THE EFFECTIVENESS OF EARLY ENDOSCOPY FOR UPPER GASTROINTESTINAL HEMORRHAGE - A COMMUNITY-BASED ANALYSIS

OBJECTIVES. The effectiveness of upper endoscopy in unselected patient s with upper gastrointestinal hemorrhage has not been well studied. Th is study was undertaken to identify factors associated with the perfor mance of early endoscopy (ie, within 1 day of hospitalization) and, af ter adjusting for these factors, to determine associations between ear ly endoscopy and in-hospital mortality length of stay, and performance of surgery. METHODS. Subjects in this observational cohort study were 3,801 consecutive admissions with upper gastrointestinal hemorrhage t o 30 hospitals in a large metropolitan region. Demographic and clinica l data were abstracted from hospital records, A multivariable model ba sed on factors that potentially could relate to the decision to perfor m endoscopy was developed to determine the propensity (0 to 100%) for early endoscopy in each patient. RESULTS. Early endoscopy was performe d in 2,240 patients (59%), and although it was not associated with mor tality after adjusting for severity of illness among all patients, it was associated with a higher risk of death for patients in the lowest propensity group. Early endoscopy was associated with a lower likeliho od of upper gastrointestinal surgery in all patients and in the two hi ghest propensity groups and with a shorter length of stay in the entir e cohort and in all subgroups. CONCLUSIONS. In the absence of specific contraindications, early endoscopy should be considered because of as sociated reductions in length of stay and surgical intervention. Furth er studies are needed to identify subgroups in whom the procedure may be associated with adverse effects on survival.