Emergency endoscopic interventions in acute upper gastrointestinal bleeding: a cohort study

Abstract

Abstract Introduction: Acute upper gastrointestinal bleeding frequently leads to emergency department admissions. The standard approach for diagnosing and treating acute upper gastrointestinal bleeding involves endoscopy of the upper gastrointestinal tract. While daytime emergency endoscopy has been well-studied, there is limited evidence regarding its effectiveness during nighttime procedures Patientes and Methods: We conducted a retrospective cohort study at a single center, analyzing adult patients referred for emergency endoscopy outside of regular hospital hours due to AUGIB. Endoscopic hemostatic methods were employed, and patients were categorized into day-hours and night-hours groups based on the timing of their procedures. The primary clinical endpoint was 120-day all-cause mortality, with secondary endpoints including haemostasis and recurrence. Results: Among the 752 enrolled patients with acute upper gastrointestinal bleeding symptoms, 592 underwent endoscopy during the day, while 160 had procedures performed at night. In the day-hours group, the median time from symptom onset to endoscopy was 10 hours (IQR 6-15h), compared to 6 hours (IQR 4-16h) in the night-hours group. Intervention times were significantly shorter during the night hours (P < 0.001). In both groups, endoscopic intervention after the 6th hour from symptom onset yielded improved outcomes, while treatment before the 5th hour resulted in poorer outcomes. Although the night-hours group had higher 120-day all-cause mortality, the difference was not statistically significant. Conclusion: Our findings indicate that emergency endoscopic intervention for acute upper gastrointestinal bleeding is similarly effective during both day and night hours, particularly when performed after the 6th hour from symptom onset.