Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal bleeding: propensity score matching analysis of real-world data from Thailand
Abstract Background The findings on mortality, rebleeding rate, and hospital stay in patients who underwent early vs. late endoscopy are conflicting. We aimed to compare in-hospital outcomes and medical resource use in patients with acute non-variceal upper gastrointestinal bleeding. Methods We retr...
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BMC
2025-02-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-025-03673-w |
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| author | Arunchai Chang Natthawat Sitthinamsuwan Nuttanit Pungpipattrakul Kittiphan Chienwichai Keerati Akarapatima Sorawat Sangkaew Manus Rugivarodom Attapon Rattanasupar Bancha Ovartlarnporn Varayu Prachayakul |
| author_facet | Arunchai Chang Natthawat Sitthinamsuwan Nuttanit Pungpipattrakul Kittiphan Chienwichai Keerati Akarapatima Sorawat Sangkaew Manus Rugivarodom Attapon Rattanasupar Bancha Ovartlarnporn Varayu Prachayakul |
| author_sort | Arunchai Chang |
| collection | DOAJ |
| description | Abstract Background The findings on mortality, rebleeding rate, and hospital stay in patients who underwent early vs. late endoscopy are conflicting. We aimed to compare in-hospital outcomes and medical resource use in patients with acute non-variceal upper gastrointestinal bleeding. Methods We retrospectively reviewed the medical records of patients with acute non-variceal upper gastrointestinal bleeding who underwent early or late endoscopy between 2016 and 2019. The primary outcome was in-hospital mortality. The secondary outcomes were the need for packed red blood cells and number of transfusions, the proportion of lesions with high-risk stigmata, endoscopic and additional hemostasis, in-hospital rebleeding, duration of stay, and admission cost. Statistical analysis was performed using Pearson’s chi-squared or Fisher’s exact test for categorical variables, Student’s t-test, and Wilcoxon rank-sum test for continuous variables. Results Early and late endoscopies were performed on 451 and 279 patients, respectively. After 1:1 propensity score matching, 278 patients from each group were included, and patients’ baseline characteristics were similar in the matched groups. Compared with the late group, the early group had a significantly increased rate of endoscopic hemostasis (22.7% vs. 13.7%, P = 0.006) and a low rate of packed red blood cell transfusion (53.6% vs. 61.9%, P = 0.048). Duration of stay and admission costs were significantly higher in the late group than in the early group (all P < 0.05). After adjusting for confounding factors, early endoscopy was positively associated with ulcers with high-risk stigmata (adjusted odds ratio = 1.83, P = 0.023) and endoscopic hemostasis (adjusted odds ratio = 1.97, P = 0.004). It was negatively associated with the need for packed red blood cell transfusion (adjusted odds ratio = 0.62, P = 0.017) and duration of stay (adjusted coefficient=-0.10, P < 0.001) with no impact on in-hospital mortality, rebleeding, or radiological interventions. Conclusions The timing of endoscopy does not affect in-hospital mortality or rebleeding rate. This study supports using early endoscopy in patients with acute non-variceal upper gastrointestinal bleeding based on the potential benefits and feasibility of medical resource use. |
| format | Article |
| id | doaj-art-c267376ce07948eaa0698c6d02e9ea5d |
| institution | DOAJ |
| issn | 1471-230X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| series | BMC Gastroenterology |
| spelling | doaj-art-c267376ce07948eaa0698c6d02e9ea5d2025-08-20T03:13:14ZengBMCBMC Gastroenterology1471-230X2025-02-0125111010.1186/s12876-025-03673-wImpact of duration to endoscopy in patients with non-variceal upper gastrointestinal bleeding: propensity score matching analysis of real-world data from ThailandArunchai Chang0Natthawat Sitthinamsuwan1Nuttanit Pungpipattrakul2Kittiphan Chienwichai3Keerati Akarapatima4Sorawat Sangkaew5Manus Rugivarodom6Attapon Rattanasupar7Bancha Ovartlarnporn8Varayu Prachayakul9Division of Gastroenterology, Department of Internal Medicine, Hatyai HospitalDepartment of Internal Medicine, Hatyai HospitalDivision of Gastroenterology, Department of Internal Medicine, Hatyai HospitalDepartment of Internal Medicine, Hatyai HospitalDivision of Gastroenterology, Department of Internal Medicine, Hatyai HospitalDepartment of Social Medicine, Hatyai HospitalSiriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol UniversityDivision of Gastroenterology, Department of Internal Medicine, Hatyai HospitalNKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla UniversitySiriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol UniversityAbstract Background The findings on mortality, rebleeding rate, and hospital stay in patients who underwent early vs. late endoscopy are conflicting. We aimed to compare in-hospital outcomes and medical resource use in patients with acute non-variceal upper gastrointestinal bleeding. Methods We retrospectively reviewed the medical records of patients with acute non-variceal upper gastrointestinal bleeding who underwent early or late endoscopy between 2016 and 2019. The primary outcome was in-hospital mortality. The secondary outcomes were the need for packed red blood cells and number of transfusions, the proportion of lesions with high-risk stigmata, endoscopic and additional hemostasis, in-hospital rebleeding, duration of stay, and admission cost. Statistical analysis was performed using Pearson’s chi-squared or Fisher’s exact test for categorical variables, Student’s t-test, and Wilcoxon rank-sum test for continuous variables. Results Early and late endoscopies were performed on 451 and 279 patients, respectively. After 1:1 propensity score matching, 278 patients from each group were included, and patients’ baseline characteristics were similar in the matched groups. Compared with the late group, the early group had a significantly increased rate of endoscopic hemostasis (22.7% vs. 13.7%, P = 0.006) and a low rate of packed red blood cell transfusion (53.6% vs. 61.9%, P = 0.048). Duration of stay and admission costs were significantly higher in the late group than in the early group (all P < 0.05). After adjusting for confounding factors, early endoscopy was positively associated with ulcers with high-risk stigmata (adjusted odds ratio = 1.83, P = 0.023) and endoscopic hemostasis (adjusted odds ratio = 1.97, P = 0.004). It was negatively associated with the need for packed red blood cell transfusion (adjusted odds ratio = 0.62, P = 0.017) and duration of stay (adjusted coefficient=-0.10, P < 0.001) with no impact on in-hospital mortality, rebleeding, or radiological interventions. Conclusions The timing of endoscopy does not affect in-hospital mortality or rebleeding rate. This study supports using early endoscopy in patients with acute non-variceal upper gastrointestinal bleeding based on the potential benefits and feasibility of medical resource use.https://doi.org/10.1186/s12876-025-03673-wEarly endoscopyTime to endoscopyNon-variceal upper gastrointestinal bleedingClinical outcomesMedical resource use |
| spellingShingle | Arunchai Chang Natthawat Sitthinamsuwan Nuttanit Pungpipattrakul Kittiphan Chienwichai Keerati Akarapatima Sorawat Sangkaew Manus Rugivarodom Attapon Rattanasupar Bancha Ovartlarnporn Varayu Prachayakul Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal bleeding: propensity score matching analysis of real-world data from Thailand BMC Gastroenterology Early endoscopy Time to endoscopy Non-variceal upper gastrointestinal bleeding Clinical outcomes Medical resource use |
| title | Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal bleeding: propensity score matching analysis of real-world data from Thailand |
| title_full | Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal bleeding: propensity score matching analysis of real-world data from Thailand |
| title_fullStr | Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal bleeding: propensity score matching analysis of real-world data from Thailand |
| title_full_unstemmed | Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal bleeding: propensity score matching analysis of real-world data from Thailand |
| title_short | Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal bleeding: propensity score matching analysis of real-world data from Thailand |
| title_sort | impact of duration to endoscopy in patients with non variceal upper gastrointestinal bleeding propensity score matching analysis of real world data from thailand |
| topic | Early endoscopy Time to endoscopy Non-variceal upper gastrointestinal bleeding Clinical outcomes Medical resource use |
| url | https://doi.org/10.1186/s12876-025-03673-w |
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