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Endoscopy Within 1 Day of Peptic Ulcer Bleeding Provides Better Outcomes in Elders

OAK BROOK, Ill -- August 18, 2009 -- A study published in the August issue of Gastrointestinal Endoscopy shows that elderly patients who underwent endoscopy within 1 day of presentation for peptic ulcer bleeding had a 2-day shorter hospital stay and were less likely to require upper gastrointestinal surgery than patients who did not receive endoscopy within the first day of presentation.

Researchers noted that unless specific contraindications exist, the data supports the routine use of early endoscopy for upper gastrointestinal bleeding.

Early upper endoscopy, defined as endoscopy performed within one day of the patient presenting with peptic ulcer bleeding, has been proposed as an intervention to improve efficiency and outcomes for these patients; however, the use and outcomes have not been studied in a national, US-based sample.

"We set out to determine the prevalence and associated outcomes of early versus delayed endoscopy in patients with bleeding peptic ulcers and found that endoscopic intervention in elderly patients within 24 hours of presentation reduced the length of hospital stay by 2 days compared with those whose endoscopy was delayed," said lead author Gregory S. Cooper, MD, University Hospitals Case Medical Center, Cleveland, Ohio.

"Patients who received an early endoscopy also were less likely to require surgery. Using a large cohort, these results are consistent with the known beneficial effects of this practice."

Dr. Cooper and colleagues used a 5% random sample of inpatient and outpatient Medicare claims from 2004 in patients aged 66 years and older. Statistical analysis models (univariate and multivariate) were used to determine factors associated with 30-day mortality, upper gastriointestinal surgery, and length of hospital stay. All models adjusted for demographic factors, comorbidity, and the use of outpatient management.

Overall, 1,854 (71.5%) patients were managed with early endoscopy and 738 (28.5%) with delayed endoscopy. Delayed endoscopy was defined as endoscopy performed after 1 day of the patient presenting with peptic ulcer bleeding. A therapeutic procedure to stop active bleeding or prevent a recurrence in bleeding was performed during endoscopy in 590 (31.8%) early endoscopy patients compared with 243 (32.9%) delayed endoscopy patients.

Early endoscopy was associated with statistically significant reductions in both the need for surgery to control bleeding and the length of hospital stay. Surgery was performed in 23 (1.2%) patients who underwent early endoscopy compared with 25 (3.4%) who underwent delayed endoscopy. The median length of hospital stay was 4 days in patients who underwent early endoscopy compared with 6 days in patients who underwent delayed endoscopy. Thirty-day mortality was no different between the early and delayed endoscopy groups.

Researchers noted that the use of claims data was lacking in clinical detail and the study was restricted to the Medicare-age population, however, they were able to assess other factors shown to have prognostic value including age and comorbid illness.

They concluded that in this large, nationally based cohort of patients with peptic ulcer bleeding, early endoscopy was associated with increased efficiency of care as measured by a significant reduction in the length of hospital stay. Although they were unable to demonstrate any association with 30-day mortality, the lower rate of upper gastrointestinal surgery associated with early endoscopy is consistent with the beneficial effects of early endoscopic intervention.

SOURCE: American Society for Gastrointestinal Endoscopy

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