BACKGROUND AND AIMS:
The optimal timing of endoscopy in patients with peptic ulcer bleeding (PUB) remains unclear. The aim of this study was to examine the association between timing of endoscopy and mortality in PUB.
A nationwide cohort study based on a database of consecutive patients admitted to hospital with PUB in Denmark. Patients were stratified according to presence of hemodynamic instability at presentation and American Society of Anesthesiologists (ASA) score. Using descriptive statistics and logistic regression analyses, we identified optimal time frames for endoscopy and analyzed the association between timing of endoscopy and in-hospital mortality after adjusting for confounding factors.
A total of 12,601 patients were included. We did not find any universal association between timing of endoscopy and mortality in hemodynamically stable patients with an ASA-score of 1 to 2. In hemodynamically stable patients with an ASA-score of 3 to 5, endoscopy in the period 12 to 36 hours after admission to hospital was associated with lower in-hospital mortality (Odds ratio [OR], 0.48; 95% confidence interval [CI], 0.34-0.67) compared with endoscopy outside this time frame. In patients with hemodynamic instability, endoscopy in the period 6-24 hours after admission to hospital was associated with lower in-hospital mortality (OR, 0.73; 95% CI, 0.54-0.98) compared with endoscopy outside this time frame.
Timing of endoscopy is associated with mortality in patients with PUB and an ASA-score of 3 to 5 or hemodynamic instability. Our findings suggest that in these patients, a period of time to optimise resuscitation and manage comorbidities before endoscopy may improve outcome.