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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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sábado, 22 de agosto de 2020

Endoscopy for AUGB

 

The Bottom Line - August 20, 2020 - By walker G
Ref. Lau, J.Y.W et al. NEJM 2020; 382:1299 – 1308. doi:10.1056/NEJMoa1912484
"Clinical Question
In patients with acute upper GI (UGI) bleeding and a Glasgow-Blatchford score ≥ 12, does endoscopy performed within 6 hours of gastroenterological consultation, compared with endoscopy performed within 6 – 24 hours have a lower 30 day mortality?
Authors’ Conclusions
Endoscopy performed within 6 hours of gastroenterology consultation rather than 6 – 24 hours did not reduce 30 day mortality
The Bottom Line
  • In patients with high risk upper GI bleeding, who were treated with pre-endoscopy PPI and were not in persistent shock, an endoscopy performed at a median of 10 hours vs. a median of 25 hours post presentation did not reduce 30 day mortality
  • Personally, given the fact that the patients were relatively stable I will not be using this study to inform my management of critical care patients admitted with acute UGI bleeds, or let this trial be used as an argument to delay endoscopy for an unwell patient
  • It’s utility (within the confines of its weaknesses) would be for those patients in ED or on the acute medical take
  • The reduction in endoscopic interventions in the early group is interesting and warrants further research"