REBEL Cast Ep82 - May 21, 2020 - By Salim Rezaie
"Clinical Question: In patients admitted with acute UGIB who are predicted to be at high risk (Glasgow-Blatchford score ≥12) for further bleeding or death, does endoscopy performed within 6 hours after gastroenterologic consultation (urgent endoscopy) or endoscopy performed between 6 to 24 hours after consultation (early endoscopy) decrease further bleeding and improve outcomes?
Author Conclusion: “In patients with acute upper gastrointestinal bleeding who were at high risk for further bleeding or death, endoscopy performed within 6 hours after gastroenterologic consultation was not associated with lower 30-day mortality than endoscopy performed between 6 and 24 hours after consultation.”
Clinical Take Home Point: In this RCT of patients with UGIB in patients who are HD stable at high risk of bleeding, this study does not answer the question of <6hrs vs 6 – 24hrs for timing of endoscopy as only ¼ of patients had endoscopy at <6hours. In patients who are hemodynamically unstable (mostly excluded in this study), who are receiving maximal resuscitation and medical therapy and non-responders or transient responders, the optimal time for endoscopy is likely as soon as possible (ASAP)."