Urgent endoscopy in severe non-variceal upper gastrointestinal hemorrhage: does the Glasgow-Blatchford score help endoscopists?

Abstract

Objective. The Glasgow-Blatchford score (GBS) has been validated to select severe patients with non-variceal upper gastrointestinal hemorrhage (UGIH). The aim was to compare the yield of the triage based on the GBS with an endoscopist' decision to perform an urgent upper gastrointestinal endoscopy (UGIE) in newly admitted patients and inpatients with UGIH in the setting of an endoscopy on-duty service in 13 tertiary care centers. Material and methods. During a 6-month period, GBS and patient data were collected for all patients with non-variceal UGIH for whom an UGIE was requested in emergency. If patients experienced severe endoscopic lesion, surgery or death, they were categorized as patients who had been at need for urgent UGIE. Results. The 102 UGIH patients included (mean age 62, men 73%) had a median GBS of 12 (range 0–21), significantly lower for new patients compared with inpatients (11, range 0–21 vs. 14, range 2–21, respectively, p = 0.001). If triage for urgent UGIE had followed the GBS, no more patients would have had an urgent UGIE compared with what endoscopists performed (99/102 (97%) vs. 92/102 (90%), respectively, p = 0.09). Sensitivity for the detection of patients who needed an UGIE was no different with the GBS than endoscopists (98% vs. 98%, respectively, p = 0.10) and both showed insufficient specificity (4% and 19%, respectively). Conclusions. The GBS does not detect more patients at need for urgent UGIE than on-duty endoscopists. Both methods lead to numerous unjustified UGIEs. A score that would equally help endoscopists in their decision to intervene urgently is still warranted.

Key Words::

• endoscopy
• score
• upper gastrointestinal hemorrhage

Acknowledgments

The following Endoscopists of the “Groupe des endoscopistes de garde à l'AP-HP” participated in this study: Dr Mathias Bon, Service d'Hépato-Gastroentérologie, Hôpital Avicenne, Bobigny, France; Dr Mohamed Merrouche, Service d'Hépato-Gastroentérologie, Hôpital Louis Mourier, Colombes, France; Dr Redha Moussaoui, Service d'Hépato-Gastroentérologie, Centre Hospitalier d'Etampes, Etampes, France; Dr Ariane Chryssostalis, Service d'Hépato-Gastroentérologie, Hôpital Cochin, Paris, France; Dr Olivier Corcos, Service d'Hépato-Gastroentérologie, Hôpital Beaujon, Clichy, France; Dr Pascal Crenn, Service de Médecine aigüe spécialisée, Hôpital Raymond Poincaré, Garches, France; Dr Xavier Dray, Service d'Hépato-Gastroentérologie, Hôpital Lariboisière, Paris, France; Dr Bruno Huguenin, Hôpital Groupe hospitalier Sud Réunion, St Pierre, La Réunion; Dr Djamila Ouanezar, Service d'Hépato-Gastroentérologie, Hôpital Bichat, Paris, France; Dr Akli Ramdani, Service d'Hépato-Gastroentérologie, Hôpital Bichat, Paris, France; Dr Milad Taouk, Service d'Hépato-Gastroentérologie, Hôpital Bichat, Paris, France; Dr Xavier Tréton, Service de Gastroentérologie et Assistance Nutritive, Hôpital Beaujon, Clichy; Dr Kouroche Vahedi Service d'Hépato-Gastroentérologie, Hôpital Lariboisière, Paris, France.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.