Share This Article:

Outcome of patients undergoing early versus late endoscopic intervention for acute oesophageal variceal bleeding at Air Force Hospital, Egypt. A population based cohort study

Abstract Full-Text HTML Download Download as PDF (Size:246KB) PP. 24-31
DOI: 10.4236/ojgas.2014.41005    3,355 Downloads   4,465 Views  

ABSTRACT

Background: Whether on-call gastroenterologists should perform emergency endoscopic treatment or delay endoscopy the next day has not been investigated. This study aims to investigate the effect of timing of endoscopy on patients with acute esophageal variceal bleeding. Patients and Methods: We included 167 patients with acute variceal bleeding in the gas-troenterology unit of the air force hospital, Cairo, Egypt, from 15 January till 15 July 2010. Endoscopy was scheduled once the patient’s hemodynamics permitted. Time from admission to endoscopy was recorded. Patients were stratified into 2 groups: Early endoscopy: when done ≤ 12 hours and late endoscopy: when done > 12 hours. Patients were followed up for 42 days. Results: The study included 102 males (61.1%) and 65 females (38.9%) (mean age 54 ± 11 years). 151 patients received endoscopic treatment. Early endoscopy group included 85 patients (56.3%), and the late endoscopy group included 66 patients (43.7%) (p = 0.14). Early endoscopy patients were transfused a mean of 2.9 (±1.8) units of blood versus 4.3 (±0.14) units in the late endoscopy patients p = 0.001. Mean hospital stay was 7.1 (±3.3) days versus 9.3 (±4.6) days in the early and late groups respectively p: 0.001. 5-day mortality was reported in 6 (±7) cases in the early endoscopy group and 23 (±34.8) cases in the late endoscopy group p: 0.001. Conclusion: Early endoscopic intervention for patients with acute variceal bleeding is associated with a more favorable outcome in terms of morbidity and mortality. On call gastroenterologists should comply with the 12-hour period rather than delaying cirrhotic patients with acute variceal bleeding to the following day.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Esmat, G. , Hamza, I. and Abbas, B. (2014) Outcome of patients undergoing early versus late endoscopic intervention for acute oesophageal variceal bleeding at Air Force Hospital, Egypt. A population based cohort study. Open Journal of Gastroenterology, 4, 24-31. doi: 10.4236/ojgas.2014.41005.

References

[1] Abdel-Wahab, M.F., Esmat, G., Ramzy, I., Fouad, R., Abdel-Rahman, M., Yosery, A., Narooz, S. and Strickland, G.T. (1992) Schistosoma haematobium infection in Egyptian schoolchildren: Demonstration of both hepatic and urinary tract morbidity by ultrasonography. Transactions of the Royal Society of Tropical Medicine & Hygiene, 86, 406-409. http://dx.doi.org/10.1016/0035-9203(92)90241-4
[2] Abdel-Wahab, M.F., Esmat, G., El-Boraey, Y., Ramzy, I., Medhat, E. and Strickland, G.T. (2000) The epidemiology of schistosomiasis in Egypt: Methods, training, and quality control of clinical and ultrasound examinations. The American Journal of Tropical Medicine and Hygiene, 62, 17-20.
[3] Abdel-Wahab, M.F., Esmat, G., Medhat, E., Narooz, S., Ramzy, I., El-Boraey, Y. and Strickland, G.T. (2000) The epidemiology of schistosomiasis in Egypt: Menofia Governorate. The American Journal of Tropical Medicine and Hygiene, 62, 28-34.
[4] El-Raziky, M.S., El-Hawary, M., El-Koofy, N., Okasha, S., Kotb, M., Salama, K., Esmat, G., El-Raziky, M., Abouzied, A.M. and El-Karaksy, H. (2004) Hepatitis C virus infection in Egyptian children: Single centre experience. Journal of Viral Hepatitis, 11, 471-476.
http://dx.doi.org/10.1111j.1365-2893.2004.00535.x
[5] Yan, B.M. and Lee, S.S. (2006) Emergency management of bleeding esophageal varices: Drugs, bands or sleep? Canadian Journal of Gastroenterology, 20, 165-170.
[6] Garcia-Tsao, G., Sanyal, A.J., Grace, N.D. and Carey, W. (2007) Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology, 46, 922-938. http://dx.doi.org/10.1002/hep.21907
[7] De Franchis, R. (2005) Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. Journal of Hepatology, 43, 167-176. http://dx.doi.org/10.1016/j.jhep.2005.05.009
[8] Inokuchi, K. (1980) The general rules for recording endoscopic findings on esophageal varices. The Japanese Journal of Surgery, 10, 84-87. http://dx.doi.org/10.1007/BF02468653
[9] De Franchis, R. (2000) Updating consensus in portal hypertension: report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. Journal of Hepatology, 33, 846-852. http://dx.doi.org/10.1016/S0168-8278(00)80320-7
[10] Jalan, R. and Hayes, P.C. (2000) UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut, 46, iii1-iii15. http://dx.doi.org/10.1136/gut.46.suppl_3.iii1
[11] Villanueva, C., Piqueras, M., Aracil, C., Gómez, C., López-Balaguer, J.M., Gonzalez, B., et al. (2006) A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding. Journal of Hepatology, 45, 560-567. http://dx.doi.org/10.1016/j.jhep.2006.05.016
[12] Del Olmo, J.A., Peña, A., Serra, M.A., Wassel, A.H., Benages, A. and Rodrigo, J.M. (2000) Predictors of morbidity and mortality after the first episode of upper gastrointestinal bleeding in liver cirrhosis. Hepatology, 32, 19-24.
[13] De Franchis, R. (1996) Developing consensus in portal hypertension. Journal of Hepatology, 25, 390-394. http://dx.doi.org/10.1016/S0168-8278(96)80127-9
[14] D’Amico, G., Pietrosi, G., Tarantino, I. and Pagliaro, L. (2003) Emergency sclerotherapy versus vasoactive drugs for variceal bleeding in cirrhosis: A Cochrane meta-analysis. Gastroenterology, 124, 1277-1291. http://dx.doi.org/10.1016/S0016-5085(03)00269-5
[15] Altamirano, J., Zapata, L., Agustin, S., Muntaner, L., González-Angulo, A., Ortiz, A.L., Degiau, L., Garibay, J., Camargo, L. and Genescà, J. (2009) Predicting 6-week mortality after acute variceal bleeding: Role of classification and regression tree analysis. Annals of Hepatology, 8, 308-315.
[16] Krige, J.E., Shaw, J.M. and Bornman, P.C. (2005) The evolving role of endoscopic treatment for bleeding esophageal varices. World Journal of Surgery, 29, 966-973. http://dx.doi.org/10.1007/s00268-005-0138-2
[17] Graham, D.Y. and Smith, J.L. (1981) The course of patients after variceal hemorrhage. Gastroenterology, 80, 800-809.
[18] Abraldes, J.G. and Bosch, J. (2007) The treatment of acute variceal bleeding. Journal of Clinical Gastroenterology, 41, S312-S317. http://dx.doi.org/10.1097/MCG.0b013e318150d3dd
[19] Carbonell, N., Pauwels, A., Serfaty, L., Fourdan, O., Lévy, V.G. and Poupon, R. (2004) Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology, 40, 652-659. http://dx.doi.org/10.1002/hep.20339
[20] Cheung, J., Soo, I., Bastiampillai, R., Zhu, Q. and Ma, M. (2009) Urgent vs. non-urgent endoscopy in stable acute variceal bleeding. The American Journal of Gastroenterology, 104, 1125-1129. http://dx.doi.org/10.1038/ajg.2009.78
[21] Krige, J.E. and Beckingham, I.J. (2001) ABC of diseases of liver, pancreas, and biliary system. Portal hypertension—1: Varices. BMJ, 322, 348-351. http://dx.doi.org/10.1136/bmj.322.7282.348
[22] Bañares, R., Albillos, A., Rincón, D., Alonso, S., González, M., Ruiz-del-Arbol, L., et al. (2002) Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: A meta-analysis. Hepatology, 35, 609-615. http://dx.doi.org/10.1053/jhep.2002.31354
[23] Bosch, J., Thabut, D., Albillos, A., Carbonell, N., Spicak, J., Massard, J., et al. (2008) Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial. Hepatology, 47, 1604-1614. http://dx.doi.org/10.1002/hep.22216
[24] Sarin, N., Monga, N. and Adams, P.C. (2009) Time to endoscopy and outcomes in upper gastrointestinal bleeding. Canadian Journal of Gastroenterology, 23, 489-493.
[25] Wysocki, J.D., Srivastav, S. and Winstead, N.S. (2012) A nationwide analysis of risk factors for mortality and time to endoscopy in upper gastrointestinal haemorrhage. Alimentary Pharmacology & Therapeutics, 36, 30-36. http://dx.doi.org/10.1111/j.1365-2036.2012.05129.x
[26] Cooper, G.S., Chak, A., Way, L.E., Hammar, P.J., Harper, D.L. and Rosenthal, G.E. (1999) Early endoscopy in upper gastrointestinal hemorrhage: Associations with recurrent bleeding, surgery, and length of hospital stay. Gastrointestinal Endoscopy, 49, 145-152. http://dx.doi.org/10.1016/S0016-5107(99)70478-5
[27] Hsu, Y.C., Chung, C.S., Tseng, C.H., Lin, T.L., Liou, J.M., Wu, M.S., Hu, F.C. and Wang, H.P. (2009) Delayed endoscopy as a risk factor for in-hospital mortality in cirrhotic patients with acute variceal hemorrhage. Journal of Gastroenterology and Hepatology, 24, 1294-1299. http://dx.doi.org/10.1111/j.1440-1746.2009.05903.x
[28] Rollhauser, C. and Fleischer, D.E. (1999) Ulcers and nonvariceal bleeding. Endoscopy, 31, 17-25. http://dx.doi.org/10.1055/s-1999-13644
[29] Bjorkman, D.J., Zaman, A., Fennerty, M.B., Lieberman, D., Disario, J.A. and Guest-Warnick, G. (2004) Urgent vs. elective endoscopy for acute non-variceal upper-GI bleed- ing: An effectiveness study. Gastrointestinal Endoscopy, 60, 1-8. http://dx.doi.org/10.1016/S0016-5107(04)01287-8
[30] Lee, J.G. (2006) What is the value of early endoscopy in upper gastrointestinal bleeding? Nature Clinical Practice Gastroenterology & Hepatology, 3, 534-535.
http://dx.doi.org/10.1038/ncpgasthep0609

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.