Bedside Endoscopy for Significant Acute Upper Gastrointestinal Bleed

Introduction: Acute upper gastrointestinal bleeding (AUGIB) is a frequent life-threatening scenario in everyday clinical practice. We undertook a study to understand the role of bedside endoscopy for significant AUGIB in sick patients unstable to be shifted, their etiologies, and major outcomes at our institution.

Methods: This is a prospective observational study conducted between December 2019 and December 2022. Patients were followed up to 1 month after initial endoscopy.

Inclusion criteria:

Any patient above 16 years of age, with history of clinically significant AUGIB undergoing bedside endoscopy in an ICU/HDU setting.

Exclusion criteria:

Patients/relatives who do not give a valid consent.

Patients under the age of 16 years.

Results: Seventy patients were included in the study. There was a male preponderance (80%) with mean age (SD) of patients being 51.27 (13.45) years. The mean (SD) hemoglobin, APACHE score, SOFA score, and GCS of these patients at the time of initial gastroenterology consultation were 6.71 (2.14), 20.3 (8.3), 8.28 (4.64), and 10.9 (4.68), respectively. Early endoscopy (<24 hours) was done in 56 patients (80%).

The major etiologies of AUGIB were portal hypertension in 28 (40%) and peptic ulcer disease in 25 (36%) patients. Etiology of bleeding could not be identified in three patients.

Primary hemostasis rate was achieved in 91% (41/45) of those who required initial endotherapy. Eleven (15.7%) of seventy patients had recurrent bleed. Radiological intervention was needed for three patients and surgery for two patients. Overall, 30-day mortality was 54.2%. AUGIB was the cause of mortality in only 21% of those who died.

On multivariate logistic regression analysis, sepsis, coagulopathy, and liver failure were independent factors that predicted 30-day mortality.

Conclusion: This is the first study looking at the role of bedside endoscopy in AUGIB among South Asian patients. The most common etiologies of AUGIB in our cohort were portal hypertension and peptic ulcer disease. Rebleed, surgery, and 30-day mortality rates were 15.7, 2.9, and 54.2%, respectively. Majority of the deaths was due to underlying co-morbidities.

Publication History

Article published online:
22 April 2024