Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2018; 24(44): 5025-5033
Published online Nov 28, 2018. doi: 10.3748/wjg.v24.i44.5025
Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding
Jeong-Ju Yoo, Young Chang, Eun Ju Cho, Ji Eun Moon, Sang Gyune Kim, Young Seok Kim, Yun Bin Lee, Jeong-Hoon Lee, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon
Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim, Department of Gastroenterology and Hepatology, Soonchunhyang University school of Medicine, Bucheon 14584, South Korea
Young Chang, Eun Ju Cho, Yun Bin Lee, Jeong-Hoon Lee, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
Ji Eun Moon, Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
Author contributions: All authors helped to perform the research; Yoo JJ and Chang Y contributed equally as co-first authors; Yoo JJ and Chang Y did the manuscript writing, drafting conception and design, and data analysis; Moon JE did the manuscript writing, and data analysis; Kim SG, Kim YS, Lee YB, Lee JH, Yu SJ, Kim YJ, and Yoon JH made contribution to the manuscript writing; Cho EJ made contribution to the manuscript writing, conception drafting and design.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of each hospital, and also conformed to the ethical guidelines of the World Medical Association Declaration of Helsinki (H-1801-057-914, SCH 2018-06-013).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors have no conflict of interest with respect to the subjects described in this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author to: Eun Ju Cho, MD, PhD, Assistant Professor, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul 03080, South Korea.
Telephone: +82-2-20722228 Fax: +82-2-7436701
Received: August 30, 2018
Peer-review started: August 30, 2018
First decision: October 14, 2018
Revised: October 15, 2018
Accepted: November 13, 2018
Article in press: November 13, 2018
Published online: November 28, 2018

To examine the association between the timing of endoscopy and the short-term outcomes of acute variceal bleeding in cirrhotic patients.


This retrospective study included 274 consecutive patients admitted with acute esophageal variceal bleeding of two tertiary hospitals in Korea. We adjusted confounding factors using the Cox proportional hazards model and the inverse probability weighting (IPW) method. The primary outcome was the mortality of patients within 6 wk.


A total of 173 patients received urgent endoscopy (i.e., ≤ 12 h after admission), and 101 patients received non-urgent endoscopy (> 12 h after admission). The 6-wk mortality rate was 22.5% in the urgent endoscopy group and 29.7% in the non-urgent endoscopy group, and there was no significant difference between the two groups before (P = 0.266) and after IPW (P = 0.639). The length of hospital stay was statistically different between the urgent group and non-urgent group (P = 0.033); however, there was no significant difference in the in-hospital mortality rate between the two groups (8.1% vs 7.9%, P = 0.960). In multivariate analyses, timing of endoscopy was not associated with 6-wk mortality (hazard ratio, 1.297; 95% confidence interval, 0.806-2.089; P = 0.284).


In cirrhotic patients with acute variceal bleeding, the timing of endoscopy may be independent of short-term mortality.

Keywords: Cirrhosis, Endoscopy, Upper gastrointestinal bleeding, Gastroesophageal varices, Timing

Core tip: Most guidelines recommend performing endoscopy for acute variceal bleeding within 12 h. However, the evidence level for this recommendation is very low. We found that, after inverse probability weighting matching, compared to non-urgent endoscopy, performing endoscopy within 12 h of admission (so-called urgent endoscopy) was not associated with short-term prognosis, including overall survival at 6 wk or transplant-free survival at 6 wk. Rather, age, hepatocellular carcinoma, model for end-stage liver disease score, and degree of ascites were related to short-term mortality. These results indicate that, in cirrhotic patients with acute variceal bleeding, the timing of endoscopy does not appear to be associated with short-term prognosis.