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Type: Conference item
Title: Urgent endoscopy for oesophageal variceal bleeding: does it matter?
Author: Rahman, A.H.A.
Low, I.W.
Chan, F.
Rizvi, Q.A.
Schoeman, M.N.
Harley, H.A.J.
Andrews, J.M.
Holloway, R.H.
Citation: Journal of Gastroenterology and Hepatology, 2013, vol.28, iss.S2, pp.42-42
Publisher: Wiley
Issue Date: 2013
ISSN: 0815-9319
Conference Name: Australian Gastroenterology Week (AGW) (7 Oct 2013 - 9 Oct 2013 : Melbourne, Victoria)
Statement of
AH Abdul Rahman, IW Low, F Chan, QA Rizvi, MN Schoeman, Haj Harley, JM Andrews, RH Holloway
Abstract: Introduction: Recommendations in various guidelines regarding when a patient with acute oesophageal variceal bleeding should receive endoscopy range from 4 to 24 hours. Studies to support these recommendations are lacking but one study has shown increased mortality when TTE exceeds 15 hours.1 We thus assessed the relationship between TTE and mortality in our patient cohort. Methods: We analysed a prospectively collected database of patients with suspected gastrointestinal bleeding referred to the Royal Adelaide Hospital from November 2007 to January 2013. Patient and disease specific characteristics including severity of chronic liver disease (Child-Pugh class), bleeding severity (Rockall & Glasgow-Blatchford scores; need for transfusion) and outcomes (mortality) were examined in relation to TTE. Results: Of 1766 patients referred, 79 patients with variceal bleed were included in the analysis, after excluding those with 1) endoscopy elsewhere prior to admission (n = 2) 2) bleeding during admission (n = 11) & 3) incomplete or unreliable data (n = 7). Mortality was similar in patients who received endoscopy within 15 hours (8/62) compared to those that did not (1/17) (p = 0.675). Median TTE for patients who died was significantly shorter than for survivors (2.1 vs. 8.23 hours, p = 0.04). There was a moderate inverse correlation between TTE and the full Rockall score (rs = -0.519 p < 0.001), and a weaker inverse correlation with the preendoscopy Rockall Score (rs = -0.39, p < 0.001) and Glasgow Blatchford score (rs = -0.371, p = 0.011, n = 46). When adjusted for age, gender, presentation symptoms of either haematemesis and/or melaena, blood transfusion, pre-endoscopy Rockall score and TTE, mortality was significantly increased only in patients with Child Pugh Class C (OR 12.3, 95% CI 1.21–125.2). Conclusion: Time to endoscopy does not affect mortality in patients with variceal bleeding. However, it is influenced by patient’s condition with patients with more severe disease or bleeding receiving endoscopy sooner. When adjusted for other factors, Child Pugh Class C was the main risk factor for mortality
Rights: © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
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