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Urgent Endoscopy in Nonvariceal Upper Gastrointestinal Hemorrhage:A Retrospective Analysis

Current Medical Science 2022年第4期42卷 856-862页

作者： Jia-lun GUAN Ying-ying HAN Dan FANG Mu-ru WANG Ge WANG De-an TIAN Pei-yuan LI Division of Gastroenterology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Department of Gastroenterology Wenchang People's HospitalWenchang 571300China

Objective:The role of urgent endoscopy in nonvariceal upper gastrointestinal hemorrhage(NVUGIH)remains *** designed a retrospective study to compare the outcomes between urgent endoscopy(within 12 h)and non-urgent endoscopy for patients with ***:A total of 540 hospitalized patients with NVUGIH were included in our *** who received endoscopy within 12 h or after 12 h were divided into two groups,the urgent and non-urgent endoscopy groups,*** clinical outcomes including rebleeding,mortality,endoscopic re-intervention,need for emergency surgery and interventional radiotherapy were compared between the *** with glasgow-blatchford scores(GBS)12 were defined as the lower-and high-risk groups,respectively,and the predictors of rebleeding and mortality in both groups were analyzed ***:Patients with NVUGIH in the urgent endoscopy group had a higher rate of rebleeding(27.6%vs.16.9%,P=0.003)and blood transfusion(73.2%vs.55.5%,P0.05).For lower-risk patients,urgent endoscopy was independently associated with a higher likelihood of rebleeding(adjusted OR:1.73,95%CI:1.03-2.88),while it was not associated with in-hospital ***,the urgent need for endoscopy was not associated with rebleeding and in-hospital mortality in high-risk ***:Endoscopy within 12 h did not provide any advantage in the outcomes of patients with NVUGIH,and may even lead to an increased rebleeding rate in lower-risk patients.

关键词： nonvariceal upper gastrointestinal hemorrhage urgent endoscopy glasgow-blatchford score rebleeding clinical outcomes

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Scoring systems for peptic ulcer bleeding: which one to use?

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World Journal of Gastroenterology 2017年第41期23卷 7450-7458页

作者： Ivan Budimir Sanja Stojsavljevic Neven Barsic Alen Biscanin Gorana Mirosevic Sven Bohnec Lora Stanka Kirigin Tajana Pavic Neven Ljubicic Division of Gastroent-erology Department of Internal Medicine 'Sestre Milosrdnice' University Hospital Center Division of Endo-crinology Department of Internal Medicine 'Sestre Milosrdnice' University Hospital Center Gastronterologie Allgemeine Innere Medizin und Geriatrie Rems -Murr Klinik Winnenden

AIM To compare the glasgow-blatchford score(GBS), Rockall score(RS) and Baylor bleeding score(BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers. METHODS Between January 2008 and December 2013, 1012consecutive patients admitted with peptic ulcer bleeding(PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores(RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics(AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were *** PUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome(AUROC 0.82 vs 0.67 vs0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality(AUROC0.84 vs 0.57 vs 0.64), rebleeding(AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion(AUROC 0.83 vs0.63 vs 0.58) and surgical intervention(0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome(AUROC 0.82 vs 0.69, respectively).CONCLUSION The RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one 'perfect score' and we suggest that these two tests be used concomitantly.

关键词： Upper gastrointestinal bleeding Peptic ulcer bleeding glasgow-blatchford score Rockall score Baylor bleeding score

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