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. 2024 Dec 2;24(1):444.
doi: 10.1186/s12876-024-03541-z.

Optimal endoscopy timing in elderly patients presenting with acute non-variceal upper gastrointestinal bleeding

Yavuz Cagir  1 , Muhammed Bahaddin Durak  2 , Ilhami Yuksel  3   4
Affiliations

Optimal endoscopy timing in elderly patients presenting with acute non-variceal upper gastrointestinal bleeding

Yavuz Cagir et al. BMC Gastroenterol. .

Abstract

Background: To evaluate the optimal endoscopy time in elderly patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) based on clinical outcomes.

Methods: Patients over 65 years of age presenting with NVUGIB are three patient groups based on endoscopy timing: very early endoscopy (< 12 h), early endoscopy (12-24 h) and late endoscopy (> 24 h). Endoscopic intervention was undertaken during the first 12 h for patients who had unstable hemodynamic settings, ongoing bleeding, or a low hematocrit despite transfusion. The clinical outcomes investigated were: The primary endpoint was 30-day mortality, with the need for endoscopic intervention, rebleeding, and length of hospital stay considered as secondary endpoints.

Results: The study population was 468, 260 of whom were ≥ 65 years. Based on the timing of endoscopy, very early endoscopy (within 12 h) was performed in 180 (69.2%) patients aged > 65 years and 150 (72.1%) younger patients (p > 0.05). Early endoscopy (12-24 h) was performed in patients aged > 65 years and younger patients 53 (20.4%) vs. 41 (19.7%), respectively, while late endoscopy (24-48 h) was performed in 27 (10.4%) vs. 17 (8.2%) patients, respectively (p > 0.05, for all parameters). The clinical results of subgroups based on endoscopy time in the ≥ 65 population and comparisons between groups. When groups were compared, it was found that the very early endoscopy group had a considerably lower likelihood of need for surgical/radiological intervention than the late endoscopy group [3 (1,7) vs. (3,7), p = 0.016], and 30-day mortality rates by the endoscopy timing were statistically significantly different in the very early group (15.6%), early endoscopy group (7.5%), and late endoscopy group (29.6%) (p < 0.05, for all groups). Endoscopy time within 24-48 h (late) (OR: 3.133, 95%Cl: 1.127-8.713, p: 0.029) was an independent predictor of rebleeding during the hospital stay.

Conclusions: Early endoscopy may benefit the management of acute UGIB, especially in the elderly population with high comorbidities and the severity of bleeding.

Keywords: 30-day mortality; Early endoscopy; Elderly patient; Upper gastrointestinal bleeding.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the ethical guidelines of the institutional research committee, the 1964 Declaration of Helsinki, and its subsequent amendments, or comparable ethical standards. The Ankara Bilkent City Hospital Scientific Research and Ethics Committee accepted the project with approval No: E1/22/2951. Informed consent statement was waived by the committee due to the retrospective design of the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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