Outcome of patients undergoing early versus late endoscopic intervention for acute oesophageal variceal bleeding at Air Force Hospital, Egypt. A population based cohort study

Abstract

Background: Whether on-call gastroenterologists should perform emergency endoscopic treatment or delay endoscopy the next day has not been investigated. This study aims to investigate the effect of timing of endoscopy on patients with acute esophageal variceal bleeding. Patients and Methods: We included 167 patients with acute variceal bleeding in the gas-troenterology unit of the air force hospital, Cairo, Egypt, from 15 January till 15 July 2010. Endoscopy was scheduled once the patient’s hemodynamics permitted. Time from admission to endoscopy was recorded. Patients were stratified into 2 groups: Early endoscopy: when done ≤ 12 hours and late endoscopy: when done > 12 hours. Patients were followed up for 42 days. Results: The study included 102 males (61.1%) and 65 females (38.9%) (mean age 54 ± 11 years). 151 patients received endoscopic treatment. Early endoscopy group included 85 patients (56.3%), and the late endoscopy group included 66 patients (43.7%) (p = 0.14). Early endoscopy patients were transfused a mean of 2.9 (±1.8) units of blood versus 4.3 (±0.14) units in the late endoscopy patients p = 0.001. Mean hospital stay was 7.1 (±3.3) days versus 9.3 (±4.6) days in the early and late groups respectively p: 0.001. 5-day mortality was reported in 6 (±7) cases in the early endoscopy group and 23 (±34.8) cases in the late endoscopy group p: 0.001. Conclusion: Early endoscopic intervention for patients with acute variceal bleeding is associated with a more favorable outcome in terms of morbidity and mortality. On call gastroenterologists should comply with the 12-hour period rather than delaying cirrhotic patients with acute variceal bleeding to the following day.