Urgent endoscopy in gastro-intestinal bleeding: how it impacts mortality rate

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Aims The evaluation of efficacy in endoscopic treatments for gastrointestinal bleeding is burdened by many bias in the available literature. Our study aims to evaluate the efficacy of urgent endoscopy in managing gastrointestinal bleeding and affecting the mortality rate in this setting. Methods We conducted a retrospective analysis of urgent procedures performed at Niguarda Hospital from July 2018 to January 2024, enrolling a consecutive cohort of 200 patients who underwent colonoscopy and 200 patients who underwent gastroscopy for bleeding. We defined success as the absence of further intervention required to manage bleeding; failure was defined as a rebleeding event necessitating further interventions (endoscopic, radiological, or surgical). The present study focused on urgent endoscopy's impact on changing the mortality rate [ 1 ] [ 2 ] [ 3 ] [ 4 ]. Results Regarding EGDS, we identified 200 instances of bleeding out of 306 urgent procedures performed (65%): we could not determine the etiology of the bleeding in 59 cases (30%), established its etiology in 39 cases (19%), and performed hemostasis in 102 cases (51%). Overall, we achieved success in 163 patients (81%): success rates were 85% (50 patients) when the etiology was undetermined, 87% (34 patients) when the etiology was established, and 78% (79 patients) when hemostasis was performed (Fisher test for multiple variables, p=1,3). Concerning mortality, 15 patients died in the “successful” group (9%), compared to 7 in the “failure” group (19%) (Chi-squared test, p=0,03). We had 141 patients classified as ASA 3 and 4 while 41 patients were classified as ASA 1 and 2 in our sample. All 13 deaths were observed among ASA 3 and 4 patients (0.09%). Regarding colonoscopy, we identified 200 instances of bleeding out of 322 urgent colonoscopies performed (62%): the etiology was undetermined in 92 cases (46%), established in 30 cases (15%), and hemostasis was performed in 75 cases (38%), with empirical treatment applied in 3 cases (1%). Overall, we achieved success in 169 patients (85%): 83% in 76 patients when the etiology was undetermined, 87% in 26 patients when the etiology was established, 85% in 64 patients when hemostasis was performed, and 100% in 3 patients who received empirical treatment (Fisher test, p=0,9). In terms of mortality, 18 patients died in the “successful” group (11%), compared to 6 in the “failure” group (19%) (Chi-squared test, p=0,08). In our sample, 115 patients were classified as ASA 3 and 4, while 85 patients were classified as ASA 1 and 2. We found 23 deaths among ASA 3 and 4 (0.2%), and 1 death in ASA 1 and 2 patients (0.01%) Conclusions In conclusion, our study highlights the limited diagnostic and therapeutic efficacy of urgent endoscopy as similar success rates were observed both in upper and lower GI endoscopies regardless of the outcome of the endoscopic result. As expected, what predicts mortality is the ASA status of the patient at the time of endoscopy and the occurrence of the rebleeding event. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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