Endoscopic urgency triaging impacts acute variceal bleeding patient survival and hospital stay length
Upper gastrointestinal bleeding (UGIB) needs accurate endoscopic timing. This study investigates the debate on the necessity of upper endoscopy in UGIB, proposes predictors for adverse outcomes if urgent endoscopy is deferred, and assesses the risk to patient health or results compared to non-urgent...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2025-12-01
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| Series: | Libyan Journal of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/19932820.2025.2516313 |
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| author | Amr Shaaban Hanafy Ahmed Behiry Dalia Mahmoud Abdelmonem Elsherbini Hasnaa Ali Ebrahim Ateya Megahed Ibrahim Khalid I. AlQumaizi Moaz Abulfaraj Mohamed El-Sherbiny Hany A. Elkattawy |
| author_facet | Amr Shaaban Hanafy Ahmed Behiry Dalia Mahmoud Abdelmonem Elsherbini Hasnaa Ali Ebrahim Ateya Megahed Ibrahim Khalid I. AlQumaizi Moaz Abulfaraj Mohamed El-Sherbiny Hany A. Elkattawy |
| author_sort | Amr Shaaban Hanafy |
| collection | DOAJ |
| description | Upper gastrointestinal bleeding (UGIB) needs accurate endoscopic timing. This study investigates the debate on the necessity of upper endoscopy in UGIB, proposes predictors for adverse outcomes if urgent endoscopy is deferred, and assesses the risk to patient health or results compared to non-urgent endoscopy. A non-randomized controlled study conducted at a single center involved 200 patients with acute life-threatening UGIB. The study group comprised 100 who had an urgent endoscopy within 6 h and a control group included 100 who waited or declined the procedure within 6–24 h. Glasgow-Blatchford score was used for risk stratification of UGIB. Doppler ultrasound was applied to measure lower esophageal wall thickness. D-dimer, lactate, and procalcitonin were measured. The study group revealed recurrent bleeding after 13.5 ± 3.6 days. Death occurred in 4 (4%) which is statistically significant lower (p = 0.024) compared to the control group due to hypovolemic shock, pulmonary embolization, or aspiration pneumonia. Control group showed recurrent bleeding following 15.8 ± 4.7 days (p = 0.306). Death occurred in 14 (14%) of patients due to hypovolemic shock, disseminated intravascular coagulation, or pulmonary embolization. A shorter hospital stay (8.4 ± 3.2 days) was evident in the study group compared to the control group (16.4 ± 2.76 days, p < 0.001). D-dimer, serum lactate, and procalcitonin (Adjusted Odds Ratio (AOR) = 1.004, 2.207, 0.563, p < 0.001, <0.001, 0.011, respectively), and their corresponding values at follow-up (AOR = 0.988, 0.528, 177.04, p < 0.001, 0.011, <0.001, respectively) were significantly associated with higher mortality. Waiting time till endoscopy, baseline D-dimer (AOR = 1.794, 0.998, p < 0.001, 0.014, respectively), creatinine, procalcitonin, and esophageal wall thickness at follow-up were significantly associated with longer hospital stay. The study suggests that higher lower esophageal wall thickness and elevated serum lactate, D-dimer, and procalcitonin are novel triaging markers for early endoscopic intervention, which can improve patient outcomes, reduce blood transfusion risks, and eliminate unnecessary procedures. |
| format | Article |
| id | doaj-art-31d9e4106c8a4e6996ff1c5d547249f7 |
| institution | Kabale University |
| issn | 1993-2820 1819-6357 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
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| series | Libyan Journal of Medicine |
| spelling | doaj-art-31d9e4106c8a4e6996ff1c5d547249f72025-08-20T03:25:42ZengTaylor & Francis GroupLibyan Journal of Medicine1993-28201819-63572025-12-0120110.1080/19932820.2025.2516313Endoscopic urgency triaging impacts acute variceal bleeding patient survival and hospital stay lengthAmr Shaaban Hanafy0Ahmed Behiry1Dalia Mahmoud Abdelmonem Elsherbini2Hasnaa Ali Ebrahim3Ateya Megahed Ibrahim4Khalid I. AlQumaizi5Moaz Abulfaraj6Mohamed El-Sherbiny7Hany A. Elkattawy8Internal Medicine Department - Gastroenterology and Hepatology Division, Zagazig University, Zagazig, EgyptDepartment of Gastroentrology Hepatology and Infectious disease, Faculty of Medicine, Zagazig University, Zagazig, EgyptDepartment of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi ArabiaDepartment of Basic Medical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi ArabiaCollege of Nursing, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi ArabiaDepartment of Family Medicine, College of Medicine, AlMaarefa University, Riyadh, Saudi ArabiaDepartment of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaDepartment of Basic Medical Sciences, College of Medicine, AlMaarefa University, Riyadh, Saudi ArabiaDepartment of Basic Medical Sciences, College of Medicine, AlMaarefa University, Riyadh, Saudi ArabiaUpper gastrointestinal bleeding (UGIB) needs accurate endoscopic timing. This study investigates the debate on the necessity of upper endoscopy in UGIB, proposes predictors for adverse outcomes if urgent endoscopy is deferred, and assesses the risk to patient health or results compared to non-urgent endoscopy. A non-randomized controlled study conducted at a single center involved 200 patients with acute life-threatening UGIB. The study group comprised 100 who had an urgent endoscopy within 6 h and a control group included 100 who waited or declined the procedure within 6–24 h. Glasgow-Blatchford score was used for risk stratification of UGIB. Doppler ultrasound was applied to measure lower esophageal wall thickness. D-dimer, lactate, and procalcitonin were measured. The study group revealed recurrent bleeding after 13.5 ± 3.6 days. Death occurred in 4 (4%) which is statistically significant lower (p = 0.024) compared to the control group due to hypovolemic shock, pulmonary embolization, or aspiration pneumonia. Control group showed recurrent bleeding following 15.8 ± 4.7 days (p = 0.306). Death occurred in 14 (14%) of patients due to hypovolemic shock, disseminated intravascular coagulation, or pulmonary embolization. A shorter hospital stay (8.4 ± 3.2 days) was evident in the study group compared to the control group (16.4 ± 2.76 days, p < 0.001). D-dimer, serum lactate, and procalcitonin (Adjusted Odds Ratio (AOR) = 1.004, 2.207, 0.563, p < 0.001, <0.001, 0.011, respectively), and their corresponding values at follow-up (AOR = 0.988, 0.528, 177.04, p < 0.001, 0.011, <0.001, respectively) were significantly associated with higher mortality. Waiting time till endoscopy, baseline D-dimer (AOR = 1.794, 0.998, p < 0.001, 0.014, respectively), creatinine, procalcitonin, and esophageal wall thickness at follow-up were significantly associated with longer hospital stay. The study suggests that higher lower esophageal wall thickness and elevated serum lactate, D-dimer, and procalcitonin are novel triaging markers for early endoscopic intervention, which can improve patient outcomes, reduce blood transfusion risks, and eliminate unnecessary procedures.https://www.tandfonline.com/doi/10.1080/19932820.2025.2516313Bleedingendoscopygastrointestinallength of staysurvival |
| spellingShingle | Amr Shaaban Hanafy Ahmed Behiry Dalia Mahmoud Abdelmonem Elsherbini Hasnaa Ali Ebrahim Ateya Megahed Ibrahim Khalid I. AlQumaizi Moaz Abulfaraj Mohamed El-Sherbiny Hany A. Elkattawy Endoscopic urgency triaging impacts acute variceal bleeding patient survival and hospital stay length Libyan Journal of Medicine Bleeding endoscopy gastrointestinal length of stay survival |
| title | Endoscopic urgency triaging impacts acute variceal bleeding patient survival and hospital stay length |
| title_full | Endoscopic urgency triaging impacts acute variceal bleeding patient survival and hospital stay length |
| title_fullStr | Endoscopic urgency triaging impacts acute variceal bleeding patient survival and hospital stay length |
| title_full_unstemmed | Endoscopic urgency triaging impacts acute variceal bleeding patient survival and hospital stay length |
| title_short | Endoscopic urgency triaging impacts acute variceal bleeding patient survival and hospital stay length |
| title_sort | endoscopic urgency triaging impacts acute variceal bleeding patient survival and hospital stay length |
| topic | Bleeding endoscopy gastrointestinal length of stay survival |
| url | https://www.tandfonline.com/doi/10.1080/19932820.2025.2516313 |
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