Differences in emergency endoscopy outcomes according to gastrointestinal bleeding location

Abstract

Background and aim

With recent technological advances in the field of endoscopic hemostasis, the prognosis of patients with gastrointestinal (GI) bleeding has improved. However, few studies have reported on the clinical course of patients with GI bleeding. This study aimed to evaluate the differences in clinical outcomes of patients with lower GI bleeding (LGIB) compared with upper GI bleeding (UGIB) and the factors related to their prognosis.

Methods

Patients who had undergone emergency endoscopy for GI bleeding were retrospectively reviewed. The severity of GI bleeding was evaluated using the Glasgow–Blatchford (GB), AIMS65, and NOBLADS scores. Patients in whom obvious GI bleeding relapsed and/or iron deficiency anemia persisted after emergency endoscopy were considered to exhibit rebleeding.

Results

We reviewed 1697 consecutive patients and divided them into UGIB (1054 patients) and LGIB (643 patients) groups. The proportion of patients with rebleeding was significantly greater in the UGIB group than in the LGIB group; the mortality rate was significantly higher in the UGIB group than in the LGIB group. Multivariate analysis showed that a GB score ≥12 and an AIMS65 score ≥2 were significantly associated with rebleeding in the UGIB group, whereas a NOBLADS score ≥4 was significantly associated with rebleeding in the LGIB group. Notably, the influence of emergency endoscopy differed according to GI bleeding location.

Conclusions

The clinical course was significantly worse in patients with UGIB than in patients with LGIB. The influence of emergency endoscopy differed according to GI bleeding location.

Keywords:

• Upper gastrointestinal bleeding
• lower gastrointestinal bleeding
• clinical course
• prognostic factors
• NOBLADS score
• Glasgow–Blatchford score
• AIMS65 score

Acknowledgments

The authors thank all staff members of the Division of Gastroenterology and the Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine at Kawasaki Medical School Hospital, and the Division of General Internal Medicine 2 at Kawasaki Medical School General Medical Center. They also thank Hugh McGonigle, Ryan Chastain-Gross, and Jane Charbonneau, Ph.D., from Edanz Group (https://en-author-services.edanzgroup.com/ac) for editing a draft of this manuscript.

Author contributions

Fujita M and Manabe N participated in study design and performance, and in writing the paper. Murao T, Suehiro M, Tanikawa T, Nakamura J, Yo S, Fukushima S, Osawa M, Ayaki M, Sasai T, Kawamoto H, Shiotani A, and Haruma K participated in the performance of the study and in reviewing the paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).