Optimal endoscopy timing according to the severity of underlying liver disease in patients with acute variceal bleeding.
Adult
Aged
Endoscopy, Gastrointestinal
/ methods
Esophageal and Gastric Varices
/ complications
Female
Gastrointestinal Hemorrhage
/ diagnosis
Hemostasis, Endoscopic
/ methods
Humans
Kaplan-Meier Estimate
Liver Diseases
/ complications
Logistic Models
Male
Middle Aged
Republic of Korea
Retrospective Studies
Risk Assessment
Severity of Illness Index
Time-to-Treatment
Endoscopy timing
Liver function
Mortality
Rebleeding
Variceal bleeding
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
14
08
2018
revised:
10
12
2018
accepted:
14
01
2019
pubmed:
26
2
2019
medline:
27
2
2020
entrez:
27
2
2019
Statut:
ppublish
Résumé
Current guidelines recommend endoscopic therapy to be performed within 12 h for acute variceal bleeding (AVB). However, the optimal timing of endoscopic therapy for AVB remains unclear. To examine the relationship between the endoscopy timing and clinical outcomes in AVB, with emphasis on liver function and endoscopy timing. From January 2010 to June 2017, cirrhotic patients with AVB confirmed by endoscopy were evaluated. The primary outcome was a composite of 6-week rebleeding and mortality. We stratified patients according to the MELD score. In 411 patients, the overall composite outcome rate was 30.9% (n = 127) at 6 week. Patients who underwent urgent endoscopy (≤12 h) had a significantly higher composite outcome than patients who underwent non-urgent endoscopy (>12 h) (34.4% vs. 19.1%; P = 0.005). Low-risk patients who underwent urgent endoscopy were more likely to reach the composite outcome (adjusted OR, 0.84 per 4 h; 95% CI, 0.73-0.98; P = 0.027). These findings persisted even after adjustment for baseline characteristics between the urgent and non-urgent groups. Urgent endoscopy is significantly associated with a poorer outcome in patients with AVB, especially in low-risk patients. Our result provides a treatment strategy according to the severity of underlying liver disease in patients with AVB.
Sections du résumé
BACKGROUND
Current guidelines recommend endoscopic therapy to be performed within 12 h for acute variceal bleeding (AVB). However, the optimal timing of endoscopic therapy for AVB remains unclear.
AIMS
To examine the relationship between the endoscopy timing and clinical outcomes in AVB, with emphasis on liver function and endoscopy timing.
METHODS
From January 2010 to June 2017, cirrhotic patients with AVB confirmed by endoscopy were evaluated. The primary outcome was a composite of 6-week rebleeding and mortality. We stratified patients according to the MELD score.
RESULTS
In 411 patients, the overall composite outcome rate was 30.9% (n = 127) at 6 week. Patients who underwent urgent endoscopy (≤12 h) had a significantly higher composite outcome than patients who underwent non-urgent endoscopy (>12 h) (34.4% vs. 19.1%; P = 0.005). Low-risk patients who underwent urgent endoscopy were more likely to reach the composite outcome (adjusted OR, 0.84 per 4 h; 95% CI, 0.73-0.98; P = 0.027). These findings persisted even after adjustment for baseline characteristics between the urgent and non-urgent groups.
CONCLUSIONS
Urgent endoscopy is significantly associated with a poorer outcome in patients with AVB, especially in low-risk patients. Our result provides a treatment strategy according to the severity of underlying liver disease in patients with AVB.
Identifiants
pubmed: 30803858
pii: S1590-8658(19)30041-6
doi: 10.1016/j.dld.2019.01.013
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
993-998Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.