ผลลัพธ์ทางคลินิกของผู้ป่วยภาวะเลือดออกทางเดินอาหารส่วนต้นชนิดไม่ใช่เส้นเลือดขอดเปรียบเทียบการส่องกล้องภายใน 24 ชั่วโมงกับมากกว่า 24 ชั่วโมงในโรงพยาบาลที่ไม่มีบริการส่องกล้องฉุกเฉินตลอด 24 ชั่วโมง: โดยใช้วิธีการจับคู่ด้วยคะแนนความโน้มเอียง

Natee Faknak; Peeranat  Piriyathanawat; Watcharasak  Pongpraphai

Authors

Natee Faknak Sawanpracharak Hospital
Peeranat Piriyathanawat Takhli Hospital
Watcharasak Pongpraphai Swanpracharak Hospital

Keywords:

Non-variceal Upper Gastrointestinal Bleeding, Esophagogastroduodenoscopy, Endoscopy Timing, Risk Stratification, Mortality

Abstract

Background: Current guidelines recommend early endoscopy for non-variceal upper gastrointestinal bleeding (UGIB); however, implementation remains limited in hospitals without 24-hour emergency Esophagogastroduodenoscopy (EGD) services. The impact of delayed endoscopy on UGIB-related mortality and clinical outcomes in different risk groups remains uncertain. This study evaluated mortality and outcomes according to endoscopy timing using a risk-stratified approach.

Methods: We retrospectively analyzed 238 adults admitted with non-variceal UGIB (early EGD ≤24 hours: n=82; delayed EGD >24 hours: n=156). Primary outcomes was 30-day UGIB-related mortality Secondary outcomes included all-cause mortality, rebleeding and transfusion requirements. Propensity score matching (PSM) was performed using baseline demographic and clinical severity variables, resulting in 77 matched patients in each group. Subgroup analyses were conducted according to Glasgow-Blatchford Score (GBS) risk categories.

Results: After propensity score matching, baseline characteristics were comparable between groups. UGIB-related mortality at 30 days was 0% in the early EGD group and 2.6% in the delayed EGD group (p-value=0.155). Thirty-day all-cause mortality was 0% in the early EGD group and 9.1% in the delayed EGD group (risk difference -0.09, 95% CI -0.15 to -0.03; p-value =0.006). In the high-risk GBS subgroup, 30-day all-cause mortality was 0% in the early EGD group and 15.2% in the delayed EGD group (p-value =0.004), while UGIB-related mortality was 0% and 4.4%, respectively (p-value=0.144). Among non–high-risk patients, no significant differences were observed in UGIB-related mortality or all-cause mortality between early and delayed groups. Rates of 7-day and 30-day rebleeding and blood transfusion requirements were similar between groups.

Conclusion: Delayed endoscopy was not associated with an increase in bleeding-related mortality. However, it was associated with higher all-cause mortality in high-risk patients. These findings support a risk-stratified approach to endoscopy timing, particularly in settings where 24-hour endoscopic services are not available.

Keywords: Non-variceal Upper Gastrointestinal Bleeding, Esophagogastroduodenoscopy, Endoscopy Timing, Risk Stratification, Mortality

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