BACKGROUND AND STUDY AIMS: In previous randomized trials, early endoscopy improved the outcome in patients with bleeding peptic ulcer, though most of these studies defined "early" as endoscopy performed within 24 hours after admission. Using the length of hospital stay as the primary criterion for the clinical outcome, we compared the results of endoscopy done immediately after admission (early endoscopy in the emergency room, EEE) with endoscopy postponed to a time within the first 24 hours after hospitalization, but still during normal working hours ("delayed" endoscopy in the endoscopy unit, DEU). PATIENTS AND METHODS: We conducted a retrospective analysis of data from 81 consecutive patients with bleeding peptic ulcer admitted in 1997 and 1998 (age range 16 - 90 years). Of these 81 patients, 38 underwent DEU (the standard therapy at the hospital) and 43 underwent EEE. Patients in the two groups were comparable with regard to admission criteria, were equally distributed with respect to their risk of adverse outcome (assessed using the Baylor bleeding score and the Rockall score), and differed only in the treatment they received. Endoscopic hemostasis was performed whenever possible in all patients with Forrest types I, IIa, and IIb ulcer bleeding. RESULTS: We found similar rates in the two groups for recurrent bleeding (16 % in DEU patients vs. 14 % in EEE patients), persistent bleeding (8 % in DEU patients vs. none in EEE patients), medical complications (21 % in DEU patients vs. 26 % in EEE patients), the need for surgery (8 % in DEU patients vs. 9 % in EEE patients), and the length of hospital stay (5.1 days for DEU patients vs. 5.9 days for EEE patients). None of the differences between the two groups in these parameters were statistically significant. None of the patients died. CONCLUSIONS: Early endoscopy in an emergency room did not improve the clinical outcome in our 81 consecutive patients with bleeding peptic ulcer.
BACKGROUND AND STUDY AIMS: In previous randomized trials, early endoscopy improved the outcome in patients with bleeding peptic ulcer, though most of these studies defined "early" as endoscopy performed within 24 hours after admission. Using the length of hospital stay as the primary criterion for the clinical outcome, we compared the results of endoscopy done immediately after admission (early endoscopy in the emergency room, EEE) with endoscopy postponed to a time within the first 24 hours after hospitalization, but still during normal working hours ("delayed" endoscopy in the endoscopy unit, DEU). PATIENTS AND METHODS: We conducted a retrospective analysis of data from 81 consecutive patients with bleeding peptic ulcer admitted in 1997 and 1998 (age range 16 - 90 years). Of these 81 patients, 38 underwent DEU (the standard therapy at the hospital) and 43 underwent EEE. Patients in the two groups were comparable with regard to admission criteria, were equally distributed with respect to their risk of adverse outcome (assessed using the Baylor bleeding score and the Rockall score), and differed only in the treatment they received. Endoscopic hemostasis was performed whenever possible in all patients with Forrest types I, IIa, and IIb ulcer bleeding. RESULTS: We found similar rates in the two groups for recurrent bleeding (16 % in DEU patients vs. 14 % in EEE patients), persistent bleeding (8 % in DEU patients vs. none in EEE patients), medical complications (21 % in DEU patients vs. 26 % in EEE patients), the need for surgery (8 % in DEU patients vs. 9 % in EEE patients), and the length of hospital stay (5.1 days for DEU patients vs. 5.9 days for EEE patients). None of the differences between the two groups in these parameters were statistically significant. None of the patients died. CONCLUSIONS: Early endoscopy in an emergency room did not improve the clinical outcome in our 81 consecutive patients with bleeding peptic ulcer.
Authors: Keith Siau; James Hodson; Richard Ingram; Andrew Baxter; Monika M Widlak; Caroline Sharratt; Graham M Baker; Tom Troth; Ben Hicken; Faraz Tahir; Malik Magrabi; Nouman Yousaf; Claire Grant; Dennis Poon; Hesham Khalil; Hui Lin Lee; Jonathan R White; Huey Tan; Syazeddy Samani; Patricia Hooper; Saeed Ahmed; Muhammad Amin; Sara Mahgoub; Khayal Asghar; Farique Leet; Matthew J Harborne; Beata Polewiczowska; Sheeba Khan; Muhammad R Anjum; Michael McFarlane; Ella Mozdiak; Lauren D O'Flynn; Ilona C Blee; Rachel M Molyneux; Ashok Kurian; Syed N Abbas; Abdullah Abbasi; Aadil Karim; Asif Yasin; Fawad Khattak; Josephine White; Ruhina Ahmed; James A Morgan; Lance Alleyne; Mohamed A Alam; Naaventhan Palaniyappan; Victoria J Rodger; Paramvir Sawhney; Nasar Aslam; Theodore Okeke; Adam Lawson; Danny Cheung; Jeremy P Reid; Ashish Awasthi; Mark R Anderson; Joe R Timothy; Sanjeev Pattni; Saqib Ahmad; Gillian Townson; Jeremy Shearman; Vanja Giljaca; Matthew J Brookes; Ben R Disney; Neil Guha; Titus Thomas; Anthony Norman; Peter Wurm; Ashit Shah; Neil C Fisher; Sauid Ishaq; Giles Major Journal: United European Gastroenterol J Date: 2018-10-28 Impact factor: 4.623
Authors: Moshe Rubin; Syed A Hussain; Albert Shalomov; Rafael A Cortes; Michael S Smith; Sang H Kim Journal: Dig Dis Sci Date: 2010-07-15 Impact factor: 3.199
Authors: Cosmos L T Guo; Sunny H Wong; Louis H S Lau; Rashid N S Lui; Joyce W Y Mak; Raymond S Y Tang; Terry C F Yip; William K K Wu; Grace L H Wong; Francis K L Chan; James Y W Lau; Joseph J Y Sung Journal: Gut Date: 2021-09-21 Impact factor: 31.793
Authors: Dong-Won Ahn; Young Soo Park; Sang Hyub Lee; Cheol Min Shin; Jin-Hyeok Hwang; Jin-Wook Kim; Sook-Hyang Jeong; Nayoung Kim; Dong Ho Lee Journal: Korean J Intern Med Date: 2016-04-06 Impact factor: 2.884