Endoscopic Findings in Patients with Upper Gastrointestinal Bleeding Clinically Classified into Three Risk Groups Prior to Endoscopy

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2008 Sep 3

PMID 18763288

Citations 10

Authors

Leonardo Tammaro

Maria-Carla Di Paolo

Angelo Zullo

Cesare Hassan

Sergio Morini

Sebastiano Caliendo

Lorella Pallotta

Affiliations

Soon will be listed here.

Abstract

Aim: To investigate in a prospective study whether a simplified clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy.

Methods: All consecutive UGIB patients referred to a single endoscopic center during a 16 mo period were enrolled. Before endoscopy patients were stratified according to a simple clinical score (T-score), including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk). Endoscopy was performed in all cases within 2 h, and high-risk stigmata were considered for further analysis.

Results: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2, and 175 (40%) T3. Overall, stigmata of recent haemorrhage (SRH) were detected in 118 cases (27%). SRH occurred more frequently in T1 patients than in T2/T3 cases (85% vs 3.2%; c2 = 304.5309, P < 0.001). Older age (t = 3.311; P < 0.01) and presence of comorbidities (c2 = 14.7458; P < 0.01) were more frequently detected in T1 than in T2/T3 patients.

Conclusion: Our simplified clinical score appeared to be associated with the detection of endoscopic findings which may deserve urgent endoscopy. A further, randomised study is needed to assess its accuracy in safely scheduling endoscopy in UGIB patients.

Citing Articles

Evaluation of pre-endoscopy risk scores and base deficit for prediction adverse clinical outcomes in patients with upper gastrointestinal bleeding.

Buyurgan C, Yarkac A, Bozkurt S, Kose A, Guldur B, Temel G Intern Emerg Med. 2024; .

PMID: 39648243 DOI: 10.1007/s11739-024-03830-1.

Limits of pre-endoscopic scoring systems in geriatric patients with upper gastrointestinal bleeding.

Di Gioia G, Sangineto M, Paglia A, Cornacchia M, Parente F, Serviddio G Sci Rep. 2024; 14(1):20225.

PMID: 39215015 PMC: 11364688. DOI: 10.1038/s41598-024-70577-2.

The Clinical and Endoscopic Profiles of Patients With Upper Gastrointestinal Bleeding (UGIB) and the Role of the Rockall Scoring System in Predicting Adverse Outcomes.

Anshul , Singh N, Pahuja Jr H, Kumar V, Popli B, Kumar S Cureus. 2023; 15(6):e40418.

PMID: 37456449 PMC: 10349207. DOI: 10.7759/cureus.40418.

Comparisons of six endoscopy independent scoring systems for the prediction of clinical outcomes for elderly and younger patients with upper gastrointestinal bleeding.

Li Y, Lu Q, Song M, Wu K, Ou X BMC Gastroenterol. 2022; 22(1):187.

PMID: 35418035 PMC: 9008962. DOI: 10.1186/s12876-022-02266-1.

Evaluation of Six Preendoscopy Scoring Systems to Predict Outcomes for Older Adults with Upper Gastrointestinal Bleeding.

Li Y, Lu Q, Wu K, Ou X Gastroenterol Res Pract. 2022; 2022:9334866.

PMID: 35136407 PMC: 8818397. DOI: 10.1155/2022/9334866.

References

Thomopoulos K, Theocharis G, Mimidis K, Lampropoulou-Karatza C, Alexandridis E, Nikolopoulou V . Improved survival of patients presenting with acute variceal bleeding. Prognostic indicators of short- and long-term mortality. Dig Liver Dis. 2006; 38(12):899-904. DOI: 10.1016/j.dld.2006.08.002. View

Sacks H, CHALMERS T, Blum A, Berrier J, Pagano D . Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers. JAMA. 1990; 264(4):494-9. DOI: 10.1001/jama.264.4.494. View

Blatchford O, Murray W, Blatchford M . A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000; 356(9238):1318-21. DOI: 10.1016/S0140-6736(00)02816-6. View

Yen D, Hu S, Chen L, Liu K, Kao W, Tsai J . Arterial oxygen desaturation during emergent nonsedated upper gastrointestinal endoscopy in the emergency department. Am J Emerg Med. 1997; 15(7):644-7. DOI: 10.1016/s0735-6757(97)90178-9. View

Camellini L, Merighi A, Pagnini C, Azzolini F, Guazzetti S, Scarcelli A . Comparison of three different risk scoring systems in non-variceal upper gastrointestinal bleeding. Dig Liver Dis. 2004; 36(4):271-7. DOI: 10.1016/j.dld.2003.10.017. View

Rockall T . Risk scoring in acute upper gastrointestinal haemorrhage. Dig Liver Dis. 2005; 38(1):10-1. DOI: 10.1016/j.dld.2005.09.001. View

Keyvani L, Murthy S, Leeson S, Targownik L . Pre-endoscopic proton pump inhibitor therapy reduces recurrent adverse gastrointestinal outcomes in patients with acute non-variceal upper gastrointestinal bleeding. Aliment Pharmacol Ther. 2006; 24(8):1247-55. DOI: 10.1111/j.1365-2036.2006.03115.x. View

Lanas A, Garcia-Rodriguez L, Arroyo M, Gomollon F, Feu F, Gonzalez-Perez A . Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut. 2006; 55(12):1731-8. PMC: 1856452. DOI: 10.1136/gut.2005.080754. View

Ibanez L, Vidal X, Vendrell L, Moretti U, Laporte J . Upper gastrointestinal bleeding associated with antiplatelet drugs. Aliment Pharmacol Ther. 2006; 23(2):235-42. DOI: 10.1111/j.1365-2036.2006.02759.x. View

10.

Marshall J, Collins S, Gafni A . Prediction of resource utilization and case cost for acute nonvariceal upper gastrointestinal hemorrhage at a Canadian community hospital. Am J Gastroenterol. 1999; 94(7):1841-6. DOI: 10.1111/j.1572-0241.1999.01215.x. View

11.

Chan F, Graham D . Review article: prevention of non-steroidal anti-inflammatory drug gastrointestinal complications--review and recommendations based on risk assessment. Aliment Pharmacol Ther. 2004; 19(10):1051-61. DOI: 10.1111/j.1365-2036.2004.01935.x. View

12.

Bessa X, OCallaghan E, Balleste B, Nieto M, Seoane A, Panades A . Applicability of the Rockall score in patients undergoing endoscopic therapy for upper gastrointestinal bleeding. Dig Liver Dis. 2005; 38(1):12-7. DOI: 10.1016/j.dld.2005.05.012. View

13.

Lee J, Turnipseed S, Romano P, Vigil H, Azari R, Melnikoff N . Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc. 1999; 50(6):755-61. DOI: 10.1016/s0016-5107(99)70154-9. View

14.

Church N, Dallal H, Masson J, Mowat N, Johnston D, Radin E . Validity of the Rockall scoring system after endoscopic therapy for bleeding peptic ulcer: a prospective cohort study. Gastrointest Endosc. 2006; 63(4):606-12. DOI: 10.1016/j.gie.2005.06.042. View

15.

Rockall T, Logan R, Devlin H, Northfield T . Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996; 38(3):316-21. PMC: 1383057. DOI: 10.1136/gut.38.3.316. View

16.

Zappa M, Visioli C, Ciatto S, Grazzini G, Rubeca T, Bonanomi A . Gastric cancer after positive screening faecal occult blood testing and negative assessment. Dig Liver Dis. 2007; 39(4):321-6. DOI: 10.1016/j.dld.2006.11.010. View

17.

Barkun A, Bardou M, Marshall J . Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2003; 139(10):843-57. DOI: 10.7326/0003-4819-139-10-200311180-00012. View

18.

Pilotto A . Aging and the gastrointestinal tract. Ital J Gastroenterol Hepatol. 1999; 31(2):137-53. View

19.

Sandel M, Kolkman J, Kuipers E, Cuesta M, Meuwissen S . Nonvariceal upper gastrointestinal bleeding: differences in outcome for patients admitted to internal medicine and gastroenterological services. Am J Gastroenterol. 2000; 95(9):2357-62. DOI: 10.1111/j.1572-0241.2000.02230.x. View

20.

Parente F, Anderloni A, Bargiggia S, Imbesi V, Trabucchi E, Baratti C . Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: a two-year survey. World J Gastroenterol. 2006; 11(45):7122-30. PMC: 4725080. DOI: 10.3748/wjg.v11.i45.7122. View