Published online Nov 28, 2018. doi: 10.3748/wjg.v24.i44.5025
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
The optimal timing of emergency endoscopy in acute variceal bleeding remains unclear. Most guidelines recommend performing endoscopy for acute variceal bleeding within 12 h of admission. However, the evidence level for this recommendation is very low, with few relevant studies to date to justify it
Determining the appropriate endoscopic timing is a very important issue, and both the risk and benefit to the patient need to be considered. We hypothesized that the earlier the endoscopy was performed, the better the short-term prognosis of the cirrhotic patients with variceal bleeding.
The aim of this study was to examine the association between the timing of endoscopy and the short-term prognosis of acute variceal bleeding in cirrhotic patients.
We performed a retrospective study of cirrhotic patients with variceal bleeding. Patients were divided into two groups according to the time of endoscopy. Urgent endoscopy group was defined as performing endoscopy before 12 h of admission and non-urgent endoscopy group after 12 h of admission. The inverse probability weighting (IPW) method based on propensity score was applied to correct baseline differences between the two groups, and compared short-term prognosis between the two groups.
In 274 patients, 173 patients received urgent endoscopy, and 101 patients received non-urgent endoscopy. After IPW method, short term prognosis including 6-wk mortality rate or 6-wk transplantation rate was not different between the two groups. In multivariate analyses, timing of endoscopy was not associated with 6-wk mortality. Other factors associated with 6-wk mortality were age, hepatocellular carcinoma, MELD score, and degree of ascites.
Timing of endoscopy may not affect the clinical short-term outcomes of patients with esophageal variceal bleeding.
Because this is a retrospective study, a prospective study to determine the appropriate timing of endoscopy considering risk and benefit is needed for the future.