Urgent endoscopy in upper gastro-intestinal bleeding: assessing when it makes a difference

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Aims Gastrointestinal bleeding represents a significant clinical challenge in terms of the efficacy of endoscopic treatments. Many biases affected the studies focused on this item (i.e. exclusion of unstable patients at presentation) and specific data from 24-hour-on-duty emergency endoscopy centers are not available. The aim of our study is to evaluate the efficacy of emergency endoscopy in managing upper gastrointestinal bleeding in a tertiary referral center. Methods We conducted a retrospective analysis of urgent procedures performed at our tertiary referral endoscopy center, enrolling a consecutive cohort of 200 patients who underwent gastroscopy for bleeding. Clinical success was defined as the absence of further interventions (endoscopic, radiological, or surgical). Descriptive statistics and comparative analyses to assess the effectiveness of the procedures were performed [ 1 ] [ 2 ] [ 3 ] [ 4 ]. Results We identified 200 instances of upper gastro-intestinal bleeding out of 306 urgent procedures performed (65%): we could not determine the etiology in 59 cases (30%), established the etiology in 39 cases (19%), and performed hemostasis in 102 cases (51%). Overall, we achieved success in 163 patients (81%). In the portal hypertension subgroup success rates were 80% when the etiology was undetermined (8 cases), 50% when the etiology was established (2 cases), and 90% when hemostasis was performed (19 cases). For non-portal hypertension-related bleeding, success rates were 90% when the etiology was undetermined (35 cases), 89% when the etiology was established (24 cases), and 74% when hemostasis was performed (49 cases). In the subgroup of patients who had recently undergone surgery or another endoscopic procedure success rates were 70% when the etiology was undetermined (7 cases), 100% when the etiology was established (8 cases), and 73% when hemostasis was performed (11 cases). At the Fisher test for multiple variables, the difference in terms of efficacy in the three subgroups was statistically significant (p<0,05): the efficacy in the portal hypertension group was better than the other two. Regarding the need for transfusions, we found that 87 out of 163 “successful” patients required at least one blood transfusion (53%), while 27 out of 37 “failure” patients needed one (73%) (Chi-squared test, p=0,01). Concerning mortality, 15 patients died in the “successful” group (9%), compared to 7 in the “failure” group (19%) (Chi-squared test, p=0,03). Conclusions In conclusion, our study underscores the superior effectiveness of gastroscopy in managing bleeding associated with portal hypertension compared to other patient groups. Notably, high success rates were observed even in cases where the endoscopic examination provided no information, with no differences observed between the various groups. These results underscore the need for tailored management strategies in patients presenting with upper gastrointestinal bleeding, particularly when considering the specific characteristics and medical history of each patient. 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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