Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2018; 24(44): 5025-5033
Published online Nov 28, 2018. doi: 10.3748/wjg.v24.i44.5025
Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding
Jeong-Ju Yoo, Young Chang, Eun Ju Cho, Ji Eun Moon, Sang Gyune Kim, Young Seok Kim, Yun Bin Lee, Jeong-Hoon Lee, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon
Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim, Department of Gastroenterology and Hepatology, Soonchunhyang University school of Medicine, Bucheon 14584, South Korea
Young Chang, Eun Ju Cho, Yun Bin Lee, Jeong-Hoon Lee, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
Ji Eun Moon, Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
Author contributions: All authors helped to perform the research; Yoo JJ and Chang Y contributed equally as co-first authors; Yoo JJ and Chang Y did the manuscript writing, drafting conception and design, and data analysis; Moon JE did the manuscript writing, and data analysis; Kim SG, Kim YS, Lee YB, Lee JH, Yu SJ, Kim YJ, and Yoon JH made contribution to the manuscript writing; Cho EJ made contribution to the manuscript writing, conception drafting and design.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of each hospital, and also conformed to the ethical guidelines of the World Medical Association Declaration of Helsinki (H-1801-057-914, SCH 2018-06-013).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors have no conflict of interest with respect to the subjects described in this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author to: Eun Ju Cho, MD, PhD, Assistant Professor, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul 03080, South Korea.
Telephone: +82-2-20722228 Fax: +82-2-7436701
Received: August 30, 2018
Peer-review started: August 30, 2018
First decision: October 14, 2018
Revised: October 15, 2018
Accepted: November 13, 2018
Article in press: November 13, 2018
Published online: November 28, 2018
Research background

The optimal timing of emergency endoscopy in acute variceal bleeding remains unclear. Most guidelines recommend performing endoscopy for acute variceal bleeding within 12 h of admission. However, the evidence level for this recommendation is very low, with few relevant studies to date to justify it

Research motivation

Determining the appropriate endoscopic timing is a very important issue, and both the risk and benefit to the patient need to be considered. We hypothesized that the earlier the endoscopy was performed, the better the short-term prognosis of the cirrhotic patients with variceal bleeding.

Research objectives

The aim of this study was to examine the association between the timing of endoscopy and the short-term prognosis of acute variceal bleeding in cirrhotic patients.

Research methods

We performed a retrospective study of cirrhotic patients with variceal bleeding. Patients were divided into two groups according to the time of endoscopy. Urgent endoscopy group was defined as performing endoscopy before 12 h of admission and non-urgent endoscopy group after 12 h of admission. The inverse probability weighting (IPW) method based on propensity score was applied to correct baseline differences between the two groups, and compared short-term prognosis between the two groups.

Research results

In 274 patients, 173 patients received urgent endoscopy, and 101 patients received non-urgent endoscopy. After IPW method, short term prognosis including 6-wk mortality rate or 6-wk transplantation rate was not different between the two groups. In multivariate analyses, timing of endoscopy was not associated with 6-wk mortality. Other factors associated with 6-wk mortality were age, hepatocellular carcinoma, MELD score, and degree of ascites.

Research conclusions

Timing of endoscopy may not affect the clinical short-term outcomes of patients with esophageal variceal bleeding.

Research perspectives

Because this is a retrospective study, a prospective study to determine the appropriate timing of endoscopy considering risk and benefit is needed for the future.