performing endoscopy within 24 hours of presentation, yet the impact of this strategy in different risk stratifications is not fully elucidated.
This study aimed to evaluate the influence of early endoscopy (≤24 hours) on clinical outcomes in NVUGIB patients, with particular focus on risk stratification using the Glasgow-Blatchford Score (GBS).
Aims & Methods
This retrospective, single-center cohort study included consecutive adult patients who underwent upper gastrointestinal endoscopy for suspected NVUGIB over a four-year period. Demographic, clinical, biochemical, endoscopic, and outcome data were collected and analyzed.
Patients were stratified based on GBS into low-risk (GBS <12) and high-risk (GBS ≥12) categories. The primary outcome was 30-day mortality. Secondary outcomes included need for endoscopic hemostasis and blood transfusion
Results
A total of 298 patients were included (mean age: 65.3 ± 17.1 years; 57% male), of whom 55% were classified as high-risk. Endoscopy was performed within 24 hours in 62.1% of cases.
In low-risk patients, early endoscopy was significantly associated with:
- Higher rate of endoscopic therapy (p = 0.003)
- Lower 30-day mortality (p = 0.03)
- Reduced need for blood transfusion (p = 0.03)
Patients in the low-risk group who underwent delayed endoscopy (>24 hours) were significantly older (70.8 ± 15.2 vs. 63.5 ± 16.7; p = 0.01), had more comorbidities (Charlson Comorbidity Index: 4.0 ± 2.1 vs. 3.1 ± 2.5; p = 0.02), lower baseline hemoglobin (10.1 ± 3.1 vs. 11.3 ± 2.8; p = 0.03), and were more frequently admitted during weekends or holidays (27 vs. 0; p < 0.001).
In contrast, in high-risk patients, no statistically significant differences in outcomes were observed between early and delayed endoscopy.
Conclusion
Our findings suggest that performing upper endoscopy within 24 hours is associated with improved clinical outcomes, specifically reduced mortality and transfusion requirements, in low-risk NVUGIB patients. Early intervention appears especially beneficial in older patients with multiple comorbidities and initial anemia. These data support prioritizing early endoscopic evaluation in selected lower-risk patients as part of optimized UGIB management pathways.
References
Sung JJY, Chiu PWY, Chan FKL, Lau JYW, Goh KL, Ho LH, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding. Gut. 2018;67(10):1757–68.
Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations. Ann Intern Med. 2019;171(11):805–22.
Lau JYW, Yu Y, Tang RSY, Chan HCH, Yip HC, Chan SM, et al. Timing of endoscopy for acute upper gastrointestinal bleeding. N Engl J Med. 2020;382(14):1299–308.