World J Gastroenterol. 2018;24(44):5025-5033.

Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding.

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제1저자 유정주,장영 · 교신저자 조은주

PMID 30510377 PMC6262253 DOI 10.3748/wjg.v24.i44.5025 IF 7.7 소화기내과

소속 (4)

Department of Gastroenterology and Hepatology, Soonchunhyang University school of Medicine, Bucheon 14584, South Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea. creatio3@snu.ac.kr.
Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea.

Abstract

AIM To examine the association between the timing of endoscopy and the short-term outcomes of acute variceal bleeding in cirrhotic patients.

METHODS This retrospective study included 274 consecutive patients admitted with acute esophageal variceal bleeding of two tertiary hospitals in Korea. We adjusted confounding factors using the Cox proportional hazards model and the inverse probability weighting (IPW) method. The primary outcome was the mortality of patients within 6 wk.

RESULTS A total of 173 patients received urgent endoscopy (i.e., ≤ 12 h after admission), and 101 patients received non-urgent endoscopy (> 12 h after admission). The 6-wk mortality rate was 22.5% in the urgent endoscopy group and 29.7% in the non-urgent endoscopy group, and there was no significant difference between the two groups before (P = 0.266) and after IPW (P = 0.639). The length of hospital stay was statistically different between the urgent group and non-urgent group (P = 0.033); however, there was no significant difference in the in-hospital mortality rate between the two groups (8.1% vs 7.9%, P = 0.960). In multivariate analyses, timing of endoscopy was not associated with 6-wk mortality (hazard ratio, 1.297; 95% confidence interval, 0.806-2.089; P = 0.284).

CONCLUSION In cirrhotic patients with acute variceal bleeding, the timing of endoscopy may be independent of short-term mortality.

Keywords

CirrhosisEndoscopyGastroesophageal varicesTimingUpper gastrointestinal bleeding

Figures

**Figure 1** Comparison of 6-wk survival in the urgent and the non-urgent endoscopy groups. Kaplan-Meier survival plot stratified by timing of endoscopy of all patients. The dotted line indicates urgent endoscopy and the solid line indicates non-urgent endoscopy. The black line is the unadjusted cumulative survival graph before inverse probability weighting (IPW), and the gray line is the adjusted after the IPW correction.

**Figure 2** Comparison of 6-wk transplant-free survival in the urgent and the non-urgent endoscopy groups. Kaplan-Meier survival plot stratified by timing of endoscopy of all patients. The dotted line indicates urgent endoscopy and the solid line indicates non-urgent endoscopy. The black line is the unadjusted cumulative graph before inverse probability weighting (IPW), and the gray line is the adjusted after the IPW correction.

**Figure 3** Comparison of 6-wk re-bleeding rate in the urgent and the non-urgent endoscopy groups. Kaplan-Meier survival plot stratified by timing of endoscopy of all patients. The dotted line indicates urgent endoscopy and the solid line indicates non-urgent endoscopy. The black line is the unadjusted cumulative graph before inverse probability weighting (IPW), and the gray line is the adjusted after the IPW correction.

그림 출처: PubMed Central 공개 논문 (PMC6262253)

Conflict of interest statement

Conflict-of-interest statement: All authors have no conflict of interest with respect to the subjects described in this article.

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