Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2020; 12(2): 72-82
Published online Feb 16, 2020. doi: 10.4253/wjge.v12.i2.72
Endoscopic treatment modalities and outcomes in nonvariceal upper gastrointestinal bleeding
Benjamin Cherng Hann Yip, Hossain Sayeed Sajjad, Jie-Xun Wang, Constantinos P Anastassiades
Benjamin Cherng Hann Yip, Constantinos P Anastassiades, Department of General Medicine, Khoo Teck Puat Hospital, Singapore 768828, Singapore
Hossain Sayeed Sajjad, Department of Acute Medicine, Northampton General Hospital, Cliftonville, Northampton NN1 5BD, United Kingdom
Jie-Xun Wang, Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Singapore
Author contributions: All the authors contributed equally in data extraction, data analysis and writing of the paper.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer-NHG Domain Specific Review Board.
Informed consent statement: A waiver of informed consent has been obtained from our institution ethics review board.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Benjamin Cherng Hann Yip, MBBS, MRCP, Doctor, Department of General Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore. yip.benjamin.ch@ktph.com.sg
Received: June 18, 2019
Peer-review started: June 23, 2019
First decision: August 2, 2019
Revised: November 25, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: February 16, 2020
Processing time: 204 Days and 13.2 Hours
Abstract
BACKGROUND

In nonvariceal upper gastrointestinal bleeding (NVUGIB), the optimal volume of adrenaline, the optimal number of hemoclips, and the application of thermal coagulation in determining patient outcomes have not been well studied.

AIM

To demonstrate a dose-response relationship between the commonly used endoscopic modalities for the treatment of non-variceal upper gastrointestinal bleeding and various clinical outcomes.

METHODS

Patients presenting with NVUGIB were retrospectively identified and analyzed. These patients were stratified as follows: (1) > 10 mL of adrenaline injected vs ≤ 10 mL; (2) > 1 hemoclip placed vs ≤ 1 hemoclip; (3) Heater probe used or not; and (4) > 2 treatment modalities used vs ≤ 2. The primary outcomes were rebleeding and the need for repeat endoscopy. The secondary outcomes were the need for surgery, required transfusions, length of hospital stay, death during the same admission period and 30 d mortality. Patients with NVUGIB who required endoscopic therapy were included. Those who did not require endoscopic therapy or were initially treated with surgery or embolization were excluded.

RESULTS

In all, 501 patients with NVUGIB were treated. One hundred sixty-one (32.1%) patients needed endoscopic therapy. The injection of < 10 mL of adrenaline was associated with less rebleeding (P < 0.0001), the need for repeat endoscopy (P = 0.001) and a decreased length of hospital stay (P = 0.026). The use of > 2 treatment modalities were associated with increased rebleeding (P = 0.009) and the need for repeat endoscopy (P = 0.048). The placement of > 1 hemoclip was associated with a decreased length of hospital stay (P = 0.044). The rates of surgery and death were low, and there were no other significant differences between the patient groups.

CONCLUSION

The more restrictive use of adrenaline and number of endoscopic modalities to treat NVUGIB with the more liberal use of hemoclips was associated with better patient outcomes.

Keywords: Outcome predictors; Nonvariceal upper gastrointestinal bleeding

Core tip: This is the first study to our knowledge attempting to demonstrate a dose-response relationship between the commonly used endoscopic modalities for the treatment of non-variceal upper gastrointestinal bleeding and various clinical outcomes. Ours is also the first study to show that a greater number of hemoclips deployed led to a better outcome. It is a real-world study and results were generated from patient care in daily clinical practice.