TITLE:
Outcome of patients undergoing early versus late endoscopic intervention for acute oesophageal variceal bleeding at Air Force Hospital, Egypt. A population based cohort study
AUTHORS:
Gamal Esmat, Iman M. Hamza, Bahaa E. Abbas
KEYWORDS:
Bleeding Varices; Early Endoscopy; Late Endoscopy
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.4 No.1,
January
23,
2014
ABSTRACT: Background:
Whether on-call gastroenterologists should perform emergency endoscopic treatment
or delay endoscopy the next day has not been investigated. This study aims to
investigate the effect of timing of
endoscopy on patients with acute esophageal variceal bleeding. Patients
and Methods: We included 167 patients with acute variceal bleeding in the gas-troenterology
unit of the air force hospital, Cairo, Egypt, from 15 January till 15 July
2010. Endoscopy was scheduled once the patient’s hemodynamics permitted. Time
from admission to endoscopy was recorded. Patients were stratified into 2
groups: Early endoscopy: when done ≤ 12 hours and late endoscopy: when done
> 12 hours. Patients were followed up for 42 days. Results: The study
included 102 males (61.1%) and 65 females (38.9%) (mean age 54 ± 11 years). 151
patients received endoscopic treatment. Early endoscopy group included 85
patients (56.3%), and the late endoscopy group included 66 patients (43.7%) (p =
0.14). Early endoscopy patients were transfused a mean of 2.9 (±1.8) units of
blood versus 4.3 (±0.14) units in the late endoscopy patients p = 0.001. Mean
hospital stay was 7.1 (±3.3) days versus 9.3 (±4.6) days in the early and late
groups respectively p: 0.001. 5-day mortality was reported in 6 (±7) cases in
the early endoscopy group and 23 (±34.8) cases in the late endoscopy group p:
0.001. Conclusion: Early endoscopic intervention for patients with acute
variceal bleeding is associated with a more favorable outcome in terms of
morbidity and mortality. On call gastroenterologists should comply with the 12-hour
period rather than delaying cirrhotic patients with acute variceal bleeding to
the following day.