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| Endoscopic diagnosis and treatment analysis of patients with acute nonvariceal upper gastrointestinal bleeding and value of Glasgow-Blatchford score systems before Urgent Endoscopy |
| Pang Yan-hua, Du Li-chuan, Hao Jian-yu, Liu Zhen, Li Ning, Wu dong-fang |
| Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China |
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Abstract Objective A retrospective cohort study was conducted of patients with acute nonvariceal upper gastrointestinal bleeding(ANVUGIB) to assess the effects of Glasgow-Blatchford score(GBS) score and emergency endoscopic examination time on patients. Methods Collected 295 cases of ANVUGIB patients who were admitted in 2014-01~2018-01 in the center of the Beijing Chaoyang Hospital . By endoscopic examination time, the patients were divided into two groups, the urgent group, which include 162 cases ( endoscopic inspect within 24 h) and nonurgent group 133 cases (after 24 h).GBS score were calculated, GBS score 6 or higher were medium-high risk group of 210 cases, and<6 were low-risk group of 85 cases.Statistics of endoscopic diagnosis and treatment and outcome were analyzed. Results The number of peptic ulcer patients was 204 cases (69.1%), and Forrest grading Ⅰa to Ⅱb 176 cases (59.7%),of which 153 cases (86.9%) were underwent treatment of endoscopy. Of the number of surgical and interventional treatment patients, the urgent group is lower than the nonurgent group(1.9% vs. 5.3%, P= 0.032;1.2%vs. 3.8%, P=0.021), and the two groups were statistically significant (P<0.05). Emergency endoscopic time (24 h) on the medium-high risk groups can be used to predict the clinical outcome (OR0.91, 95%CI 0.75~1.22; P=0.003), in the medium-high risk group of patients with endoscopic examination time and disease outcome were statistically significant (P<0.05). However, low-risk patients were not significantly different between endoscopic examination time and disease outcome. Conclusion Haemorrhage from the peptic ulcer accounts for 60% ANVUGIB causes, and endoscopic treatment is given priority to with drug injection + titanium clamp hemostatic combination therapy.GBS <6 points in low-risk patients, endoscopic examination within 24 h and after 24 h does not influence the outcome of disease, and GBS of six points or high patients perform endoscopic examination within 24 h is superior to endoscopic examination after 24 h. GBS for patients with suspected clinical ANVUGIB before emergency endoscopy is important to the diagnosis and treatment of ANVUGIB patients. High-risk patients should perform emergency endoscopy winthin 24 hours.
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Corresponding Authors:
Wu dong-fang, E-mail: dongfang2245@126.com
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