Original ArticlesUrgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study☆
Section snippets
Patients and methods
The study design was prospective, randomized, blinded, and multicenter, with concealed allocation, comparing urgent endoscopy (UE) with elective endoscopy (EE). Every effort was made to study the intervention without impacting the otherwise normal process of patient care. The main outcomes of the study were specifically resource utilization (hospitalization, length of stay, ICU days, units of blood transfused, repeat endoscopy) and clinical outcomes (morbidity, mortality, need for
Results
The demographics of the two treatment groups were similar (Table 3); no significant difference was detected in any variable. The timing of endoscopy did not affect either health care resource utilization or patient outcomes (Table 4). The total length of stay was similar (OR 3.98 days: 95% CI[2.84, 5.11], median, 3 days; and OR 3.26 days: 95% CI[2.32, 4.21], median, 3 days, for UE and EE, respectively; p = 0.45). Central tendency summary statistics for the number of ICU days was the same (mean
Discussion
The timing of endoscopy in patients with acute UGI bleeding remains a subject of debate, particularly for the patient who responds rapidly to volume resuscitation and has no further evidence of bleeding. Although it may seem intuitive that early endoscopy would improve care, randomized trials have indicated that “diagnostic” early endoscopy does not improve mortality, the frequency of recurrent bleeding, the need for surgery, or the length of hospital stay.18., 19., 20. The overwhelming
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The preliminary results of this work were presented at Digestive Diseases Week, May 21-24, 2000, San Diego, California (Gastrointest Endosc 2000;51:AB129).
This study was supported by grants from the American Society for Gastrointestinal Endoscopy, the American College of Gastroenterology, and the American Digestive Health Foundation.