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Delayed endoscopy increases re-bleeding and mortality in patients with hematemesis and active esophageal variceal bleeding: A cohort study

  • Author Footnotes
    † These authors contributed equally to this work.
    Ping-Hsien Chen
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Author Footnotes
    † These authors contributed equally to this work.
    Wen-Chi Chen
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    School of Medicine, National Yang-Ming University School, Taipei, Taiwan

    Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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  • Ming-Chih Hou
    Correspondence
    Corresponding author. Address: Division of Gastroenterology, Department of Medicine, Veterans General Hospital-Taipei, No. 201, Sec 2, Shih-Pai Road, Taipei, Taiwan 11217. Tel.: +886 2 28757308; fax: +886 2 28739318.
    Affiliations
    Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    School of Medicine, National Yang-Ming University School, Taipei, Taiwan

    Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Tsu-Te Liu
    Affiliations
    School of Medicine, National Yang-Ming University School, Taipei, Taiwan

    Division of Gastroenterology, Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
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  • Chen-Jung Chang
    Affiliations
    Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    School of Medicine, National Yang-Ming University School, Taipei, Taiwan

    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
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  • Wei-Chih Liao
    Affiliations
    Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    School of Medicine, National Yang-Ming University School, Taipei, Taiwan

    Division of Gastroenterology, Department of Medicine, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
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  • Chien-Wei Su
    Affiliations
    Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    School of Medicine, National Yang-Ming University School, Taipei, Taiwan
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  • Huay-Min Wang
    Affiliations
    Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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  • Han-Chieh Lin
    Affiliations
    Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    School of Medicine, National Yang-Ming University School, Taipei, Taiwan
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  • Fa-Yauh Lee
    Affiliations
    Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    School of Medicine, National Yang-Ming University School, Taipei, Taiwan
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  • Shou-Dong Lee
    Affiliations
    School of Medicine, National Yang-Ming University School, Taipei, Taiwan

    Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
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  • Author Footnotes
    † These authors contributed equally to this work.
Published:August 09, 2012DOI:https://doi.org/10.1016/j.jhep.2012.07.038

      Background & Aims

      Active bleeding is a poor prognostic indicator in patients with acute esophageal variceal bleeding. This study aimed at determining indicators of 6-week re-bleeding and mortality in patients with “active” esophageal variceal bleeding, particularly emphasizing the presenting symptoms and timing of endoscopy to define the treatment strategy.

      Methods

      From July 2005 to December 2009, cirrhotic patients with endoscopy-proven active esophageal variceal bleeding were evaluated. Cox proportional hazards regression analysis was used to determine the indicators of 6-week re-bleeding and mortality. Outcome comparisons were performed by Kaplan–Meier method and log rank test.

      Results

      In 101 patients, the overall 6-week and 3-month re-bleeding rates were 25.7% (n = 26) and 29.7% (n = 30), respectively. The overall 6-week and 3-month mortality was 31.7% (n = 32) and 38.6% (n = 39), respectively. Door-to-endoscopy time (hr), MELD score, and portal vein thrombosis were indicators of 6-week re-bleeding, while hematemesis upon arrival, MELD score, and hepatocellular carcinoma were indicators of 6-week mortality. Overall mortality was poorer in hematemesis than in non-hematemesis patients (39.7% vs. 10.7%, p = 0.007). In hematemesis patients, 6-week re-bleeding rate (18.9% vs. 38.9%, p = 0.028) and mortality (27% vs. 52.8%, p = 0.031) were lower in those with early (⩽12 h) than delayed (>12 h) endoscopy. In non-hematemesis patients, early and delayed endoscopy had no difference on 6-week re-bleeding rate (17.6% vs. 18.2%, p = 0.944) and mortality (11.8% vs. 9.1%, p = 0.861).

      Conclusions

      It is likely that early endoscopy (⩽12 h) is associated with a better outcome in hematemesis patients, but a randomized trial with larger case numbers is required before making a firm conclusion.

      Keywords

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